Theories and Styles of Debriefing: the Good Judgment Method as a Tool for Formative Assessment in Healthcare Teorı́as y estilos de debriefing: el método con buen juicio como herramienta de evaluación formativa en salud

Over the last decade, there has been an exponential increase in the use of clinical simulation as a training tool for health professionals. This increase is due to simulation being more effective in learning to make clinical decisions, acquiring technical skills, and working in teams than traditional teaching methods. In addition, the acquired skills are transferred to the work environment, which translates into improved clinical outcomes without compromising patients and health professionals. A key element of this learning method is debriefing, which has been defined as a conversation between several people to review a real or simulated event, in which the participants analyze their actions and reflect on the role of thought processes, psychomotor skills, and emotional states to improve or maintain future performance. Although experience is the basis for adult learning, Kolb’s learning theory suggests that this learning process cannot take place without rigorous reflection on the part of learners such that they are enabled to examine the values, assumptions, and knowledge bases that guide the actions of health professionals. That is, gaining experience is not equivalent to becoming an expert. Despite its importance, debriefing is a dilemma for many instructors because they often cannot find ways to openly express their critical judgments about observed clinical performance without hurting their colleagues’ feelings or making them defensive. As a result, instructors often fail to verbalize their thoughts and feelings to avoid confronting, challenging, or provoking negative emotions in their colleagues with the aim of maintaining a good working relationship with them. This feedback dilemma is resolved by helping the professional to elicit the highest standards of performance from the trainees while holding them in the highest personal regard. This article reviews the principles of conducting effective debriefing and describes different debriefing styles and the ‘‘debriefing with good judgment’’ approach, which represents an attempt to solve this dilemma.