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Master Debriefing with the DASH Tool

Leverage this resource to develop and assess debriefing skills.

Are you confident that you and your team are maximizing learning outcomes with your simulation debriefings?

Debriefing has been described as the "heart and soul" of the simulation experience.1 Some studies have shown that without effective debriefing, learning won’t occur.2 And, research also indicates that ineffective debriefing results in persistent poor clinical judgment.3 This means that the competence level of the debriefer has a considerable influence on learning outcomes.4 

In a recent webinar poll, 69% of our clients said that effective debriefing is the most important factor in successfully implementing a simulation activity.

Debriefing’s ability to "make or break" a simulation makes it a natural choice for one of the top spots on the professional development list.

If you’re uncertain of how your team’s debriefing skills stack up, or if you’re unsure of what specific behaviors make a debriefing most effective, there are a number of expert evaluation tools that have been used in simulation research and can help you answer both of these questions.

In this article, we focus on one of these tools – the Debriefing Assessment for Simulation in Healthcare© (DASH) – and discuss how it can help you maximize learning outcomes by conducting expert debriefings.

What is good debriefing, exactly? 

The Healthcare Simulation Standards of Best Practice™, developed by the International Nursing Association for Clinical Simulation and Learning (INACSL), provide guidelines on what constitutes effective debriefing.

According to INACSL's "Debriefing Process" Standard, debriefings should be:5

  1. Planned and incorporated into the simulation in an appropriate way to guide the learner(s) in achieving the desired learning or evaluation outcomes
  2. Constructed, designed and/or facilitated by a person(s) or system capable and/or competent in providing appropriate feedback, debriefing, and/or guided reflection
  3. Conducted in a way that promotes self, team, and/or systems analysis
  4. Planned and structured in a purposeful way based on theoretical frameworks and/or evidenced-based concepts.

These criteria provide useful guidance for simulation programs to work toward. But many simulationists struggle with pinpointing the specific behaviors necessary to meet best practice standards.6

This is precisely where the DASH tool can help. 

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The DASH tool: a guidebook for effective debriefing

Developed by an expert group of simulation educators at the Center for Medical Simulation in Boston, MA, the DASH tool is a free resource designed to assist in the evaluation and development of debriefing skills. The tool accomplishes this by examining concrete behaviors.

Essentially, the DASH helps by translating debriefing best practices into a set of observable actions. Having concrete behaviors to aim for is an important component of the deliberate practice necessary to master a skill.7

The DASH assesses debriefing performance in six elements. Performance in each element is rated on a 7-point scale, from extremely ineffective/detrimental (1) to extremely effective/outstanding (7).

 

The six elements are:8

1. Setting the stage for an engaging learning experience (prebriefing), including:

Explaining the strengths and weaknesses of the simulation and what the learners could do to get the most out of it

Stimulating the learners to share their thoughts and questions about the upcoming simulation and reassuring them that they wouldn’t be shamed or humiliated in the process

2. Maintaining an engaging context for learning, including:

Showing respect towards the participants

Ensuring the focus is on learning and not on making learners feel bad about making mistakes

3. Structuring the debriefing in an organized way, including:

Guiding the conversation in way that it progresses logically rather than jumping around from point to point

Helping tie observations together and relate the case(s) to ways the learners can improve their future clinical practice

4. Provoking in-depth discussion that lead learners to reflect on their performance, including:

Using concrete examples to get learners to think about their performance

Using video or recorded data to support analysis and learning

5. Identifying what learners did well or poorly – and why, including:

Providing concrete feedback to participants on their performance based on accurate statements of fact and debriefer's point of view

Helping explore what participants were thinking or trying to accomplish at key moments

6. Helping learners see how to improve or sustain good performance, including:

Helping learners learn how to improve weak areas or repeat good performance

Being knowledgeable and using that knowledge to help learners see how to perform well in the future

The actions covered in the DASH can provide you and your team with a clear pathway to conducting optimal debriefings.

Gain feedback from different angles

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There are three versions of the DASH (and each version has a long and short option):
  • A student version for students to assess instructors
  • An instructor version for instructors to self-assess
  • A rater version for trained raters to rigorously assess instructors (raters should first receive training from the Center for Medical Simulation before using this version)

Together, these versions can allow you to get a well-rounded assessment of performance from multiple perspectives. 

Ways to leverage the DASH for high-quality debriefing

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Some examples of areas where the DASH can help include:

  • New staff onboarding. Use the DASH to familiarize new faculty with the actions that make up effective debriefing. At the same time, the new faculty can take a debriefing workshop or course to learn the foundations. Then, as they begin conducting debriefings, you can use the DASH to assess their performance and provide feedback.
  • Continuous improvement. Use the DASH to periodically assess faculty on their debriefing skills. Consider incorporating it into your regular routine as part of weekly or monthly meetings. This could look like recording a debriefing and then having faculty assess it together and provide the debriefer with feedback. If debriefers are consistently falling below a certain score, it may benefit them to enroll in an immersive debriefing workshop with an expert simulation educator. 

Tip: If you usually collect your assessment data using paper and pencil or Excel file, it may be worth exploring software that will make it easier to track the success of your debriefing professional development efforts. In addition to managing student performance data, a simulation management system like SimCapture can also help you collect and organize meaningful data on your faculty’s debriefing progress. The DASH can be completed directly within SimCapture, yielding performance reports that provide insights into specific areas that need further development. And, the ability to track performance over time will help you see if any improvement measures you’ve taken are having an impact.

Ready to DASH?

Access the DASH tool from the Center for Medical Simulation.

Please note that this article is not an endorsement of the DASH tool. It is intended to provide an overview of the DASH, which is only one of several instruments that can help you effectively assess debriefing quality. Click here for INACSL’s repository of instruments used to evaluate debriefing methods, scales, and experiences used in simulation research. 

References

  1. Rall, M., Manser, T., & Howard, S. K. (2000). Key elements of debriefing for simulator training. European Journal of Anaesthesiology, 17(8), 516–517. DOI:10.1046/j.1365-2346.2000.00724-1.x
  2. Debriefing Across the Curriculum. (2015). National League for Nursing. Retrieved from https://www.nln.org/docs/default-source/uploadedfiles/professional-development-programs/nln-vision-debriefing-across-the-curriculum.pdf
  3. Ibid.
  4. Ibid.
  5. Decker, S., Alinier, G., Crawford, S. B., Gordon, R. M., Jenkins, D., & Wilson, C. (2021). Healthcare Simulation Standards of Best Practice:™ the debriefing process. Clinical Simulation in Nursing, 58, 27–32. https://doi.org/10.1016/j.ecns.2021.08.011
  6. Rudolph, J. W., Palaganas, J., Fey, M. K., Morse, C. J., Onello, R., Dreifuerst, K. T., & Simon, R. (2016). A dash to the top: Educator debriefing standards as a path to practice readiness for nursing students. Clinical Simulation in Nursing, 12(9), 412–417. https://doi.org/10.1016/j.ecns.2016.05.003
  7. Ibid.
  8. Simon R, Raemer DB, Rudolph JW. 2012. Debriefing Assessment for Simulation in Healthcare (DASH)© – Instructor Version, Long Form. Center for Medical Simulation, Boston, Massachusetts. https://harvardmedsim.org/wp-content/uploads/2017/01/DASH.IV.LongForm.2012.05.pdf. English, French, Japanese, Spanish, Chinese.  

Helping you achieve debriefing competence

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