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Jesse Spurr: Safe Debriefing at DFTB17


This talk was recorded live on the final of DFTB17 in Brisbane.

Jesse Spurr needs very little introduction. Besides being involved in two of the greatest conferences out there (SMACC and DFTB18), Jesse is co-founder and Editor-in-Chief of Simulcast.

In this talk from the simulation stream of DFTB17, Jesse talks about the challenges of debriefing outside the simulation lab. It’s not as hard as you think it is.  He takes us through two key articles from the debriefing literature and shows how to translate them into real-life practice.

Rudolph JW, Raemer DB, Simon R. Establishing a safe container for learning in simulation: the role of the presimulation briefing. Simulation in Healthcare. 2014 Dec 1;9(6):339-49.

Ben Symon and Vic Brazil discussed this classic paper on one of the Simulcast Journal Club podcasts – you can take a listen to it (if you haven’t already done so) here.

Eppich WJ, Mullan PC, Brett-Fleegler M, Cheng A. “Let’s Talk About It”: Translating Lessons From Health Care Simulation to Clinical Event Debriefings and Coaching Conversations. Clinical Pediatric Emergency Medicine. 2016 Sep 1;17(3):200-11.

Debriefing is integral to healthcare simulation, offering professionals a platform to reflect, learn, and improve their clinical practice. Yet, as Jesse Spurr articulately conveys in his talk at DFTB17, many healthcare practitioners struggle with debriefing, especially when transitioning from simulated environments to real clinical settings.

The Challenge of Transition

Jesse’s talk emphasized the prevailing challenge many healthcare providers face – the transition from simulated debriefing environments to real-world clinical practice. The disconnect between the two settings often stems from the perception that debriefing in a clinical context is risky or could damage the team. The essence of successful debriefing isn’t just about the debriefer but rather a collective effort of the entire team.

Creating Psychological Safety

One of the critical factors in facilitating effective debriefing in clinical practice is establishing psychological safety. In Jesse’s words, this is “creating environments where everyone feels safe to take interpersonal risks.” By focusing on this principle, healthcare professionals can transcend the barriers of discomfort and fear that often hinder open and productive debriefing conversations.

The Pearls Framework

Jesse introduced the “Pearls Framework,” a structured approach to debriefing that can be tailored to clinical events. This framework outlines key phases of the debriefing process:

  1. Setting the Environment: Creating an atmosphere of psychological safety by initiating the conversation, setting expectations, and encouraging participation.
  2. Reactions: Allowing team members to share their initial reactions and feelings about the event. This phase helps gather data on team perception and emotions.
  3. Case Description: Establishing a common understanding of the event by presenting a concise and factual summary. This shared context is vital for a productive discussion.
  4. Analysis: Engaging in a deep dive into the event, exploring different perspectives, rationales, and underlying reasons for team actions. This phase encourages curiosity and understanding.
  5. Focus Deep Dive: Delving into specific issues that warrant a more comprehensive analysis due to their complexity. This phase requires genuine curiosity and a willingness to understand diverse viewpoints.
  6. Plus-Delta Technique: Offering a quick yet impactful approach, this technique prompts the team to discuss what went well and what could be improved. It’s particularly useful for time-constrained situations.
  7. Directive Feedback: This phase involves more direct teaching and instruction, often used when addressing knowledge or skill gaps within the team.
  8. Translating Learning into Practice: Concluding the debrief by identifying actionable steps to implement the insights gained from the discussion into clinical practice.

Empowering the Team

Debriefing is not an individual endeavour, nor is it solely the responsibility of the designated debriefer. Instead, it’s a collaborative effort that involves the entire team. When healthcare professionals shift their focus from “I” to “we,” they create an environment where learning is a collective venture and improvements are a shared goal.

By nurturing psychological safety, adopting structured frameworks like the Pearls Framework, and embracing debriefing as a team event, healthcare practitioners can bridge the gap between simulation and clinical practice. Safe debriefing isn’t about the debriefer or the team; it’s about the shared journey of learning, growth, and enhancing patient care.

Suppose you want to learn more about what is going on in the world of debriefing. In that case, you must check out Simulcast, especially their monthly journal club series, for an accessible and understandable dive into the multi-faceted world of simulation.

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