Debriefing with Good Judgment: Combining Rigorous Feedback with Genuine Inquiry

Authors and Affiliations

• Jenny W. Rudolph, PhD
  • Department of Health Policy and Management, Boston University School of Public Health
• Robert Simon, EdD
  • Harvard Medical School, Massachusetts General Hospital
• Peter Rivard, PhD
  • Center for Organization, Leadership and Management Research, VA Boston Healthcare System
• Ronald L. Dufresne, PhD
  • Department of Management, Haub School of Business, St. Joseph's University
• Daniel B. Raemer, PhD
  • Center for Medical Simulation, Harvard Medical School

Key Concepts

• Experiential Learning and Reflection

  • Reflection is critical for integrating experiences into future actions.
  • Debriefing in medical simulation is a structured way to reflect.

• Goals of Debriefing

  • Allow trainees to explain, analyze, and synthesize information to improve future performance.
  • Process usually involves analyzing situations and forming generalizations.

• Challenges in Debriefing

  • Creating an environment that is both challenging and safe for reflection.
  • Instructors often avoid critical judgments due to fear of confrontation.

Model of Debriefing

• Adapted from research on improving professional effectiveness.
• Three Components
  1. Conceptual Framework: Guides instructors to reveal mental models guiding actions.
  2. Debriefing Stance: Combines curiosity and respect with clear judgments.
  3. Communication Style: Uses advocacy and inquiry to explore trainee perspectives.

Reflective Practice

• Scrutinizing professional practices collaboratively.
• Helps develop crisis management and reflective skills.
• Draws on cognitive science, social psychology, and anthropology.

Understanding Frames

• Mental models (frames) shape actions.
• Different frames lead to different actions and results.
• Debriefing helps trainees analyze and revise their frames for future actions.

Debriefing Approaches

Judgmental

• Instructor-centric truth.
• Often leads to defensiveness and embarrassment.

Nonjudgmental

• Avoids criticism to maintain psychological safety.
• Can obscure important feedback.

Good Judgment

• Combines clear insights with inquiry.
• Encourages a mutual learning environment.

Advocacy-Inquiry Technique

• Pairs observations with questions.
• Encourages trainees to reflect on their frames and assumptions.
• Promotes open discussion and deeper learning.

Application Examples

• Dialogues demonstrating the good judgment approach.
• Focus on understanding and revising frames, not just correcting actions.

Summary

• The good judgment approach enhances learning by making critical insights explicit while maintaining psychological safety.
• It aligns educational objectives with insights into trainees' frames and assumptions.
• Effective when trainees are cooperative and open to learning.

Acknowledgments

• Supported by various foundations and institutions for developing these ideas.

References

• Includes literature on reflective practice, and studies on debriefing and professional development.