Wednesday, 30 March 2016

Sharpening the saw: everyday debriefing practice

Participants on our 2-day introductory faculty development course are given all the tools they need to plan, run and debrief a simulated experience aligned to learning objectives. However, on returning to their own workplaces, they often do not have the opportunity to run simulations regularly. This lack of practice means that their skills in debriefing do not improve as quickly as they would like. Also participants often mention that they don't have the time to carry out a 40 minute debrief. The good news is that they don't have to.

In Stephen Covey's book "The 7 Habits of Highly Effective People", the seventh habit is "Sharpen the Saw". This habit, which includes social, emotional and physical well-being, also focuses on learning. This blogpost will explain how you can "sharpen the saw" every day with respect to debriefing in a few straightforward steps:

1) Find a learner
Anybody will do (a trainee, a student, a colleague...)

2) Rustle up some learning objectives
The learning objectives can come from your learner (e.g. "What do you want to focus us on today?" "What do you want to get out of today?" "What have you been struggling with?") Or they can come from you. 

3) Have an experience together
This can be pretty much anything. Inserting a nasogastric tube, carrying out a laparoscopic cholecystectomy, doing the drug round on a ward, going on a home visit, etc. The proviso is that you must have enough mental workspace available to observe the learner. This does not mean that you must be "hands off". However if you are too involved in the experience yourself, perhaps because it is complicated or time-critical, you are unlikely to be able to have a conversation with the learner about their performance.

4) Practice your debriefing skills (as per the SCSCHF method)

a) Reactions
Ask him/her how that felt. What are their emotions about the experience.

b) Agenda
Ask him/her what they thought went well and what the challenges were.

c) Analysis
The assumption is that you don't have the time to spend 30 minutes in this phase of the debrief, so focus on just one thing. Use good questioning technique (taught on the faculty development course) to delve into the mental frames, heuristics, assumptions etc. which led to this being a challenge or a good performance.

d) Take Home Messages
What is your learner going to differently or the same next time based on your facilitated discussion.

5) Get feedback
Practice does not make perfect, practice makes permanent. Deliberate practice with feedback propels you up the slope towards perfection. So get feedback from the learner. What was good about the way you helped them learn, what didn't work? If you can, now and again get a colleague, who has also been on the faculty development course, to sit in on the above and also give you feedback.

6) Reflect on your performance
This does not have to take long or to be done then and there. At some stage reflect on your performance with the benefit of the feedback you have obtained. What are you going to do differently next time?

7) Repeat
Do steps 1-6 again. Tell us how you get on....

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