Safely Debriefing Unexpected Simulation Death: How We Did It

Medical students feel inadequately prepared to cope with patient death. Simulation training may provide learners with the opportunity to experience death in a safe environment with a structured debriefing.

Nineteen fourth-year medical students who matched into surgical specialties participated in a 2-week surgical intern preparatory course. During an individual surgical decision-making simulation, 6 learners experienced unexpected patient death at the hands of a facilitator who deviated from the simulation script. Subjectively, these learners displayed high anxiety before the debriefing. Objectively, their self-reported anxiety after the structured debriefing was similar to the self-reported anxiety of learners who did not experience simulation death.

We formalized a bi-directional debriefing instrument using the Gather Analyze Summarize (GAS) model as a framework. We recognized that learners who experienced simulation death need to debrief on 2 aspects of the simulation: 1) Simulation death and 2) Scientific content.

Our unexpected experience with simulation death led to the development of a debriefing tool that can be used by other surgical educators. Learning how to process the ensuing emotional response to patient death in simulation may benefit trainees provided they undergo a structured debriefing.