Ongoing Debriefing for Health Simulations

BUdebrief

Video for low-cost simulation and skills practice in Nursing and other health professions

The power of simulation for learning has been clear for centuries. Even the mighty Roman military did simulations to make sure their armies were ready for battle. They also used simulation for soft skills so they could convince people in their conquered territories to be loyal citizens. (You’d never know this from Asterix, though.)

But the Romans didn’t have video to make debriefing happen powerfully anywhere across time and space. Now it’s so easy to record video, but the challenge is how to use it for simulation without breaking the bank — and how to break free of the constraints of using video recorded only on fixed cameras in a fancy simulation lab.

Finally, simulation in health professions is becoming mainstream. INACSL, the International Nursing Association for Clinical Simulation Learning has thousands of members and a big conference every year where simulation educators share knowledge and experiences. While simulation educators like high-fidelity, carefully scripted and organized simulations, there is a move to incorporate much more flexible, low-cost simulation and skills learning more frequently in nursing programs. This approach goes by a few names including “the frugal sim”, “low cost simulation”, “low-fidelity simulation”.  There’s even a site called lowcostsim.wordpress.com with plenty of advice for “Medical Simulation on a Shoestring.” The problem is that in places that need low cost simulation, video debriefing has been out of reach.

Simulation educators feel a tension between, on one hand, the high cost and logistical challenges of recording video, and on the other, the limited value of the video in a traditional debriefing where the participants gather immediately following the simulation. But this tension can be overcome with a slight change to how educators conceive of debriefing. 

Instead of a debriefing event, held in-person at one time, educators might think of a debreifing process that occurs as a dialogue over time and space. It includes not only facilitated debriefing, but “self-debriefing” reflection, which is just as effective. When debriefing is a process rather than an event, not only will it be more flexible, convenient and cheaper, but it will probably have a greater impact on learning. The Cloud has made this possible and now you could even say it’s easy. For quite a few years we’ve all been having discussions that are not in real time, using our devices: text messaging, Facebook, Slack, and even comments on Word or Google Docs.  That approach will work for simulation debriefing if we can just combine it with a video of the simulation. But can it be done in a low-cost simulation context?

Some of the simulation-specific video solutions, like EMS SimulationIQ, bundled with or an add-on to simulation equipment, are fairly expensive. Instead, low-cost sim educators should consider WeVu, a lightweight, inexpensive video system for education. WeVu allows recording with any camera, including webcams or phones, and then lets you share, make comments, and have a dialogue right along the timeline of the video.  With low-cost recording and an affordable video platform, debriefing happens over time and space. It’s more convenient and less taxing for educators and it has a bigger impact on learners, since they can take the time to consider how they’ve performed, get feedback, and ask questions about how to improve.

Here’s how it would work.

You would define the simulation or skills practice activity. Record with a laptop and webcam or an old smartphone on a little phone tripod (from Amazon). Make sure your audio is adequate – iphones are pretty good, some android phones are not bad, and a webcam with a speakerphone as the mic is probably best.

Tell your learners to use the top half of one page in Word and type their name in a bold, 48-point font, along with any other details like a student number. Then at the very start of each recording, your learners should hold up that half-page in front of the camera when the recording starts.

After all the simulations are done, you’ll just go to WeVu and upload them. You can then assign them to each learner’s own account and to an assignment (the names they held up on that sheet are on the thumbnail of the video in WeVu). Then you’re ready to ask them to self-debrief, reflecting on their performance in the simulation, which has been shown to really improve learning (here too). Instructors or coaches can go on and provide pointed feedback. Learners can then even ask questions along the video about how they can do better.

This even works for assigning students some skills practice. Tell them to record themselves or each other and then upload to the assignment you’ve defined in WeVu. It’s that easy. You’ll get all the submissions organized in one place and can watch some of it and give feedback. That will surely save time, as compared to waiting for students to file in and do the skills over and over in person. Learners will get feedback they can reflect on after the fact, rather than in the immediate aftermath of the simulation or skill exercise, when their hearts are still thumping too hard to benefit from the debrief.