Research Abstract From ‘There’ to ‘Here’ to ‘Elsewhere’: Enacting Debriefing in Inter-professional Medical Education Simulation.

Hypothesis Simulation is gaining international interest as a way to arrange a safe environment for practicing clinical, communicative and interprofessional competence in professional education within health care. However, simulation was originally developed to support and train professionals. The application of medical simulation in interprofessional education for students is still underresearched and undertheorised.1 Recent research and theory argue that professional learning in simulation is embodied, relational, and situated in social-material relations.2-3 Research on how instructional design of simulation as an integrated part of professional curricula support student learning is needed,4 as well as research focusing on what the relevant characteristics of debriefing that lead to effective learning are.1 The aim of this study is to explore the enactment of debriefing as a support for learning in interprofessional medical education simulation. Methods This paper draws on findings from a large research project conducted by research environments at Linköping University (LiU), Karolinska Institute (KI) and University of Gothenburg (GU), Sweden. The data have been collected by standardised video recordings of all phases in the simulation (briefing, simulation and debriefing phases). A total of 30 simulation sessions were video-recorded; 10 sessions by each research team. Out of these recordings, 13 simulation sessions were professional teams and 17 sessions were nursing and medical students simulating as a compulsory part of their education in the last semester before graduation. The student sessions are around 18 hours of recordings and altogether 106 students, 71 females and 35 males, participated in the simulation either as active participants in the simulation or as observers. 66 were nursing students and 40 were medical students. The research project has been ethically approved by Linköping University, Sweden (Dnr 2012/439-31). Results A framework for the analysis of the video-recordings was developed on the basis of socio-material theory, with a particular focus on interprofessional collaboration. Sayings, doings and relatings in the debriefing with regard to specific activities or events during the sequence of the scenario were noted through ethnographic field notes and selected segments were transcribed.5 A purposeful constant comparative qualitative analysis6 was made in three steps comparing sequences of the scenario 1) within a single video-recording 2) between different video-recordings of the same scenario 3) between video-recordings of different scenarios. The findings suggest that interprofessional learning in medical education simulation can become jeopardised in the debriefing. Three interrelated aspects of lacking support for learning were identified, a) debriefing as algorithm or as laisséz-faire, b) neglect of team performance as a topic for reflection, and c) time constraints. Conclusion The results raise questions whether debriefing in medical simulation as modeled on training of qualified health professionals provides a useful framework applied in undergraduate education with students learning to become health professionals. The experiences of the simulation ‘there’ are intended to become re-contextualised in the debriefing ‘here’. Our findings indicate that the socio-material arrangements of the debriefing instead risk taking the students ‘elsewhere’. Structure or lack of structure of the debriefing seem both to jeopardise the support of interprofessional learning or even overlook interprofessional collaboration as a topic for reflection. The time constraints of the complex logistics of arranging interprofessional simulation-based education as a regular curricular activity for large classes can potentially turn debriefing into a superficial exercise with little or no connection to the intended learning outcomes. References 1. Issenberg B, Ringsted C, Østergaard D, Dieckmann P. Setting a Research Agenda for Simulation-Based Healthcare Education. A Synthesis of the Outcome From an Utstein Style Meeting. Sim Healthcare 2011; 6:155–167. 2. Nyström S, Dahlberg J, Hult H. Crossing locations of enacting and observing simulations: Ways of constructing interprofessional learning. Paper to be presented at the Second International ProPEL conference ’Professional Matters: Materialities and Virtualities of Professional Learning’, University of Stirling, UK; 2014, 25-27 June. 3. Schatzki T. The site of the social: A philosophical account of the constitution of social life and change. University Park: Pennsylvania State University Press; 2002. 4. Motola I, Sullivan J, Issenberg S, Devine L, Chung H. Simulation in healthcare education: A best evidence practical guide. AMEE Guide No. 82. Medical Teacher [serial online]. October 1, 2013;35(10):e1511-e1530. 5. Heath C, Hindmarsh J, Luff P. Video in qualitative research: analysing social interaction in everyday life. Los Angeles: SAGE; 2010. 6. Boeije H. A Purposeful Approach to the Constant Comparative Method in the Analysis of Qualitative Interviews. Quality & Quantity 2002; 36:391–409.