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Helping without harming: the instructor's feedback dilemma in debriefing--a case study.

Jenny W Rudolph1, Erica Gabrielle Foldy, Traci Robinson

  • 1From the Center for Medical Simulation (J.W.R., R.S.); Massachusetts General Hospital (J.W.R., R.S.); Harvard Medical School (J.W.R., R.S.); New York University, Wagner School of Public Service (E.G.F.); Alberta Childrens Hospital (T.R.); Wellesley College (S.K.); and Worcester Polytechnic Institute, School of Business (S.S.T.).

Simulation in Healthcare : Journal of the Society for Simulation in Healthcare
|October 3, 2013
PubMed
Summary

Simulation instructors can resolve the task-versus-relationship dilemma by adjusting their assumptions and interactions. This allows for rigorous, empathic feedback to improve learner performance in simulation settings.

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Area of Science:

  • Medical Education
  • Simulation-Based Learning
  • Faculty Development

Background:

  • Simulation instructors face a common dilemma: balancing direct feedback on task performance with maintaining learner relationships.
  • This is particularly challenging in formative simulation settings where constructive criticism is essential for growth.
  • Effective strategies for navigating this task-versus-relationship conflict are vital for simulation faculty development.

Purpose of the Study:

  • To explore a case study of a simulation instructor struggling with the task-versus-relationship dilemma.
  • To identify specific instructor assumptions and interactional patterns contributing to this dilemma.
  • To propose actionable strategies for resolving the dilemma and enhancing feedback delivery.

Main Methods:

  • A qualitative case study approach was employed, focusing on a single debriefer.
  • The "2-column case" method was used to capture debriefing dialogue alongside the instructor's subjective experience (thoughts and feelings).
  • A "learning pathways grid" facilitated a peer group's step-by-step analysis of the debriefing interaction.

Main Results:

  • The instructor initially assumed honest critique would harm learners, used vague feedback, and created an unsafe learning environment.
  • Analysis revealed that making generous inferences about learners, normalizing simulation challenges, and acknowledging diverse team understandings were effective strategies.
  • The instructor's initial approach led to learners feeling unsafe and unclear about improvement pathways.

Conclusions:

  • Resolving the task-versus-relationship dilemma in simulation requires specific instructor assumptions and interactional adjustments.
  • By adopting these strategies, instructors can deliver feedback that is both rigorous and empathic.
  • This approach supports the maintenance of good performance and the improvement of suboptimal performance in future simulations.