A common concern for healthcare simulation debriefers can be how to manage the clinical simulation participant who dominates a debrief. Although a relatively uncommon occurrence, this can happen and there pays to be a number of known tools in a debriefers toolkit available to deploy as required. This article by Erin Carn-Bennett, RN, MSN will explore this conundrum and how to manage this as a healthcare simulation debriefer.
As a clinical simulation facilitator there is a lot of use to trust in a lot of the processes involved with the debrief process. There is a requirement to trust in the adult learner and their experience of reflection from the experience. There is a need to trust in the debrief process and the debrief structure. As a clinical simulation debriefer there needs to be good judgment applied to as well as to assume best intentions of everyone involved in the clinical simulation experience and also debrief. This includes the participant who dominates the healthcare simulation debrief.
People involved in healthcare simulation, will all reflect on the experience in different ways. Some clinical simulation participants may be quiet and reflect in an internal way and not verbalise anything through this process. Other clinical simulation participants such as the more dominant clinical simulation participant may reflect through verbalising what has occurred in the clinical simulation experience through words. This reflection process can be the participant making sense of the experience and is a method to process and reflect on the experience.
Participants Often Read the Debrief Room
Some clinical simulation participants will be able to read the room as to whether their reflections are useful to other team members. However at times, some participants may not be conscious of the impact that their domination of the clinical simulation debrief is having on others in the room. This is a fairly uncommon experience, however particularly as a new debriefer there can be a fear of this happening and how to manage this best. Mostly a trust in the debrief process and non judgement of the healthcare simulation participant will work best. However there are methods that can be applied as required as a clinical simulation debriefer.
As a clinical simulation facilitator there needs to be an awareness that a more dominant participant in the debriefs reflections may actually be useful to others in the room. At times these reflections can help to guide others into their own personal reflections. As clinical simulation debriefers there is a requirement to steer the direction of the conversation and assist with boundaries. However, ultimately the debrief conversation is about what the clinical simulation participants want to talk about, not the debriefers.
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The allowance for the initial emotion based or exploratory phase of the debrief to be prolonged can be useful. This can allow the more dominant clinical simulation participants to have their voices heard, externally reflect and also start to make sense of what has happened in the clinical simulation experience. To let this process go on for a bit of a prolonged time when dominant participants are present in the debrief can assist to reduce confusion, frustration and heat within the debrief circle. This can be useful as further phases of the debrief progress.
Create Spaces for All Participants to Speak Into
There should be space that is allowed for the quieter clinical simulation participants in the room to speak into. This can be through transparency with statements such as โDid anyone who has not shared anything yet want to share or reflect in any way on the clinical simulation scenario?โ. The use of silence after such a statement can be useful to cool off the debrief circle and allow participants some space to be able to breathe and reconsider the direction of the conversation. If no one speaks into the space, this is ok, but this process can help to subtly shift the focus of the conversation to bring other voices to the forefront.
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The use of body language can be incredibly useful in the debrief circle. This can be subtle such as eye contact for a prolonged time with other participants who have been yet to share. Or other tactics such as leaning forward with open body language of limbs can be useful to encourage other voices to enter the debrief circle. As a clinical simulation debriefer there should also be observation of other participants’ body language such as crossed arms and legs and observation of the impact that the dominant participant has on others in the room.
Most People Just Want Validation and to Be Heard
For the more dominant voice in a healthcare simulation debrief validation and active listening from a healthcare simulation debriefer can be incredibly useful to assist to move the conversation forward. This can be achieved through statements such as โI really hear how the frustration about not being able to find that piece of equipment has had a big impact on youโ. The process of validation through paraphrase of the conversation back to the participant can make a big impact in terms of closure and the ability to move a conversation forward.
Probably the most important element of the management of a more dominant clinical simulation participant is to not blame, shame or dull clinical simulation participants sparkle. Clinical simulation participants’ enthusiasm for healthcare simulation should be encouraged yet gently managed with respect. As clinical simulation debriefers there is a requirement to have knowledge and skills to understand and manage all different personality and learner types.
This article has discussed the management of a more dominant clinical simulation participant in the debrief circle. Although a relatively uncommon occurrence, knowing how to manage this particular participant is often a concern in particular for the new clinical simulation debriefer. Through the use of a prolonged initial stage of debrief, non verbal communication and other gentle strategies, this situation can be managed usually fairly effectively in order to lead to a successful clinical simulation debrief experience overall.
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