1. Debriefing in AHA Courses
Content developed by:
Bryan L. Fischberg, NRP
Clinical Instructor, Department of Emergency Medicine
Rutgers—Robert Wood Johnson Medical School
2. AHAコースでのデブリーフィング
Content developed by:
Bryan L. Fischberg, NRP
Clinical Instructor, Department of Emergency Medicine
Rutgers—Robert Wood Johnson Medical School
この発表は、AHAの標準的内容に準拠して、
一部を補足解説します。
動画は以下でご覧下さい。
https://youtu.be/QO3O3B2Fmmc
一部日本語化、補足
松本尚浩
日本医療教授システム学会国際トレーニングセンター(JSISH-ITC)
ACLS/BLSファカルティー
3. • I have no relevant financial
relationships related to this
presentation.
• I will not be discussing any unlabeled
or investigational uses of products.
• At the conclusion of this presentation,
participants will be able to:
– Define debriefing
– List 2 benefits of classroom debriefing
– Describe the gather, analyze, summarize
(G-A-S) debriefing model and where to
use it in AHA Provider Courses
Opening Remarks & Objectives
4. • I have no relevant financial
relationships related to this
presentation.
• I will not be discussing any unlabeled
or investigational uses of products.
• At the conclusion of this presentation,
participants will be able to:
– Define debriefing
– List 2 benefits of classroom debriefing
– Describe the gather, analyze, summarize
(G-A-S) debriefing model and where to
use it in AHA Provider Courses
Opening Remarks & Objectives
5. • I have no relevant financial
relationships related to this
presentation.
• I will not be discussing any unlabeled
or investigational uses of products.
• At the conclusion of this presentation,
participants will be able to:
– Define debriefing
– List 2 benefits of classroom debriefing
– Describe the gather, analyze, summarize
(G-A-S) debriefing model and where to
use it in AHA Provider Courses
Opening Remarks & Objectives
このプレゼンテーションのゴールは、聴衆が
1:デブリーフィングを定義できる
2:コースでのデブリーフィングの利点を
二つ挙げることができる
3:GAS法デブリーフィングモデルを記述
でき、AHAプロバイダーコースのどこで
使うか記述できる
6. • You don’t have to
memorize what
you understand.
• You learn what
you’re taught…
Intersection of Philosophies
8. … you own what you discover.
人は見つけたこと(体験)を持っている
(意訳案:人は体験から学ぶ)
9. Debriefing
• Debriefing is a learner-focused,
nonthreatening technique to
assist individual rescuers or
teams to reflect on, and improve,
performance. (AHA, 2010)
– Should be included in all advanced
life support courses (Class I, LOE
B).
– Debriefing of actual resuscitation
events can be a useful strategy to
improve future performance (Class
IIa, LOE C).
• Need debriefer, participants,
experience, impact, recollection,
report, time. (Lederman, 1992)
• Basis in experiential learning
(Kolb & Fry; 1975, 1984)
10. • I have no relevant financial
relationships related to this
presentation.
• I will not be discussing any unlabeled
or investigational uses of products.
• At the conclusion of this presentation,
participants will be able to:
– Define debriefing
– List 2 benefits of classroom debriefing
– Describe the gather, analyze, summarize
(G-A-S) debriefing model and where to
use it in AHA Provider Courses
Opening Remarks & Objectives
このプレゼンテーションのゴールは、聴衆が
1:デブリーフィングを定義できる
2:コースでのデブリーフィングの利点を
二つ挙げることができる
3:GAS法デブリーフィングモデルを記述
でき、AHAプロバイダーコースのどこで
使うか記述できる
11. Debriefing
• Debriefing is a learner-focused,
nonthreatening technique to
assist individual rescuers or
teams to reflect on, and improve,
performance. (AHA, 2010)
– Should be included in all advanced
life support courses (Class I, LOE
B).
– Debriefing of actual resuscitation
events can be a useful strategy to
improve future performance (Class
IIa, LOE C).
• Need debriefer, participants,
experience, impact, recollection,
report, time. (Lederman, 1992)
• Basis in experiential learning
(Kolb & Fry; 1975, 1984)
13. Feedback vs. Debriefing
Ends of a spectrum
• Feedback
– Instructor-centered
– Monologue
– Targets objectives irrespective of
students’ needs
– Information gleaned varies among
group members
– Useful when student is novice
– Aims to correct discrete actions
– Suited for simple, narrow tasks and
lessons
– Less time, more control
• Debriefing
– Student-centered
– Dialogue
– Tailors objectives to student’s
needs
– Information is self-referentially
contributory (customized)
– Best when student has sufficient
platform of knowledge and
experience
– Aims to correct understanding
– Suited for team or complex
situations where critical thinking is
involved
– More time, less control
14. • I have no relevant financial
relationships related to this
presentation.
• I will not be discussing any unlabeled
or investigational uses of products.
• At the conclusion of this presentation,
participants will be able to:
– Define debriefing
– List 2 benefits of classroom debriefing
– Describe the gather, analyze, summarize
(G-A-S) debriefing model and where to
use it in AHA Provider Courses
Opening Remarks & Objectives
このプレゼンテーションのゴールは、聴衆が
1:デブリーフィングを定義できる
2:コースでのデブリーフィングの利点を
二つ挙げることができる
3:GAS法デブリーフィングモデルを記述
でき、AHAプロバイダーコースのどこで
使うか記述できる
16. • Structured and Supported Debriefing (AHA, 2009)
• An organized,
• Evidence-based,
• Learner-focused process
• Takes place in a non-threatening environment.
• Assists learners in thinking about
• what they did;
• when, why and how they did it, and
• how they can improve.
• Recommended debriefing model: G-A-S
– Gather
– Analyze
– Summarize
– Recommended time estimates: G 2.5, A 4, S 3.5
Debriefing in AHA Courses
17. • I have no relevant financial
relationships related to this
presentation.
• I will not be discussing any unlabeled
or investigational uses of products.
• At the conclusion of this presentation,
participants will be able to:
– Define debriefing
– List 2 benefits of classroom debriefing
– Describe the gather, analyze, summarize
(G-A-S) debriefing model and where to
use it in AHA Provider Courses
Opening Remarks & Objectives
このプレゼンテーションのゴールは、聴衆が
1:デブリーフィングを定義できる
2:コースでのデブリーフィングの利点を
二つ挙げることができる
3:GAS法デブリーフィングモデルを記述
でき、AHAプロバイダーコースのどこで
使うか記述できる
18. • Structured and Supported Debriefing (AHA, 2009)
• An organized,
• Evidence-based,
• Learner-focused process
• Takes place in a non-threatening environment.
• Assists learners in thinking about
• what they did;
• when, why and how they did it, and
• how they can improve.
• 推奨デブリーフィングモデル: G-A-S
– Gather(情報収集)
– Analyze(情報分析)
– Summarize(要約)
– 推奨される所要時間比: G 2.5, A 4, S 3.5
AHA コースでのデブリーフィング
19. • Goal
– Listen to students to understand what they think and how
they feel about the simulation
• Implementation
– Open-ended questions
– Active listening
– Solicit team leader first
Perception of the case?
Surprises, things that went better than expected or
unexpectedly wrong often trigger or enhance self-reflection
(Lockyer et al., 2004)
– Clarifying or supplemental information from the rest of the
team
Next the code recorder
Gauge the accuracy of the code record at the outset
Remaining team members
Gather Phase(情報収集の段階)
20. • Goal
– Facilitate students’ reflection on and thoughtful analysis of their actions
• Implementation
– Review event log/record
– Report observations of correct and incorrect steps (areas for improvement)
Reinforces team’s understanding of facilitator's intent
Recognize students usually have a logical explanation about why they made a particular
choice.
Mistakes may be missed or perceived differently by team members
– Assist students in thoroughly reflecting on/examining performance and perceptions
during the debriefing
Patience pays off. Use silence (5-8 seconds) effectively to allow students time to
compose thoughts.
– Maintain focus on session objectives
Analysis does not mean determining blame for errors
Analyze Phase(情報分析の段階)
21. • Goal
– Facilitate students in identifying and reviewing the lessons
learned
• Implementation
– Summarize student comments and statements
– Have students identify aspects of team or individual behaviors
that
Were positive
Require change or improvement
– Be clear. Lack of clarity in a non-judgmental approach keeps
students wondering what the instructor means or expects.
– Promote linkage to other course concepts and activities
– Relate back to practice application outside of the class
Summarize Phase(要約の段階)
22. Do’s and Don’ts
(NASA, 1997)
• Do
– Introduce ground rules, roles,
expectation, and structure at the
outset
– Encourage self-reflection
– Engage all participants
– Guide the session to include all
debriefing objectives
– Reinforce positive behaviors
• Don’t
– Lecture
– Use closed-ended questions
– Interrupt or preempt students with
your thoughts
– Give the impression that only your
perceptions are important
– Dominate the discussion
– Interrogate
– Have a rigid agenda
– Shortchange high-performing
crews by cutting the session short
参考資料
NASA Technical Memorandum 112192 DOT/FAA/AR-97/6
25. • 2010 ECC Guidelines: ALS
• Course cases/simulation
– Independent of simulation fidelity
– PALS Provider (→)
Content and team dynamics
– ACLS Provider
– BLS for Prehospital Providers
• Faculty
– Training Center Faculty
Instructor classes
Instructor monitoring
– Regional Faculty
Course monitoring
• Written exam review and
remediation
Training Center Applications
26. • I have no relevant financial
relationships related to this
presentation.
• I will not be discussing any unlabeled
or investigational uses of products.
• At the conclusion of this presentation,
participants will be able to:
– Define debriefing
– List 2 benefits of classroom debriefing
– Describe the gather, analyze, summarize
(G-A-S) debriefing model and where to
use it in AHA Provider Courses
Opening Remarks & Objectives
このプレゼンテーションのゴールは、聴衆が
1:デブリーフィングを定義できる
2:コースでのデブリーフィングの利点を
二つ挙げることができる
3:GAS法デブリーフィングモデルを記述
でき、AHAプロバイダーコースのどこで
使うか記述できる
30. • Adapt debriefing level to teams’ varying experience,
confidence, complexity, and motivation
• Not everybody gets a medal; there’s always something
to learn
• Debriefing taps into the affective domain to influence
the cognitive and psychomotor domains of learning
• Don’t let perfection stand in the way of progress
• Facilitating a debriefing is a learned skill, like any other.
Subject matter expertise isn’t sufficient alone.
• A culture of debriefing in class promotes a culture of
debriefing in clinical practice
Considerations