Abstract
The healthcare simulation field has no shortage of debriefing options. Some demand considerable skill which serves as a barrier to more widespread implementation. The plus-delta approach to debriefing offers the advantages of conceptual simplicity and ease of implementation. Importantly, plus-delta promotes learners’ capacity for a self-assessment, a skill vital for safe clinical practice and yet a notorious deficiency in professional practice. The plus-delta approach confers the benefits of promoting uptake of debriefing in time-limited settings by educators with both fundamental but also advanced skills, and enhancing essential capacity for critical self-assessment informed by objective performance feedback. In this paper, we describe the role of plus-delta in debriefing, provide guidance for incorporating informed learner self-assessment into debriefings, and highlight four opportunities for improving the art of the plus delta: (a) exploring the big picture vs. specific performance issues, (b) choosing between single vs. double-barreled questions, (c) unpacking positive performance, and (d) managing perception mismatches.
Highlights
The evolution of simulation-based education in healthcare has been accompanied by growth in the number of debriefing methods, frameworks, and/or conversational strategies [1,2,3,4,5,6]
Learner self-assessment in debriefing Critics may question the value of learner self-assessment during debriefing if clinicians struggle with providing accurate self-assessments of their own performance [19]. We argue that such criticism highlights why we should integrate learner self-assessment into debriefing; after all, without having learners self-assess, how will you know how they perceive their own performance? If learners overestimate their own performance, would you not want to know so that you could directly address this misperception? Failure to conduct a learner selfassessment during debriefing places the facilitator at risk for missing out on critical learner misperceptions that may be perpetuated if they are not addressed during the debriefing
To maximize the benefit of this process, the facilitator should work towards optimizing accurate learner self-assessment
Summary
The evolution of simulation-based education in healthcare has been accompanied by growth in the number of debriefing methods, frameworks, and/or conversational strategies [1,2,3,4,5,6]. Plus-delta approach triggers teams to evaluate their performance, which enhances team performance by promoting shared mental models, triggering adaptation, and crystallizing learning [13, 14] For these reasons, we see a facilitated learner self-assessment as serving a distinctly unique role in debriefing, which emphasizes the importance of being able to conduct a plus-delta during debriefing in a purposeful manner. In order to provide feedback on their self-assessments (i.e., stage 3), facilitators should close performance gaps by reviewing performance relative to specific standards (e.g., use of a performance checklist) [30, 31, 33] and generalize discussion to other clinical contexts (i.e., stage 4), both which are tasks central to effective debriefings [2, 12, 37]. The facilitator might say: “I’d like to spend some time discussing the task of defibrillation; and I’d like to get your take before
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