Discussion In Simulated Learning – A CHAT Perspective

Simulation factiliators can use CHAT and activity system as a framework for observing simulations training and organising their thinking about which topics to explore during the debriefing sessions. The whole process starts when the factiliators think about which cases are more suitable to the learning objectives and continues the whole simulation activities and so to prepare for the debriefing. The factiliators can ask themselves related to each compontent of the activity system (rules, community, division of labour, objective, subject and tools)for the simulated events and how to generalize the evets to the real clinical practice in order to help the student apply the theory into practice.

The above fingure as shown is example on the factiliators can orient the questions by applying the activity system in simulation training.

For the debriefing session, faciliators should explore the related components as the relate to the learning objective of particular sbjects, the performance of students during simulation, and issues that raised during the debriefing sessions. It would not desirable to explore each componets of the activity system. We can use this theoretical framework as a complementary to the exiting approaches in simulation education but not a new fom of debriefing. Especially when simulation faciliators already poses the basic debriefing skills. Such skills included forming a supportive environment (Rudolph, Raemer & Simon, 2014), well structing the debriefing time (Eppich & Cheng, 2015), basic facilitation techniques (McDonnell, Jobe & Dismukes, 1997), and learner self-assessment strategies (Eppich & Cheng, 2015).

For example, factiliators can use CHAT/activity systems to recognise a topic and question student by marking subsequent discussion like “ I would like to ask about how you are dividing the work among your team members in taking care of the patient.” Another example might be to explore the decision-making on the timing for prioritising different task in an emergency condition. Thus, CHAT does not required to inform which debriefing approach to use, rather to helps simulation faciliators focus on exploring barriers to achieving subject objectives by surfacing contradictions within the health care team’s activity system, so they can be discussed unequivocally. These contradication may have arised during the simulation but also happen when the discussion related to real clinical situations.

Once systemic contradiction surface, faciliators can explicitly acknowledge those are common and then generalize the discussion to the clinical practice and identify possible soultions. However, during debriefing sessions, commonly we may concrentrate on the students’ performance on the case scernario during simulation, but not relate the performance or discussion to key issues in clinical setting to help student apply the learning experience into the practice. CHAT can provides a valuable lens direct the attention to interactions between simulation participants and context. In figure 4 for example of lines on inequiry to generalize discussion to clinical practice. These may explore implicit and explicit rules, policies, and local traditions on particular clinical unit. Others may focus on tools and mediating artifacts, such as electronic medical record, and/or language, such as verbal communication strategies like close-loop communication. By keeping CHAT/ activity system in mind, facililators can help students to generalize the key issues to clinical practice in ways that focus related factors and systems.

Debriefing as “facilitated reflection in the experiential learning cycle” (Fanning & Gabe, 2007) clearly refers to Kolb’s experiential learning theory (Kolb, 1984). This widely used theory described how simulation and debriefing can be work. Simulation including concrete experiences, and then debriefing ecompassing refective observation and abstract conceptualization, and active experimentation. Critics of Kolb’s experiential learning cycle, emphasis individual rather than sociocultural contexts increasingly recoginzed as important for learning (Swanwick, 2005).

Socialcultural learning theories emphasis how the interaction between the context and the learning and how they interwine each other. Health care simutlation and debriefing integrate sociological factors such as power relations, professional identity and Interprofessional conflict (Kitto, Gruen & Smith, 2009) to enhance sociological fidelity. CHAT as a theoretical framework focuses the attention on the inspiration of contents in learning and offer simulation faciliators perceptions into complexity of multidisciplinary team work. (Varpio et al, 2008).

CHAT offers an perspective outside the box to help simulation faciliators explore multipart interactions within health care teams and their working envorniment. In particular, activity system may serve to stimulus meaningful discussion that help students generalize lesson learned form the simulation experience to the clinical situation.

Conclusion

CHAT informed deberifing does not represent a new debriefing approach, rather it offers a complementary conceptual framework to use with traditional strategies. CHAT may also help simulation faciliators observe and interpret complex social interactions within team simulations and identify high-yield topic areas for debriefing. Improtantly, more discussions about related factors can facilitate safe and effective patient care and it may help students generalize lessons learned from varies simulation experience and apply to future clinical practice.