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05.17 - Debrief of Debriefing of Operative Complication

Course video 77 of 100

The objectives for this module are that after you actively engage in the activities, you will be able to: 1. Describe the basic theoretical underpinnings of the BID model. 2. Develop a briefing focused on a learning objective 3. Perform intra-encounter teaching focused on the learning objective 4. Perform a short debriefing focused on the learning objective Note: while this model was developed for the operating room, you will find that it applies to any clinical setting. In each encounter think about first working with learner to set her objectives, then teaching during the clinical encounter and finally providing feedback or debriefing.

The purpose of this course is to improve feedback, clinical teaching, and assessment of clinical skills.

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Ministrado por

Sally Santen, M.D., Ph.D.
Associate Professor - Emergency Medicine

Transcrição

You know, there are times in surgery where you want to teach, but it's really hard.

There are times when a case is not going well and

you would like to share some insights with the learner.

>> Mm Hm.

>> But it's tricky because everybody is emotionally unsettled and

you want to make sure the patient is safe.

And the mood changes when there's problems during a surgery, so here it

was an example of trying to debrief after something bad happened during a case.

What were your thoughts on that?

>> I think it's a critical tension that a surgeon faces,

is how long do I let this go on before I step in?

I have to let the learner make mistakes.

Learners learn from their mistakes.

And I think that the critical thing that happened in this video is that there was

a calm debriefing of what happened, why did it happen?

The learner was able to express some things that he felt as though

he could have done better, and I think that that's critical.

That's really where some learning's going to happen.

The patient ended up being safe.

And the attending was able to say well you made the right

move by calling vascular in.

And I think that that's, it's not that,

it's not that surgery has to be mistake-free, because it can't be.

It never will be, either with learners or with surgeons.

What has to happen though is that you as the expert have to help the learner

process, what do we do when bad things happen?

And that's what I liked about that is, that this was a calm

debriefing of something that was not what you intended to have happen.

>> Ideally after a debriefing like this,

in theory the mood can maybe change during the surgery and get back on course.

I feel like being objective is a good thing here.

I always worry about the learner feeling that they're taking the blame.

Because, of course, it's a shared experience in surgery.

Do you have any pearls for that?

[LAUGH] Any pearls of wisdom for teaching in that context?

>> Yeah, and I think that there's always the understanding

globally that whatever happens in the operating room

belongs to the attending, >> And

even if the learner was doing the thing that caused the problem,

the attending has the overarching responsibility.

And the attending is dancing a delicate dance.

Was there a point during which she could have said okay,

wait a minute, we need to do something different here?

Probably not.

And so, now it's just a matter of saying, okay, as an attending here's something

that I might have done in order to keep it from getting quite this far.

If you want to.

But I think it's important for

the learner to be able to reflect on what aspect of performance was his.

>> Yeah, I think the debrief from even a difficult case is so

valuable because that rests in your mind, really indefinitely.

Even if you don't have that difficult experience again,

you're always thinking about it.

>> Yeah, I agree.

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