Sangah Lee, Cerrone Foster, Min Zhong, Hannah Bruce-Opris, Mainlyng Duenas, Victoria Parente, Chaniece Reid, Melissa McCartney
Annotations Serve as an On Ramp for Introductory Biology Students Learning to Read Primary Scientific Literature
Journal of microbiology & biology education
aim paper critically review felt important role debriefing field simulationbased learning come developed time different styles approaches used effective process recent systematic review high fidelity simulation literature identified feedback including debriefing important feature simulationbased medical education1 despite surprisingly papers peerreviewed literature illustrate debrief teach learn debrief methods debriefing exist effective achieving learning objectives goals review means systematic review literature available debriefing contains information peer nonpeer reviewed sources meeting abstracts presentations within medical field disciplines versed practice debriefing military psychology business also contains many examples expert facilitators learned years practice area feel would interest novices field introduction debriefing experts illustrate gaps currently exist might addressed research within medical simulation community collaborative ventures disciplines experienced art debriefing background simulationbased learning generally simulationbased learning dealing educating adult professional adult learning provides many challenges seen typical student population adults arrive complete set previous life experiences frames knowledge assumptions feelings ingrained personality traits relationship patterns drive actions2 adult learners become selfdirected mature like learning problem centered meaningful life situation learn best immediately apply learned3 attitudes towards specific learning opportunity vary depend factors motivation attending training whether voluntary mandatory whether participation linked directly recertification job retention traditional teaching methods based linear communication models ie teacher imparts facts student unidirectional manner particularly effective adult learning may even less teamoriented training exercises estimated halflife professional knowledge gained formal education may little 2 25 years4 case activities requiring formal knowledge core set skills advanced cardiac life support retention little 6 12 months56 much research teaching adults indicates active participation important factor increasing effectiveness learning population7 fact given curriculum learning occurs formal curriculum per se informally personalized teaching methods informal curricula even embedded cultures structures within organization hidden curricula8 adults learn best actively engaged process participate play role experience concrete events cognitive fashion also transactional events emotional fashion learner must make sense events experienced terms world combination actively experiencing something particularly accompanied intense emotions may result longlasting learning type learning best described experiential learning learning thinking assimilation lessons learned everyday behaviors kolb describes experiential learning cycle containing four related parts concrete experience reflective observation abstract conceptualization active experimentation9 gibbs also describes four phases planning action carrying action reflection action relating happens back theory10 grant marsden similarly describe experiential learning process experience thinking experience identifying learning needs would improve future practice area planning learning undertake applying new learning practice11 simulation training sessions structured specific learning objectives mind offer opportunity go stages experiential cycle structured manner often combine active experiential component simulation exercise subsequent analysis reflection experience aiming facilitate incorporation changes practice simulation offers opportunity practiced experience controlled fashion reflected leisure experiential learning particularly suited professional learning integration theory practice pertinent ongoing11 experiential learning experience used major source learning one thinking required must related minds learner10 concept reflection event activity subsequent analysis cornerstone experiential learning experience facilitators guide reflective process indeed ability reflect appraise reappraise considered cornerstone lifelong learning one core elements training healthcare articulated accreditation council graduate medical education united states12 practice however everyone naturally capable analyzing making sense assimilating learning experiences particularly included highly dynamic teambased activities attempt bridge natural gap experiencing event making sense led evolution concept postexperience analysis13 debriefing debriefing represents facilitated guided reflection cycle experiential learning origins debriefing simulationbased learning historically debriefing originated military term used describe account individuals gave returning mission14 account subsequently analyzed used strategize missions exercises militarystyle debriefing educational operational objectives another connotation debriefing developed combat arena therapeutic psychological association sort defusing aided processing traumatic event aim reducing psychologic damage returning combatants frontline quickly possible therapeutic approach emphasis placed importance narrative reconstruct happened cognitive reconstruction events performed groups shared meaning participants brought together describe occurred account actions taken place develop new strategies commanding officers another form debriefing critical incident debriefing pioneered mitchell15 used mitigate stress among emergency first responders formulated set procedures termed critical incident stress debriefing cisd15 cisd facilitatorled approach enable participants review facts thoughts impressions reactions critical incident main aim reduce stress accelerate normal recovery traumatic event stimulating group cohesion empathy dyregrov modified technique called psychological debriefing designed take place 48 72 hours traumatizing event attempt assist participants cognitive emotional processing experienced16 currently concern unrealistic expectation cisd usefulness may developing single session approach may inadequate certain individuals situations particularly technique applied outside realms originally designed17 another origin term debriefing comes experimental psychology describes means participants deceived manner part psychology study informed true nature experiment18 purpose ethically required debrief allow dehoaxing occur reverse negative effects experience may had19 three fields contributed development debriefing educational arena facilitatorled participant discussion events reflection assimilation activities cognitions produce longlasting learning debriefing process approach debriefing noneducational debriefing exists ethical duty facilitators set safe confidential scene facilitation ethical obligation facilitator simulationbased learning determine parameters within behavior analyzed thereby attempting protect participants experiences might seriously damage sense selfworth20 ensure successful debriefing process learning experience facilitator must provide supportive climate21 students feel valued respected free learn dignified environment participants need able share experiences frank open honest manner14 awareness vulnerability participant needed must respected times highlighted recent study regarding barriers simulationbased learning approximately half participants found stressful intimidating environment similar proportion cited fear educator peers judgment22 essential facilitator creates environment trust early typically prebrief session prebrief period time facilitator illustrates purpose simulation learning objectives process debriefing entails period participants learn expected sets ground rules simulationbased learning experience also time facilitator reflect learning objectives consider every participant comes simulation preceding set individual frames life experiences2 previous experiences impact effective training need taken consideration irrespective debriefing model employed frames internal images reality person perceives something relative someone else affect way people receive process assimilate information2 simulation scenario debriefing techniques employed need take individual learning styles consideration factor illustrated kolb incorporation experiential learning cycle basic learning styles23 four prevalent learning styles identified diverging assimilating converging accommodating participants diverging learning styles use concrete experience reflective observation learn style facilitates generation ideas brainstorming individuals learning style prefer work groups listening receiving feedback individuals assimilating learning styles prefer abstract conceptualization reflective observation like reading lectures analysis convergingstyled learners use abstract conceptualization active experimentation like find practical uses ideas theories formal learning setting prefer experiment new ideas simulations laboratory experiments practical applications accommodatingstyled learners use concrete experience active experimentation people style learn primarily handson experience formal learning prefer work teams set goals fieldwork test different approaches compiling project learning teams individuals tend orientate contribute team learning process using individual learning styles help team achieve learning objectives highly effective teams tend possess individuals number different learning styles experience pairing appropriately learningstyled individuals may add teams performance individual learning styles team composition important factors facilitators consider choosing style debriefing successful simulation session also important facilitators learn characteristics group whether group members know novices experienced new simulation prebrief period afford experienced facilitator opportunity observe team behaviors identify learner characteristics early debrief accordingly structural elements debriefing process despite many approaches debriefing2425 number structural elements common forms facilitation lederman identified seven common structural elements involved debriefing process table 118 first two elements debriefers debriefed possible two participants act debriefers26 third element experience eg simulation fourth impact experience participants concept impact important adult learners typically need emotionally moved event event needs relevant everyday lives make impact fifth sixth elements involve recollection report reporting event although usually carried verbal manner may written involve completion formal questionnaire24 seventh element time experience seen differently depending much time passed debriefing although debriefing approaches conducted soon experience allow time formal reflection reporting long event via written report individual event keeping journal written review educational experiences semester24table 1 seven common structural elements involved debriefing process18models debriefing number models exist incorporating structural elements describe various debriefing facilitation styles2729 models probably evolve natural order human processing experience event reflect discuss others learn modify behaviors based experience although reflection learning experience might occur naturally likely unsystematic may occur especially pressure events prevents focusing transpired conducting formal debriefing focuses reflective process individual participants group whole naturally debriefings may move power three phases description analogyanalysis application however without facilitator participants may trouble moving first descriptive phase particularly active hotseat participant emotionally absorbed event blinkered view occurred challenge facilitator allow enough time defusing occur direct discussion objective broadbased capacity facilitator needs move discussion away personalized account participant thought occurred global perspective away individual group person event must cognizant cut participant make himher feel alienated although core debrief centers reflection active experience making sense event supporting phases necessary allow reflection assimilation occur phases debrief described many authors categorized different manners basic tenets various debriefing models many overlapping elements table 2table 2 models debriefing processan initial phase identifying impact experience considering processes developed clarifying facts concepts principles used simulation described thatcher robinson27 lederman describes phase introduction systematic reflection analysis follows active component simulation recollection happened description participants words28 paternek describes introductory phase description events occurred29 second phase described identifying ways emotion involved either individually group27 intensification personalization analysis experience participants explore feelings experienced event28 emotional empathic content discussion29 third phase involves identifying different views formed participant correlate picture whole27 generalization application experience participants attempt make comparisons reallife events28 phase explanations analysis everyday applicability evaluation behaviors2 objectives debriefing session design debriefing session tailored learning objectives participant team characteristics objectives may well defined specified beforehand may emergent evolve within simulation welldefined objectives technical skill particular team behavior debriefing session affords opportunity examine closely participants performance approached known target needs done bridge observed gaps performance target also affords opportunity share objectives participants emergent objectives participants may asked reflect observed evolution scenario see behaviors attitudes choices uncovered simulation relate real life situations exploring objectives goals two main questions 1 pieces knowledge skills attitudes learned 2 specifically learned case emergent objectives simulations may viewed experiments participants try alternative ways behavior test new strategies courses action debrief objectives complicated fewer predefined ideas participants acted discussion must focus around issues arise events meaning involved role facilitator debriefing process tension making participants active responsible learning versus ensuring address important issues extract maximum learning debriefings data surveys participants indicates perceived skills debriefer highest independent correlation perceived overall quality simulation experience30 skill debriefer paramount ensuring best possible learning experience training facilitation vital number centers offer facilitation courses providing training debriefing skills table 331 addition formal education facilitators techniques pairing expert novice facilitators early career give guidance direction important recent study facilitation problembased learning illustrated facilitators felt formal training course provided sufficient skills commence debriefing experience presence expert role model became comfortable process32 study students commented skill facilitators important factor learning process credibility course basic advanced courses refresher courses facilitation probably universally requiredtable 3 list institutions organizations offer formal training simulationbased healthcare educator31the exact level facilitation degree facilitator involved debriefing process depend variety generic factors objective experiential exercise complexity scenarios experience level participants individuals team familiarity participants simulation environment time available session role simulations overall curriculum individual personalities relationships participants unlike traditional classroom teacher facilitators tend position authorities experts rather colearners fraternal approach may productive learning objective behavioral change facilitators aim guide direct rather lecture role student participant debriefing expanded traditional passive role one skills demanded ability critically analyze ones performance retrospectivelynot went well went wrong went way contribute actively learning process practical points debriefing number methods debriefing levels facilitation may employed dismukes smith discussing debriefing aviation delineate three levels facilitation33 high participants largely debrief facilitator outlining debriefing process assisting gently guiding discussion necessary acting resource ensure objectives met thus paradoxically high level facilitation actually implies low level involvement facilitator level facilitationinitially described carl rogersdescribes facilitator catalyst allowing clients students draw conclusions creating prescription change34 described core conditions facilitative process counseling educational congruence realness acceptance empathy realness refers genuine nature facilitator idea acceptance learner feels opinions prized feelings person third empathy teacher aims understand learners viewpoint sensitivity examples techniques highlevel facilitation would use pauses allow thoughtful responses comment openended questions phrases rather statements fact artful use silence another technique draw discussion group intermediate increased level instructor involvement may useful individual team requires help analyze experience deep level capable much independent discussion examples techniques used intermediatelevel facilitation would include rewording rephrasing rather giving answers asking questions number ways number participants changing tone questions techniques would asking one member comment another moving around group asking input team members low intensive level instructor involvement may necessary teams show little initiative respond superficially cases facilitator guides individual group debriefing stages asks many questions strongly directs nature discussion lowlevel facilitation participants show little initiative tend respond superficially facilitator may need directive operate stepwise pattern analysis examples techniques used lowlevel facilitation would include answering participants confirming statements agreeing recapping reinforcing thoughts ideas techniques active listening echoing expanding statements nonverbal encouragement nodding leaning forward focused eye contact useful probably beneficial facilitate highest possible level participants independently generating rich discussion among key issues experience healthcare ideal rarely achieved especially relatively junior trainees firsttime simulation participants age matching level instructor involvement nature material group critical conversely may tendency instructors debrief lower level instructor involvement participant group might really needthat overinstruct ensure participants become involved highest level good prebrief essential individuals teams unfamiliar kind learning may start sequence simulations debriefings need high instructor input become participantdirected day progresses styles facilitation different levels facilitation may employed suit needs participants different facilitator techniques may used engage participants debriefing process examples styles facilitation include funneling facilitator guides funnels participants refrains commenting framing introducing experience manner enhances relevance meaning frontloading using punctuated questions experience redirect reflection solutionfocused facilitation changes focus questions away problems directionalstyle debriefing intended change way people feel think35 techniques plusdelta may also useful technique involves creating two headings columns entitled delta greek symbol change plus delta column participants orand facilitator place behaviorsactions would change improve future plus column contains examples good behaviors actions different participants contribute critique may single individual team behaviors variations technique include placing behaviors actions found difficult delta column easier tasks behaviors plus column subsequently discussing case facilitators karolinska university hospital sweden use targetfocused technique aid facilitation36 target behaviors identified prior simulation scenario prebrief period subsequently debrief identified evaluated facilitators participants observers technique offers structure debriefing may facilitate debriefing participants facilitators may decide use different communication styles debriefing using commands cues questions may also decide use acceptance praise scolding corrective37 number debriefers may decide use opposing styles good copbad cop encourage discussion cohesiveness within participant team group debriefers may offer advantages specific educational technical points need addressed expert expert content debriefer may debrief specialized issues offer credibility discussion particularly dealing experienced group participants number facilitators present roles need clearly described debriefing commences avoid excessive facilitator input discussions particularly pertinent principal debriefer attempting use techniques active listening silence encourage group participation debriefing setting physical environment debriefing conducted also important factor complex debriefings lasting minutes debriefings often take place room separate active portion simulation allow diffusion tension provide setting conducive reflection also frees simulation room set next scenario however debriefings held simulation certain instances example aim teach technical skill team behaviors seriously flawed debriefing may occur simulation inscenario debriefing debriefing room comfortable private relatively intimate environment example large auditorium would typically appropriate seating arrangement may vary style debriefing degree facilitation