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MEdIC Series: The Case of the Difficult Debrief

2017-10-28T10:55:25+00:00

Welcome to season 5, episode 2 of the ALiEM Medical Education in Cases (MEdIC) series! Our team (Drs. Tamara McColl, Teresa Chan, John Eicken, Sarah Luckett-Gatopoulos, Eve Purdy, Alkarim Velji, and Brent Thoma) is pleased to welcome you to our online community of practice where we discuss the practice of academic medicine!

This month’s case was developed collaboratively with the team at Simulcast. For the unacquainted, Simulcast is an excellent simulation website operated by our Australian colleagues that even includes a Journal Club set-up based loosely on the MEdIC discussion concept. Check it out following the completion of the case for a podcast that will delve into some of the issues that arose from this month’s MEdIC case which presents a simulation educator who is having difficulty connecting with her learners during debriefing sessions.

MEdIC: The Case of the Difficult Debrief

By Brent Thoma, MD, Victoria Brazil, MBBS, FACEM, MBA, and Ben Symon, MBBS

Eliza slumped down at her desk and without a word began to tap quietly at her keyboard. It had only been a few weeks since she’d started at the Simulation Center, but her director, Susan, could already recognize the telltale signs of frustration.

“Tough debrief?” Susan asked.

“Just a rough session,” Eliza replied. “We did an airway scenario and I wanted to discuss some communication points, but less than a minute after I got into the room I found myself arguing with the senior residents about the merits of apneic oxygenation… That wasn’t even something that I wanted to talk about!”

She clapped shut her laptop and turned her chair towards Susan.

“I remember how much fun simulation was in residency. I learned so much from those sessions and thought that I’d be able to give our residents the same experience. But it’s just not happening! Our residents and nurses don’t seem to “buy in” to the scenarios, you know? They’re always complaining about the manikins rather than owning their performance, and when I ask them questions in the debrief, they just stare at me!”

Susan listened closely. “Tell me more.”

“I just…” She paused warily in front of her new boss, but then allowed herself to be honest. “When I ask them how the sim went, they say it went well. When I hint about issues that came up, they don’t take the bait. And when I clearly outline their mistakes, the seniors get defensive! Even when I finally get them talking, they’re talking about the wrong things!”

She gestured at the Masters of Education degree hanging on her wall. “I thought that thing would prepare me to teach in any environment,” she said, “but my debriefs aren’t working, and I don’t even know where to start.”

Susan paused for a second before responding. How could she help Eliza?

Discussion Questions

  1. How is teaching with simulation different than teaching on shift? Does debriefing effectively require a skillset beyond that of a medical educator?
  2. What are the qualities of a “good” debrief?
  3. Eliza mentioned that she both had difficulty getting her learners to talk and with them talking about the “wrong things.” How can simulation debriefers start the conversation effectively while ensuring that they address both their priorities and the needs of the participants?

Weekly Wrap Up

As always, we will post the expert responses and a curated commentary derived from the community responses 2 weeks after the case is published.

Our 2 experts for this month’s case will be:

  • Dr. Glen Posner
  • Dr. Andrew Hall

On November 10,  2017 we will post the curated commentary and expert responses to this case! After that date, you may continue to comment below, but your commentary will no longer be integrated into the curated commentary. That said, we’d love to hear from you, so please comment!

All characters in this case are fictitious. Any resemblance to real persons, living or dead, is purely coincidental. Also, as always, we will generate a curated community commentary based on your participation below and on Twitter. We will try to attribute names, but if you choose to comment anonymously, you will be referred to as your pseudonym in our writing.

MEdIC Series: The Concept
Inspired by the Harvard Business Review Cases and initially led by Dr. Teresa Chan (@TChanMD) and Dr. Brent Thoma (@Brent_Thoma), the Medical Education In Cases (MEdIC) series puts difficult medical education cases under a microscope. On the last Friday of the month, we pose a challenging hypothetical dilemma, moderate a discussion on potential approaches, and recruit medical education experts to provide “Gold Standard” responses. Cases and responses are made available for download in PDF format – feel free to use them! If you’re a medical educator with a pedagogical problem, we would love for you to get involved in the MEdIC series! Send us your most difficult dilemmas (guidelines) and help the rest of us bring our teaching to the next level.
Tamara McColl, MD FRCPC

Tamara McColl, MD FRCPC

Associate Editor, ALiEM MEdIC Series
Emergency Physician, St. Boniface Hospital, WRHA
Academic Lead, Educational Scholarship
Department of Emergency Medicine
University of Manitoba