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Table 1 Elements and dimensions of the DASH

From: Translation of the Debriefing Assessment for Simulation in Healthcare in Portuguese and cross-cultural adaptation for Portugal and Brazil

DASH element Element dimensions
1. Establishes an engaging learning environment • Clarifies course objectives, environment, confidentiality, roles, and expectations
• Establishes a “fiction contract” with participants
• Attends to logistic details
• Conveys a commitment to respecting learners and understanding their perspective
2. Maintains an engaging learning environment • Clarifies debriefing objectives, roles, and expectations
• Helps participants engage in a limited-realism context
• Conveys respect for learners and concern for their psychologic safety
3. Structures the debriefing in an organized way • Encourages trainees to express their reactions and, if needed, orients them to what happened in the simulation, near the beginning
• Guides analysis of the trainees’ performance during the middle of the session
• Collaborates with participants to summarize learning from the session near the end
4. Provokes engaging discussions and uses concrete examples and outcomes as the basis for inquiry and discussion • Reveals own reasoning and judgments
• Facilitates discussion through verbal and nonverbal techniques
• Uses video, replay, and review devices (if available)
• Recognizes and manages the upset participant
5. Identifies and explores performance gaps • Provides feedback on performance
• Explores the source of the performance gap
6. Helps trainees achieve or sustain good future performance • Helps close the performance gap through discussion and teaching
• Demonstrates firm grasp of the subject
• Meets the important objectives of the session