Clinical debriefingClinical debriefingKurt WilsonKurt Wilson

Intended learning outcomes

Use clinical debriefing to deliver teaching, learning and assessment

Enhance reflective practice

Gain greater two-way feedback through clinical debriefing

Clinical debrief sessions: Aims and Clinical debrief sessions: Aims and objectivesobjectives

Students will use debrief sessions to:Students will use debrief sessions to:– Learn through their own and each other’s clinical experienceLearn through their own and each other’s clinical experience

– Develop presentation, communication, examination and Develop presentation, communication, examination and therapeutic skillstherapeutic skills

– Practice record keepingPractice record keeping

– Discuss ethical issuesDiscuss ethical issues

– Prepare for future undergraduate assessmentPrepare for future undergraduate assessment

Where does it happen at the moment?

What is meant by “clinical debriefing”

Case presentation

History Examination Investigations

Margin hypothesis Best test?Examination first

Debate and discussion

Tutor led Student led

Intended learning outcomes

Who helps them understand what is happening in clinical environments?

How well are they able to help each other understand wider issues from clinical experience?

‘Miseducation’

Generic techniques

Case presentation

History Examination Investigations

Margin hypothesis Best test?Examination first

79 yr old male

Chest pain

On examination:

Sat up in bed

Oxyhen via

nasalCannulaGeneral: Pale,

Resting tremor

Margin hypothesis generation

Differential diagnosis Generation

Ranking

Discussion

Generic techniques

Case presentation

History Examination Investigations

Margin hypothesis Best test?Examination first

79 yr old male

Chest pain

Sat up in bed on

Cardiac unit

Oxygen via

nasalCannulaGeneral: Looked

Pale, tremor

noted

Examination findings first

Understand importance of patient history

Few clues from examination?

List of diagnoses and uncertainties large?

Best test?

Case presentation

History Examination Investigations

Margin hypothesis Best test?Examination first

Best test?

Only allowed one testWhich one and why?

Specificity (false positives?)

Sensitivity (false negatives?)

Positive and negative predictive values

Subsequent sessionsSubsequent sessionsContinue to address history taking/presentation/group Continue to address history taking/presentation/group interaction and case discussioninteraction and case discussion– Ideas, concerns, expectationsIdeas, concerns, expectations– Margin hypothesis generationMargin hypothesis generation– Examination findings firstExamination findings first– Best test?Best test?

– Sensitivity and specificitySensitivity and specificity

Structure sessionsStructure sessions

Topics for discussion

Issues surrounding patient centred care

Treating individuals versus population medicine

Disclosure, recommendation and understanding

What might students get out of it?

… very useful to learnfrom fellow students…

…very good as interactive and varied…

…topic discussion was particularly

useful as the group were able to address learning objectives not raised

in PBL

…feedback was constructiveand very encouraging… …I felt like I was applying my

knowledge & this simulates what will happen later in ‘real life’

Finally…

Tutor perspectives:– Support learning, including learning from

negative experience and correction of misconceptions

– An objective view of events, an appreciation of different perspectives and view points

– Stimulation of deeper and more complete learning

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Finally…

Things going well for new tutorsThings going well for new tutors– Margin hypothesisMargin hypothesis– Opportunity to learn outside of current PBL agendaOpportunity to learn outside of current PBL agenda– Roleplay and discussionRoleplay and discussion– EthicsEthics– Teaching and learning experiencesTeaching and learning experiences

Thinks not working well for new tutorsThinks not working well for new tutors– Getting the students to actually see patients!Getting the students to actually see patients!– Getting students to examine patients, even with prior Getting students to examine patients, even with prior

instruction from the tutorsinstruction from the tutors