De-role before you debrief: the importance of de-rolling from challenging training scenarios prior to debriefing.

Description

Introduction: Background, Context and Aims

Post-simulation debriefing is a key part of simulation-based education (SBE) that involves guided discussion to enable participants to comprehend the learning activities in which they have engaged to better achieve learning outcomes and improve clinical performance.[1] A developing corpus of literature outlines effective debriefing models and the value of various debriefing techniques in SBE. [2] Less researched is the potentially negative impact on learners of emotionally challenging SBE scenarios and techniques to mitigate the negative impact that can adversely affect learning as well as learners’ mental health and wellbeing. We have identified a need for learners to first engage in a process of de-rolling from the roles they performed in emotionally challenging SBE scenarios prior to engaging in debriefing with related techniques to facilitate this transition. At present, unlike debriefing models, there is no generally accepted model of de-rolling in the fields of SBE or actor training, and so we are currently engaged in the process of developing a model.

Description

Prior to debriefing, learner cohorts comprising healthcare students and professionals participating in several training courses at Queen’s University Belfast engaged in a systematic de-rolling process based on methods derived from Buddhist meditation practice commonly known as mindfulness and actor training techniques.[3] The de-rolling process involves three stages. Firstly, learners engage in breathing exercises to focus their attention. Secondly, learners engage in active reflection on their cognitive and emotional state by recognising, accepting and then investigating and detaching themselves from emotional residue from the role(s) they performed in the SBE scenario(s). Thirdly, learners visualise and conceptually inhabit the next role they will subsequently perform in the debriefing session so that they are better prepared to engage in the metacognitive aspects of debriefing.

Results & Discussion

Positive verbal feedback from learners indicated the value of the de-rolling model and we are developing a pilot project to empirically test the model. The de-rolling model we are developing is novel and could have positive impact and relevance whenever SBE is used. There is also potential for the de-rolling model to be applied across the healthcare sector to help staff regulate their emotional state on a regular, incremental basis during a working day as they transition between cases, and at the end of their shift when they transition from professional to personal roles.

Keywords

Debriefing

References/Acknowledgements

1. Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthc. 2007 Summer;2(2):115-25

2. Sawyer T, Eppich W, Brett-Fleegler M, Grant V, Cheng A. More Than One Way to Debrief: A Critical Review ofHealthcare Simulation Debriefing Methods. Simul Healthc. 2016 Jun;11(3):209-17

3. Brewer, J. A., Mallik, S., Babuscio, T. A., Nich, C., Johnson, H. E., Deleone, C. M., Minnix-Cotton, C. A., Byrne, S. A.,Kober, H., Weinstein, A. J., Carroll, K. M. and Rounsaville, B. J. (2011) 'Mindfulness training for smoking cessation: