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Debriefing Resuscitation Teams

Walter Eppich, MD, PhDAssociate Professor of Pediatrics and Medical Education

Northwestern University Feinberg School of MedicineAnn & Robert H. Lurie Children’s Hospital of Chicago/USA

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@LearnThruTalk

Objectives

After this session, you will be able to:• Identify high-yield targets for debriefing teams• Prioritize what to debrief• Outline blended approaches to debrief teams

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Ground rules

• Check your profession at the door• Everyone has a valuable contribution• Give others the chance to speak• Respect other people’s point of view• Confidentiality

Anything you would add to this list?

Our basic assumptionEveryone here is intelligent, capable, does their best, and wants to improve

Center for Medical Simulation

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• Why debrief?• Video review• How to debrief• What to debrief• Putting it together• Practice

Roadmap

YES!

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Information Reflection

Honesty

Healthcare SimulationDebriefing

Relationships & Learning culture

Process“How to debrief”

Content“What to debrief”

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Process“How to debrief”

Content“What to debrief”

Establishing a supportive learning environment

Process“How to debrief”

Content“What to debrief”

Debriefing Structure and Function:PEARLS Framework

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Eppich & Cheng 2015

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Eppich & Cheng 2015

Synthesis of educational strategies

Process“How to debrief”

Content“What to debrief”

What you say and how you say it:PEARLS Debriefing Script

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The PEARLS Debriefing Tool

https://debrief2learn.org/pearls-debriefing-tool/

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Learner self-assessment

+ Δ

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Focused facilitation:Digging deeper

using Advocacy-Inquiry (AI)

Performance gap

Actual performance

Desired performance

Rudolph et al 2008

Performance gap

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Performance gap

Actual performance

Desired performance

Rudolph et al 2008

Performance gapIntentionally

Rational

Frames of mind

Frames of

mind

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Sharing your point of view helps you dig deeper

Walter Eppich,

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Rudolph et al 2006

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Being honest but non-threatening…

First person perspective• “I saw / heard…didn’t see / hear”• “My impression is…”• “It seemed to me…”• “That made me think….”• “From my point of view…”• “My worry is/was…”• “I am concerned…”• “In my experience...• “Usually what I do”…

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Digging deeper

• “Let’s talk about about…” [topic]

• ”I saw / heard…” [data]

• “I think…” [your point of view about it]

• “What do you think? [inquiry]

After you learn the frame of mind, provide individualized teaching, or

build on it and probe further

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Process“How to debrief”

Content“What to debrief”

Debriefing Content: What to debrief• Performance domain

– Taskwork– Teamwork

• Taskwork and teamwork are interrelated entities– Use objective performance data whenever possible– Explore how teamwork achieves or prevents

attainment of taskwork

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Pre-action team reflexivity

In-action team reflexivity

Post-action team reflexivity

Situation Ad hoc briefing

Structured briefing

Concurrent reflection

Team reflexivity time-out

Ad hoc debriefing

Guided debriefing

Temporal focus &

main goal

– Future-oriented (focused on upcoming care needs); optimize upcoming patient care

– Present-oriented; optimize immediate patient care

– Past-oriented; focus on delivered care

– Future-oriented; optimize future patient care

Target of reflection

– Goals – Taskwork – Teamwork – Resources2

– Goals – Taskwork – Teamwork – Resources

– Outcome(s) – Taskwork – Teamwork – Resources

Main (team) outcome)

– SMM – Optimal preparation

– SMM – Adaptation – Learning

– Implicit or non-formal learning – Formal learning

Schmutz & Eppich, 2017

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BeforePre-action TR

“huddle, briefing”During

In-action TR“recap, summary,

inviting input

AfterPost-action TR

“debriefing”

Goal: create shared mental models, adaptation, learning

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Pre-action team reflexivity

In-action team reflexivity

Post-action team reflexivity

Situation Ad hoc briefing

Structured briefing

Concurrent reflection

Team reflexivity time-out

Ad hoc debriefing

Guided debriefing

Temporal focus &

main goal

– Future-oriented (focused on upcoming care needs); optimize upcoming patient care

– Present-oriented; optimize immediate patient care

– Past-oriented; focus on delivered care

– Future-oriented; optimize future patient care

Target of reflection

– Goals – Taskwork – Teamwork – Resources2

– Goals – Taskwork – Teamwork – Resources

– Outcome(s) – Taskwork – Teamwork – Resources

Main (team) outcome)

– SMM – Optimal preparation

– SMM – Adaptation – Learning

– Implicit or non-formal learning – Formal learning

Schmutz et al. 2018

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BeforePre-action TR

“huddle, briefing”During

In-action TR“recap, summary,

inviting input

AfterPost-action TR

“debriefing”

Key finding: In-action TR improves performance especially in larger teams

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Process“How to debrief”

Content“What to debrief”

Putting it all together

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Wrap up and take-aways

Walter Eppich, MD,