Implementation of Best Practices in Simulation Debreifing
Rationale Over the last 10 years the use of high-fidelity simulation in BSN education has been increasing. Recently it was reported that simulation may be used to replace 50% of the traditional undergraduate clinical experience. Research has demonstrated that debriefing is the most vital component in the simulation learning experience in regard to gains in knowledge for the student. Despite this fact research has shown that only 48% of faculty conducting simulations has had formal training in debriefing and only 19% were evaluated after training. Because of these data, an evidence-based simulation debriefing program was developed based on the INACSL VI, the standards for debriefing. All faculty engaged in debriefing processes were trained and then evaluated in debriefing techniques using established valid and reliable methodologies, to ensure students to receive the maximum educational benefit from their simulated patient experiences. The simulation program had already incorporated the first five of seven INACSL standards into its practices.
Methods Initially the Simulation Coordinator attended training on debriefing and evaluation through the Center for Medical Simulation. The training focused on utilizing INACSL Standard VI and the Debriefing Assessment for Simulation in Healthcare (DASH) tool for rating debriefing effectiveness. Subsequently, faculty training by the Simulation Coordinator consisted of debriefing terminology, three step model of debriefing, and INACSL Standard VI. Finally, trained faculty were evaluated during simulation debriefing using the DASH instrument. A worksheet with the DASH score and recommendations for improvement were provided as feedback. Should a faculty member require remediation, additional training, literature and support will be offered to assist with improvement of debriefing skills. Yearly competency in debriefing will be required.
Outcomes The faculty (15) who completed debriefing training were evaluated with the DASH tool. The range of scores was 5.2-5.9(scale is 0-7). This indicated that faculty were satisfactory (competently) applying the debriefing training correctly.
Conclusions Nursing courses utilizing simulation pedagogy at this school of nursing now have competent, trained faculty to facilitate the debriefing process. The next step in standardizing debriefing will be to evaluate the impact of the new debriefing process on student learning outcomes. To facilitate this video-aided debriefing is now being implemented so student performance in simulation can be measured. The Creighton tool for use in evaluation of student performance will be used for this purpose. This will address Simulation Standard VII, Participant Assessment and Evaluation. Educators utilizing simulation pedagogy should standardize their simulation process with particular attention to the debriefing phase of simulation. Methods for evaluation of both faculty and student performance should be implemented and monitored to allow for continued quality improvement efforts. As the use of simulation grows, efforts are required to improve and standardize the student learning experience. Further research into the effectiveness of implementation of INASCL's standards is warranted.