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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
• 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