Debriefing with honest curiosity

In one line: after someone practises, say clearly what you saw and what you made of it, then ask a real question about their thinking. The authors argue that being honest and being curious work best together.

What they did

This isn’t an experiment. It’s a practical guide from a team who run a large simulation centre, describing how they debrief and why.

Jenny Rudolph and colleagues taught teams of doctors and nurses using simulated emergencies, with a manikin standing in for the patient. After each scenario comes the debrief: a conversation about what happened. Over many years of running these, the team noticed that debriefs often went wrong in one of two ways. In this paper they describe both, set out their alternative, and explain the thinking behind it.

What they argued

• Hiding your view doesn’t work. Some debriefers keep their opinion to themselves so nobody feels judged. The result is hints and hedging. People can’t tell what they need to change, and the debriefer’s view leaks out anyway, through tone and the choice of questions.
• A bare verdict doesn’t work either. “You should have called for help sooner” is clear, but it shuts down thinking and makes people defensive. And you don’t learn why they did it.
• People act for reasons. What someone does makes sense to them at the time, given how they saw the situation. If you understand how they saw it, you can help them change what they do.
• So pair a view with a question. First say what you saw and what you made of it: “I noticed you waited three minutes before calling for help. I wondered if you were unsure when to escalate.” Then ask, and mean it: “What was your thinking at that point?” The authors call these two moves advocacy and inquiry.

How much should you trust it?

A well-respected practical method; not tested in trials.

• The paper describes a method and the reasons for it. It doesn’t report any outcome data, so it can’t show that this style works better than others.
• Other research suggests that debriefing after simulation helps learning. But it says little about which style of debriefing works best.
• It was built for simulation centres, with time set aside to talk. Quick chats on the ward or in a corridor need a lighter version.
• It takes practice. Staying truly curious when you’re sure you know the answer is hard, especially when you’re short of time.

If you need to convince someone

In our words (a paraphrase, not a quotation): good judgement doesn’t mean keeping your view to yourself. It means saying what you saw, clearly and specifically, and then asking a real question, because their answer might change your mind.

What it means for you

Before your next talk with someone after they’ve practised, whether that’s a simulation, a drug round or their first time using new kit, prepare three things:

1. What you saw. Something specific you could point to. Not “that was a bit rushed”, but “you started drawing up before you’d checked the allergy band”.
2. What you made of it. Your best guess at what was going on, offered as a guess, not a verdict.
3. A real question. One you don’t already know the answer to. “Anything you’d do differently?” sounds open, but it hides what you saw, so the person has to guess what you mean.

If you can’t think of a question you don’t know the answer to, you’ve slipped into giving a verdict. Come back to curiosity. Then finish with one thing they’ll do differently next time: that’s the change the whole conversation is for.

How it appears in Teaching That Lands

Not taught directly in the three core sessions. Debriefing with good judgement is parked for a future simulation-based session. Useful background for anyone who debriefs simulation or gives feedback after observing practice.

The small print

• The authors are from the Center for Medical Simulation in Massachusetts, USA. An earlier paper by the same team (Rudolph et al., 2006, in Simulation in Healthcare) makes the case more briefly, under the title “There’s no such thing as ‘nonjudgmental’ debriefing”.
• Advocacy and inquiry come from “action science”, the work of Chris Argyris and Donald Schön on how professionals reason and learn. See Argyris and Schön and Schön.
• The idea that people act from their own “frames” (their way of seeing the situation) is central. The aim of the debrief is to bring the frame into the open so it can be checked.
• A systematic review of simulation studies (Cheng et al., 2014) found debriefing was linked to better learning, but found little to say one debriefing style beats another.
• The paper doesn’t cover what to do when the debrief uncovers a serious concern about someone’s practice. That needs a separate, private conversation, following your local process.