Debriefing with Good Judgment: Combining Rigorous Feedback with Genuine Inquiry

doi:10.1016/j.anclin.2007.03.007

Anesthesiology Clinics

Volume 25, Issue 2, June 2007, Pages 361-376

https://doi.org/10.1016/j.anclin.2007.03.007 Get rights and content

Drawing on theory and empirical findings from a 35-year research program in the behavioral sciences on how to improve professional effectiveness through reflective practice, we develop a model of “debriefing with good judgment.” The model specifies a rigorous reflection process that helps trainees surface and resolve pressing clinical and behavioral dilemmas raised by the simulation. Based on the authors' own experience using this approach in approximately 2000 debriefings, it was found that the “debriefing with good judgment” approach often sparks self-reflection and behavior change in trainees.

Section snippets

Reflective practice: method and theory

Reflective practice is a method used to scrutinize one's own professional work practices and the taken-for-granted assumptions that underlie them. It is often accomplished in a collaborative setting [16]: in this case, the relevant setting is the simulation debriefing wherein colleagues and trainees are helped to develop crisis resource management, clinical, and reflective practice skills. Researchers at Harvard University and the Massachusetts Institute of Technology developed the method as

Debriefing stance: moving from judgmental debriefing to debriefing with good judgment

Although it may be obvious how discovering trainees' frames can enhance debriefing in medical simulation, the importance of identifying and revealing the instructor's frames is less obvious. Crucial to the process of a rigorous debriefing that is both nonthreatening and direct is instructors' learning to identify and examine their own frames related to the simulation they observed. Without an understanding of their own frames, instructors are handicapped in their ability to help illuminate a

Transparent talk in debriefing: enacting the good judgment approach with advocacy-inquiry

The debriefing with good judgment frames outlined in Table 1 are enacted by the style of speaking used by the instructor. Like all frames, mental models, or schemata, the values underlying the good judgment approach are invisible; the only way to see them is when they are transformed into actions, and speaking is a powerful action for instructors. One particularly effective style of debriefing speech is to pair advocacy with inquiry. An advocacy is an assertion, observation, or statement,

Summary

The debriefing with good judgment approach is designed to increase the chances that the trainee hears and processes what the instructor is saying without being defensive or trying to guess the instructor's critical judgment. The debriefing with good judgment appellation is not meant to imply that the judgmental or nonjudgmental approach do not have good judgment as their basis. The authors believe that all three approaches often start with some important evaluative insight held by the

Acknowledgment

The authors are grateful to the US Department of Veterans Affairs' Merit Review Entry Program, the Josiah Macy, Jr. Foundation, the Risk Management Foundation of the Harvard Medical Institutions, Richard Nielsen, Boston College, Carroll School of Management, and the Harvard-MIT Division of Health Sciences and Technology for support in developing the ideas and material in this article. They also express thanks to the participants in the Institute for Medical Simulation instructor workshops for

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Debriefing with Good Judgment: Combining Rigorous Feedback with Genuine Inquiry

Section snippets

Reflective practice: method and theory

Debriefing stance: moving from judgmental debriefing to debriefing with good judgment

Transparent talk in debriefing: enacting the good judgment approach with advocacy-inquiry

Summary

Acknowledgment

Learning in the thick of it

Harv Bus Rev

Facilitation and debriefing in aviation training and operations

The cognitive and affective learning effects of debriefing after a simulation game. School of education

Debriefing: toward a systematic assessment of theory and practice

Simul Gaming

Three levels of learning in simulations: participating, debriefing, and journal writing

Simul Gaming

Beyond metaphor: applying a new paradigm of change to experiential debriefing

The Journal of Experiential Education

How to facilitate a debriefing

Simul Gaming

Using games for debriefing

Simul Gaming

Psychological safety and learning behavior in work teams

Adm Sci Q

Theory in practice: increasing professional effectiveness. Jossey-Bass series in higher education

The reflective practitioner

Learning from experience: toward consciousness

The fifth discipline: the art and practice of the learning organization

Difficult conversations

Collaborative off-line reflection: a way to develop skill in action science and action inquiry

How the way we talk can change the way we work

Action science: creating communities of inquiry in communities of practice