Taking opportunities - Embracing Micro Debriefing and Self Debriefing in Clinical Practice
As healthcare professionals, our journey of learning and development is continuous and ever-evolving. In this article I’ll delve into the realms of micro debriefing and self debriefing, tools that hold immense potential in shaping the growth of clinicians.
Understanding Debriefing
At its core, debriefing is a powerful learning tool. It involves reviewing and analysing an event, traditionally associated with major incidents and simulation training. However, its scope extends far beyond, offering valuable insights in a wider range of scenarios.
Micro-Debriefing: The Power of the Immediate
Micro-debriefing refers to the brief, spontaneous debriefing sessions that follow everyday events. These could be as routine as a ward round or as critical as a resuscitation - you’d be surprised how effective this technique is in improving the quality of your processes.
The key lies in seizing these moments to reflect and learn.
Self Debriefing: The Inner Facilitator
Self debriefing, either self-facilitated or facilitated by team members (as opposed to an independent observer), is a self-driven process. This important technique has many benefits - most importantly, it allows for constructive quality improvement even in the absence of a dedicated facilitator. In addition, it promotes a culture of continual self assessment, reflection and quality improvement.
While there are valid reasons why a facilitate approach may be better, there is little evidence to support this. According to McKenna et al.'s meta-analysis of 10 trials, self debriefing can yield outcomes (such as knowledge and behavioural outcomes) comparable to facilitated debriefs, provided it is executed correctly.
Opportunities Abound
Every clinical interaction, be it an IV insertion or a patient handover, presents an opportunity for debriefing. The crucial element is feedback, which can be self-assessed through videos, recall, or documentation, or automated in platforms like Osler’s ALS simulator.
Feedback: The Catalyst for Reflection
Post-feedback, the process of analysis and synthesis begins. Tools like + delta and PEARLS facilitate this process, guiding self debriefing effectively. Written reflection, in particular, offers the advantage of easy storage and future recall.
The Benefits Unfold
The practice of debriefing, especially self debriefing, fosters a culture of lifelong self-assessment and reflection. It promotes psychological safety by reducing embarrassment, thereby encouraging honest self-assessment. This participant-led approach diminishes the authority gradient, allowing for a more inclusive and comprehensive learning experience.
Challenges to Acknowledge
However, self debriefing is not without its challenges. The absence of a facilitator can sometimes lead to less effective self-evaluation, particularly for inexperienced clinicians. The process requires honesty, effort, and can sometimes be ego-threatening. Awareness and external data sources can mitigate these issues to an extent.
Implementing the Practice
The 5A+Δ approach is a popular model for debriefing. It's a simple, five-minute process focusing on actions, what was good (plus), and what could change (delta). The key to success with this model is consistent practice and a supportive culture that normalizes self-reflection in clinical practice.
In Conclusion
Micro debriefing and self debriefing are not just tools for immediate learning; they are gateways to developing a culture of continuous improvement, humility, and team cohesion in clinical settings. As we embrace these practices, we step into a world where every clinical encounter becomes a learning opportunity, paving the way for better patient care and personal growth.
For a deeper dive into this topic, I recommend reading the insightful article at [Advances in Simulation](https://advancesinsimulation.biomedcentral.com/articles/10.1186/s41077-021-00173-1.pdf).