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Table 1 Intrinsic, extraneous and germane loads during debriefing

From: Cognitive Load Theory for debriefing simulations: implications for faculty development

 

Drivers of load

Mitigation strategies

Intrinsic load:

Related to task difficulty and debriefer expertise

Quantity of information:

• Number of learners

• Number of learning objectives

• Various learner types/professions

Match debriefer expertise to size of groups and number of professions

Use of whiteboard or flip chart for noting topics of discussion

Share decision making with learners

Co-debriefing to share cognitive load

Emotional state of learners

Prebriefing to establish a “safe container” for learning

Insufficient time for debriefing

Schedule adequate time

Do not allow the scenario to run longer than scheduled

Debriefer clinical expertise

Provide debriefers with detailed notes about clinical content

Consider inviting a content expert (co-debriefing)

Debriefer experience

Debriefing scripts for novice debriefers can help structure debriefing

Debriefing assessment tools can function as “pre-learning” around expected facilitation skills

Extraneous load:

Imposed by poor instructional design and not relevant for learning

Scenario realism needs to be addressed

Establish fiction contract prior to the simulation

Debriefing going off topic

Debriefing framework can help organize debriefing for both the debriefer and for the learner

Use previewing statements to introduce next topic of discussion

Physical space:

• Comfort

• Ambient noise

• Interruptions

Arrive early to set up debriefing space

Seating arrangement for optimal eye contact

Limit interruptions, coming and going of learners or observers

Performance anxiety

Co-debriefing for back-up

Establish a safe container for facilitators

Difficult learner dynamic

Co-debriefer can monitor members of the group for distress /participation

Facilitators can learn schemata for common learner dynamics (e.g. how to engage the quiet learner)

Video review

Co-debriefer can be tasked to run video

Strategic and selective use of video

Co-debriefing

• Interruptions

• Competing priorities

Facilitator pre-brief to set expectations/roles/goals

Co-debriefers utilize strategies such as open negotiation and permissible interruptions

Evaluation of learners

Only add concomitant learner evaluation for very experienced facilitators

Germane load:

Conscious, effortful attempts to learn from the debriefing experience

Reflection in action:

• Are all learners engaged?

• Are all of the objectives covered?

Do not be afraid to pause to make a mental or physical note of a successful strategy used or pitfall to avoid

Reflection on action:

• Review of learner feedback

• Make notes for future debriefing structure, content or approach

Peer to peer coaching in a safe learning environment

Obtain debriefing feedback from learners

Make use of published tools for assessing debriefing

Provide protected time for reflection to occur