Debriefing

For some of the 12 reviewing methods described in this article you can draw lines with pen and paper. But in most situations where you have enough space (indoors or outdoors) you and your learners will soon discover that ropes were made for reviewing! Old climbing ropes, washing lines or brightly coloured nylon line make excellent reviewing aids.

Terminology: For most purposes "Reviewing" = "Debriefing"

This paper reports a nearly two-year intervention with staff at a major urban pediatric facility. The authors worked as trainers and consultants for two groups-the Emergency Department (ED) and Chronic Care units (CC). Following two days of training about grief and loss, highlighting skill building for work with traumatized and grieving children and parents, the consultants worked to develop teams which could provide a Winnicottian holding environment for staff. The efficacy of this staff training is analyzed and support needs of staff members are identified. Findings include varied willingness to make use of group support. Chronic care participants are more likely to express willingness to engage in on-going support for one another, while ED staff members seem to prefer structured, educational training and episodic support. The holding environment of the processing groups must be adapted to fit the needs of the medical sub-culture.

The literature suggests that acts of bullying are a root cause of new nurses leaving their units or the profession entirely and have the potential to worsen the nursing shortage. As an effective way to address bullying in the perioperative setting, mentoring benefits the nursing profession. Mentoring can have a direct influence on nurses' longevity in a health care organization, thereby strengthening the nursing workforce. Magnet-designated hospitals support the importance of mentor-mentee relationships for positive employee retention and positive recruitment outcomes. One of the most important tasks that a mentor should undertake is that of a role model. Establishing a culture of mentoring requires authentic leadership, genuine caring and respect for employees, and open communication. The entire nursing profession benefits from a culture of mentoring, as do the patients and families who receive care.

Background and objectives: This analogue study served as a proof of concept trial for inoculation/resilience training with emergency services personnel. Methods: Eighty people from the general community participated in a randomized controlled trial of inoculation training to increase resilience in the mitigation of stress and trauma-type symptomatology following a stressful video of paramedics attending the scene of a car accident. Participants were randomly allocated to one of two conditions: (a) resilience training, where the participants received strategies aimed at reducing the negative effects of the event; or (b) a control 'pragmatic training' condition, where participants received practical training about what to do in the event of a car accident. A week later the full video was shown. All participants were assessed one month later. Results: Unlike with past studies which tested psychological debriefing, analyses revealed that inoculation/resilience training did not appear to have deleterious effects on psychological distress measures or memory performance. Participants who received the resilience training displayed improvements in negative affect (notable trends in depression and stress levels) suggesting a more general positive result from the intervention than normal 'pragmatic training'. Limitations: This was an analogue trial and a full field trial is warranted. Conclusions: With organisations wishing to engage in resilience training, this analogue study suggests that inoculation training at least does no harm and may be beneficial. It is, therefore, a viable option for emergency services personnel during pre-deployment training.

Healthcare simulation Simulation-based medical education (SBME) a b s t r a c t Debriefing is a lynchpin in the process of learning. As a post-experience analytic process, debriefing is a discussion and analysis of an experience, evaluating and integrating lessons learned into one's cognition and consciousness. Debriefing provides opportunities for exploring and making sense of what happened during an event or experience, discussing what went well and identifying what could be done to change, improve and do better next time. This manuscript serves as an introduction to debriefing, covering a range of topics that include a brief review of its origin, the structure and process of debriefing-specifically in the context of simulation-based medical education, and factors that facilitate effective, successful debriefing. An approach to debriefing immediately after real clinical events will be presented, as well as an evidence-based approach to evaluating debriefing skills of healthcare simulation instructors.

'Reviewing by Doing' was the second in a series of three articles about about how to review outdoor experiences. The series was published in the Journal of Adventure Education and Outdoor Leadership (1992-1993).

'Reviewing by Doing' describes a variety of active methods for reviewing adventures and introduces a four stage reviewing sequence to which they can be linked:

1. EXPERIENCE "What happened?"
2. EXPRESS "What was it like?"
3. EXAMINE "What do you think?"
4. EXPLORE "What next?"

Terminology: For most purposes "Reviewing" = "Debriefing".

Background: Simulation is a time-and cost-intensive teaching modality that consists of both hands-on experience with a lifelike manikin and a debriefing session. While many educators believe that both simulation components are important for learning, the impact of the individual components is unknown. Objectives: The purpose of this study was to determine where in a simulation experience greater knowledge gains occurred. Methods: With a 2-group, repeated measures, experimental design, this study examined the impact of simulation components (hands-on alone and hands-on plus debriefing) on heart failure (HF) clinical knowledge in 162 prelicensure nursing students (age: M ¼ 25.7 years, SD ¼ 6.6 years; 85.5% women) from 3 nursing schools who were at the same point in their curriculum. Parallel HF knowledge tests were given at baseline (Pretest) and after the hands-on (Posttest 1) and debriefing (Posttest 2) stages of the HF simulation. Results: HF knowledge scores decreased from the pretest to the first posttest (after the hands-on component of the simulation; M ¼ À5.63, SD ¼ 3.89; p < .001), whereas they dramatically improved after debriefing (M ¼ þ6.75, SD ¼ 4.32; p ¼ < .001). Conclusion: Gains in HF knowledge were achieved only after debriefing. This study suggests that the debriefing experience should be emphasized in a standardized simulation learning experience. Further investigation is needed to evaluate the impact of debriefing and intensive teaching without the hands-on simulation component.

This article presents an overview of proven methods to record experiences from projects and discusses their use in project management. We distinguish between process-based and documentation-based debriefing methods. Process-based methods focus on a procedural approach to capture key learnings from a project. Documentation-based methods serve as appropriate representation formats or structures for project insights. The article bridges the current gap between theoretical insights into this topic and the managerial reality today. It discusses central project debriefing problems such as the lacking willingness to learn from mistakes or the lacking discipline in the use of project management manuals. We conclude the article with recommendations on how debriefing processes can be integrated successfully into project procedures. # (M. Schindler), martin.eppler@unisg.ch (M. J. Eppler). We conducted (problem-focused and iterative) action research in nine multinational companies from the industry and service sector with regard to their project knowledge management using the case study research methodology to document our findings . Forty-six semi-structured expert interviews helped to record field experience with debriefing methodologies. Using half-day follow-up workshops, the interview results have been validated and developed with representatives of the participating companies such as DaimlerChrysler, IBM Global Services, Pixelpark, Schindler Elevator & Escalators, Roche and UBS. This participatory research approach has resulted in the problem compilation that is described below. The findings from this action research can complement (and contrast) the literature review on the available debriefing methods.

Events like the tragedy at Columbine High School and the terrorists attacks on New York City in 2001 have highlighted the need for mental health practitioners to become familiar with interventions that are designed to assist young people who have survived extremely stressful events. Mental health professionals often see people who have experienced car accidents, severe abuse, rape, or other victimization, as well as survivors of natural and man-made disasters during the first critical stages of the recovery period. This article describes the process of critical incident de-briefing and provides a step-by-step primer for its application. The process is short-term (four sessions or less) and provides an intervention designed to reduce the frequency and severity of post-traumatic stress symptoms. Adolescents are particularly at risk because of issues surrounding identity formation, selfesteem, and developmental differences in coping mechanisms. Therefore, those who work with an adolescent cohort should be familiar with debriefing methods and how to apply them to the teenager.

Objective: To compare the effectiveness of an interprofessional within-team debriefing with that of an instructor-led debriefing on team performance during a simulated crisis. Background: Although instructor-led simulation debriefing is considered the "gold standard" in team-based simulation education, cost and logistics are limiting factors for its implementation. Within-team debriefing, led by the individuals of the team itself rather than an external instructor, has the potential to address these limitations. Methods: One hundred twenty subjects were grouped into 40 operating room teams consisting of 1 anesthesia trainee, 1 surgical trainee, and 1 staff circulating operating room nurse. All teams managed a simulated crisis scenario (pretest). Teams were then randomized to either a within-team debriefing group or an instructor-led debriefing group. In the within-team debriefing group, the teams reviewed the video of their scenario by themselves. The teams in the instructor-led debriefing group reviewed their scenario guided by a trained instructor. Immediately after debriefing, all teams managed a different intraoperative crisis scenario (posttest). All sessions were videotaped. Blinded expert examiners used the validated Team Emergency Assessment Measure scale to assess crisis resource management performance of all teams in random order. Result: Team performance significantly improved from pretest to posttest (P = 0.008) regardless of the type of debriefing. There was no significant difference in the degree of improvement between within-team debriefing and instructor-led debriefing (P = 0.52). Conclusions: Within-team debriefing results in measurable improvements in team performance in simulated crisis scenarios. This form of debriefing may be as effective as instructor-led team debriefing, which could improve resource utilization and feasibility of team-based simulation (NCT01067378).

'Doing Reviewing' was the first in a series of three articles about about how to review outdoor experiences. The series was published in the Journal of Adventure Education and Outdoor Leadership (1992-1993).

In 'Doing Reviewing', I explain why I believe that reviewing is of fundamental importance in adventure education. Topics include: attitude shift, adding value, the consequences of not reviewing, power and responsibility, crossing thresholds, different experiences, action-packed programmes, reviewing sequences, keeping in touch, unexpected outcomes, learning from experience and "What did you learn?"

Terminology: For most purposes "Reviewing" = "Debriefing".

Several gaps exist in the training of clinicians in health care domains, such as anesthesiology, that have the cognitive profile of complexity and dynamism. These features are shared with other industries such as commercial aviation. Training for cockpit crews on Crew Resource Management (CRM) emphasizes decision-making and teamwork principles. The authors created a simulation-based curriculum (ACRM) for anesthesiology based on principles of CRM in aviation. The training philosophy adapted to health care is one of training single-discipline crews to work in teams. The ACRM curriculum involves highly realistic simulation scenarios requiring complex decision making and interaction with multiple personnel. Scenarios are each followed by a detailed debriefing using videotapes of the simulation session. ACRM has been adopted at major health care institutions around the world. Special training for instructors is provided, especially concerning debriefing. The ACRM approach has been extended to a wide variety of other health care domains that involve complexity and dynamism, such as emergency and trauma medicine, intensive care, and cardiac arrest response teams. Simulation-based training based on CRM principles is expected to become routine in many health care settings in the coming decade.

A unique, progressive multidisciplinary simulation was developed for a pediatric end-of life experience. In order to prepare all participants, regardless of discipline, extensive pre-briefing and reflective debriefing was developed. The project included seven evolving pediatric simulations, each one with multiple disciplines participating, over a four-week period. Key components of the pre-briefing stages included learning about the topic of end-of-life, understanding the different inter-professional roles, teamwork, and feeling comfortable with the simulation environment. Reflective debriefing was carried out in small groups immediately after the simulation with objective feedback and affirmation of interdisciplinary teamwork, skills, and communication. A second culminating debriefing also occurred which offered the students the ability to pull their experiences together and reflect and compare their perceptions to those of an actual survivor of the same disease. This project revealed to faculty the importance of using multi-staged pre-briefing and debriefing in a progressive multidisciplinary pediatric simulation.

By examining particular cases of belief perseverance following the undermining of their original evidentiary grounds, this paper considers two theories of rational belief revision: foundation and coherence. Gilbert Harman has argued for coherence over foundationalism on the grounds that the foundations theory absurdly deems most of our beliefs to be not rationally held. A consequence of the unacceptability of foundationalism is that belief perseverance is rational. This paper defends the intuitive judgement that belief perseverance is irrational by offering a competing explanation of what goes on in cases like the debriefing paradigm which does not rely upon foundationalist principles but instead shows that such cases are properly viewed as instances of positive undermining of the sort described by the coherence theory.

Military organisations have a long history of using games for training. Over the years, they have developed training practices involving role-play, simulations, puckstering and gaming. Most researchers in serious games, i.e. games used for non-entertainment purposes, focus their studies on the learners. This licentiate thesis, instead, takes a closer look on the roles of instructors in game-based training situations, specifically at the Swedish Land Warfare Centre. Through a mix of theoretical and empirical studies, training practices were scrutinised, resulting in a framework for gamebased vocational training. A key element of this framework is the coaching by gaming perspective in which instructors give un-intrusive, formative feedback through role-play and gameplay. Another important aspect of the framework involves dynamic debriefing. These insights points to specific needs for system support for instructors involved in game-based training. They also emphasise the fact that serious gaming is a highly contextualised activity made up of more than the game and the players.

While there is a wealth of studies on the subject of serious games, the same cannot be said on the issue of teaching with games, especially in game-based learning settings with adult learners. Over the years, most research in this area has been focused on the ‘active substance(s)’ of games for learning, focusing mainly on characteristics of games, but often failing to take the whole context of game-based learning into consideration, such as the role(s) of the teacher. However, the past two or three years has seen a shift in focus from merely the game as an isolated artefact, to also include more discussions on how games  an successfully be integrated into an educational setting, as well as challenges as pitfalls of which instructors need to be aware. This paper aims to outline the contemporary research on instructor-led serious gaming and its implications for the design of serious gaming environments.

The importance of non-technical skills among healthcare professionals is gaining a widespread recognition as critical elements complementing the technical skills used for improving patients' safety. These skills are typically acquired through simulation training, which emerged as an effective way to complement clinical training. Non-technical skills frequently use high-fidelity simulation followed by a facilitated discussion known as debriefing. Debriefing by a skilled facilitator is thought to be essential for effective learning through reflective processes. Unfortunately, evidence to support the elements which contributes towards the effectiveness of debriefing remains sparse. We review the studies where elements of debriefing that have been manipulated and its effectiveness on the acquisition of non-technical skills among healthcare professionals through eight publications across four different databases. Non-technical skills performance improved after manipulated debriefing such as multimedia debrief, self-led debrief or no debrief. Besides, there was no added performance when video recording was added to facilitator-led debriefing. The application of learning theory on specific elements together with the application of selected debriefing models is highly encouraging for effective debriefing.

Background. Research shows that learning and task performance improve when participants in management exercises understand the structure of the system they control. However, the majority of business simulators are black-boxes.

Aim. This article introduces structural debriefing, which is a debriefing activity aimed at helping students learn about causal relationships, feedbacks, accumulations, and delays within a black-box simulation.

Method. A structural debriefing can be prepared and facilitated by following the Structural Debriefing Protocol.

Results. A pilot study was conducted in which undergraduate students participated in a structural debriefing of The LITTLEFIELD TECHNOLOGIES, a popular simulation for teaching principles of operations management. The students were able to complete all eight steps of a structural debriefing, but required considerable time (three academic terms) to do so. Not every instructional simulation will require all the steps or such a large time commitment.

Conclusion. The successful completion of the pilot study demonstrates that structural debriefing is a useful debriefing technique. However, to be effective, the scope and format of a structural debriefing activity must suit practical and pedagogical considerations.

Although social inequality is critical to the study of sociology, it is particularly challenging to teach about race, class and gender inequality to students who belong to privileged social groups. Simulation games are often used successfully to address this pedagogical challenge. While debriefing is a critical component of simulation exercises that focus on teaching about social inequality, empirical assessments of the significance and effectiveness of this tool is virtually non-existent in sociology and other social sciences. This paper analyzes the significance of debriefing in a simulation game called " Cultural Capital in the Classroom " in order to address this lacunae in the pedagogy literature. The analyses reveal that the simulation contributed to students developing a greater degree of empathy for the working class and that the individual debriefing was a crucial step in developing students' critical thinking skills. Students gain even deeper insights during the collective debriefing session, which influenced them to question the validity of the ideology of meritocracy.

Following an increase in the incidence of railway suicide from an average of four events a year up to 1989 to 12 in 1990 an initiative was developed between the District Department of Clinical and Community Psychology, Exeter Health Authority and British Rail, Western Region. Trainerew leaders and management had become increasingly aware of the severity of the short-and long-term effects on drivers of experiencing a suicide. Although a management strategy had been developed over time to deal with what had been a rare phenomenon it was clear that such a dramatic increase in suicides warranted a more professional approach to debriefing and trauma counselling. This paper describes the strategies adopted by psychologists in developing an understanding of the stresses of experiencing suicides and other major incidents. The outcome of small group sessions with affected drivers is outlined. An account of the strategy developed through workshops with traincrew leaders is detailed and a three-stage debriefing (shock, search, adjustment) and follow-up protocol is discussed. This process is proposed for adoption as normal procedure following suicides or similar traumas for drivers and line managers.

This paper outlines the Technology Enhanced Learning (TEL) strategy of the University of the West of England (UWE), UK, and demonstrates examples of simulations that use a mixture of web technologies, social networking and virtual worlds. In particular we discuss in detail a simulation that enables groups of law students to work as partners in simulated law practices in a virtual town that supports a range of casework. We also describe an accident investigation simulation built in the virtual world Second Life where groups of students can experience an accident scenario, investigate it, design safe systems of work to deal with the case and work collaboratively on accident analysis and prevention.

This article has two broad objectives: (a) It reviews the theoretical and practical literature on the use of games to facilitate social and emotional learning (SEL). (b) Based on this review, it argues that games are a powerful way of developing social and emotional learning in young people. In addition, we draw on our collective experience as educational psychologists to identify effective practice when using games to teach SEL. The social and emotional skills needed to play successfully with others are those needed to succeed at work and in adult life. Prosocial skills involve regulating negative emotions, taking turns and sharing, support orientations to others that are fair, just, and respectful. The natural affiliation between children, play, and the desire to have fun with others makes games an ideal vehicle for teaching SEL. Circle Time games are used to support universal programs for teaching SEL to whole classes. Therapeutic board games provide an effective intervention for...

In this study, we examine the effects of achievement motivational goals (Learning vs. Performance) and of debriefing on the ability of trainees to acquire integrative (i.e., value-creating) negotiation skills and to effectively transfer these skills across situations. Participants in four between-subject conditions: 2 motivational goal conditions (learning/performance goals) × 2 debriefing conditions (with/without debriefing) first gained experience by engaging in repeated negotiations within an unchanging market simulation, and then proceeded to negotiate a more complex integrative negotiation task. A fifth control condition in which participants performed the second task only was also included. Experience accompanied by subsequent debriefing was found to be more effective for learning than experience without debriefing; it enhanced both integrative performance in the transfer task as well as conceptual understanding. Contrary to our expectations, participants who were assigned learning goals did not show an advantage over participants who were assigned performance goals.

A case of tics presenting as chronic intractable cough successfully treated with tetrabenazine DEEPAK G. PAWAR, HIRENNAPPA B. UDNUR What do suicide attempters think about legal status of suicide in India? SHIVANAND KATTIMANI, SIDDHARTH SARKAR, ANIRUDDHA MUKHERJEE, KALIAPERUMAL MATHAN Calloso-frontal tuberculoma presenting with symptoms of psychosis and catatonia SOURAV DAS, RAVI GUPTA, MOHAN DHYANI Catatonic depression precipitated by amiodarone prescribed for atrial fibrillation SUNDARARAJAN RAJAGOPAL Bipolar affective disorder in Huntington's disease: A neuropsychiatric perspective RAJNISH RAJ, BALWANT SINGH SIDHU, EISH DALLA

Debriefing is an important step in game-based learning environments. Fanning and
Gaba defined debriefing as “facilitated or guided reflection in the cycle of experiential
learning.” In the present study, the effect of different debriefing strategies in terms of
two factors, grouping (self vs. team) and timing (in-game vs. postgame), was investigated
on the motivation and self-efficacy levels of students. In a 22 analysis of
variance design, 62 sixth-grade students were randomly assigned into two debriefing
groups: self-debriefing and team debriefing. About half of members in each group
performed either one of the two debriefing: in-game debriefing or postgame debriefing.
Students in the self-debriefing as well as in the team-briefing group played the
game 3 days a week over 9 weeks. As students finished the task, motivation and selfefficacy
scales were administered and semistructured interviews were conducted.
Findings indicate that students showed higher motivation and self-efficacy scores in
the team debriefing than in the self-debriefing. Moreover, the in-game debriefing
group outperformed the postgame debriefing group in terms of self-efficacy and
motivation levels. Semistructured interviews supported the quantitative results
that students benefited more from collaborative debriefing sessions.

Evidenced-based educational practices propose simulation as a valuable teaching and learning strategy to promote situated cognition and clinical reasoning to teach nursing students how to solve problems. A project that uses a structured debriefing activity, the Outcome Present State-Test Model of clinical reasoning following high fidelity patient simulation, is described in this paper. The results of this project challenge faculty to create and manage patient simulation scenarios that coordinate with didactic content and clinical experiences to direct student learning for the best reinforcement of clinical reasoning outcomes. Considerations for the future include incorporating patient simulation activities as part of student evaluation and curriculum development. The arguments for using high fidelity patient simulation in the current educational environment has obvious short term benefits, however, the long term benefit of developing clinical expertise remains to be discovered.

Considerable controversy emerges when nursing educators discuss whether the patient simulator should be allowed to die during simulated clinical experiences. At the same time, there are numerous studies that show nursing students and practicing nurses do not believe that their endof-life-care education has been sufficient. Patient simulation offers a safe environment in which students can learn to appropriately care for patients who are dying. This article outlines the concerns expressed by nursing educators and the benefits of using patient simulation for learning to care for dying patients. Debriefing and psychological safety of learners are emphasized.

Researchers from NASA Ames Research Center's Flight Cognition Lab and the FAA's Flight Deck Human Factors Research Laboratory at the Civil Aerospace Medical Institute (CAMI) examined task and workload management by single pilots in very light jets (VLJs), also called entry-level jets (ELJs). Fourteen certificated Cessna Citation Mustang (C510-S) pilots flew an experimental flight with two legs involving high workload management under instrument flight rules (IFR) in a Cessna Citation Mustang ELJ level 5 flight training device 4 at CAMI. Eight of the pilots were Mustang owner-operators and the other six flew the Citation Mustang as part of their jobs as professional pilots. In addition to the Cessna Citation Mustang simulator, data collection included the use of a non-invasive eye tracker (mounted to the glare shield), instantaneous self-assessment of perceived workload, NASA Task Load Index (TLX) workload measures, researcher observations, final debriefing interviews, and three questionnaires: Cockpit Setup Preferences; Demographics; and Automation Experiences and Perceptions.

Guidelines for the techniques of resuscitating newly born infants have undergone major revisions over the past 25 years. The International Liaison Committee on Resuscitation (ILCOR) is committed to "periodically developing and publishing a consensus on resuscitation science" every five years with the most recent Consensus on Science and Treatment Recommendations (CoSTR) statement published in 2010. The CoSTR document is used as a basis for developing specific resuscitation guidelines felt to be appropriate for implementation in respective countries. A "gaps in knowledge" summary is created at the conclusion of a cycle. It is a goal that identification of these knowledge gaps will stimulate investigators to pursue more targeted studies to help close the gaps. The current document is based on the "gaps in knowledge" summary for neonatal resuscitation that was created at the conclusion of the 2005-2010 ILCOR cycle.

Higher Education and describes their applications and practical implementation, with particular emphasis on the use of the virtual world Second Life® to simulate professional practice activities. The paper also presents a number of practical challenges encountered by running those simulations and discusses the advantages of utilising automated avatars to counter those challenges and enhance the learning experience.

This article has two broad objectives: (a) It reviews the theoretical and practical literature on the use of games to facilitate social and emotional learning (SEL). (b) Based on this review, it argues that games are a powerful way of developing social and emotional learning in young people. In addition, we draw on our collective experience as educational psychologists to identify effective practice when using games to teach SEL. The social and emotional skills needed to play successfully with others are those needed to succeed at work and in adult life. Prosocial skills involve regulating negative emotions, taking turns and sharing, support orientations to others that are fair, just, and respectful. The natural affiliation between children, play, and the desire to have fun with others makes games an ideal vehicle for teaching SEL. Circle Time games are used to support universal programs for teaching SEL to whole classes. Therapeutic board games provide an effective intervention for...

Studies in cognitive psychology inform us that the recall of information and its application are best when it is taught and rehearsed in environments similar to workplace. The healthcare professions are heavily task-and performance-based where non-technical skills, decision making ...

Empirical evidence suggests that people perform poorly in dynamic tasks. The thesis of this article is that dynamic decision performance can be improved by helping people to develop more accurate mental models of the task stems through training with debriefing supported computer simulation-based interactive learning environments (CSBILEs). I report a laboratory experiment in which subjects managed a dynamic task by playing the role of fishing fleet managers. One group of participants used a CSBILE with debriefing, whereas another group used the same CSBILE but without debriefing. A comprehensive model consisting of four evaluation criteria is developed and used: task performance, structural knowledge, heuristics, and cognitive effort. It is found that debriefing was effective on all four criteria; debriefing improves task performance, helps the user learn more about the decision domain, develop heuristics, and expend less cognitive effort in dynamic decision making.

Introduction: Culture is believed to play a role in education, safety, and patient outcome in healthcare. Hofstede’s culture analysis permits a quantitative comparison between countries, along different culture dimensions, including power distance (PD). Power distance index (PDI) is a value reflecting social hierarchy in a country.We sought to explore
the relation between PDI and self-reported behavior patterns of debriefers during simulation debriefings. We determined six culture-relevant debriefing characteristics and formulated six hypotheses on how these characteristics correlate with national PDIs.

Methods: Low-PDI countries have a PDI of 50 or less, and high-PDI countries have a PDI of 51 or greater as defined by Hofstede. Interviews with simulation debriefers were used to investigate culture-relevant debriefing characteristics: debriefer/participant talking time, debriefer/participant interaction pattern, debriefer/participant interaction style, debriefer/participant initiative for interactions, debriefing content, and difficulty with which nontechnical skills can be discussed.

Results: During debriefing, in low-PDI countries, debriefers talked less and used more open-ended questions and focused more on nontechnical issues than on medical knowledge and simulation participants initiated most interactions. In low-PDI countries, debriefers felt that participants interacted more with each other and found it easier to address nontechnical skills such as speaking-up.

Conclusions: Our results supported our hypotheses. National culture is related to debriefing practice. There is a clear relation between PDI and debriefer-participant behavior patterns as described by debriefers. The higher the PDI of a country, the more the debriefer determines the course of the debriefing and the more difficult it becomes to address nontechnical skills.

Surgical patients are at risk of avoidable damage. A 'time out procedure' plus debriefing (TOPplus) to check relevant operative items systematically with all team members was designed for five Dutch hospitals in order to reduce avoidable damage during and after a surgical procedure. The overall aim of this study was to evaluate if participatory design (PD) was an appropriate method for designing TOPplus. The study consisted of two parts: 1 designing TOPplus by means of PD 2 testing the design's content and usability.

REEFGAME is a computer-assisted role-playing game that explores the interactions among management strategies, livelihood options, and ecological degradation in subsistence fishing communities. The tool has been successfully used in the Philippines and a variety of student workshops. In the field, REEFGAME operated as a two-way learning tool, helping local fishers better understand their collective impacts on the marine ecosystem and providing researchers with insights into fisher livelihood strategies. This demonstrates the game's ability to serve as powerful springboard for social learning and discussion among stakeholders, while providing useful scientific insights into decisionmaking processes. Although not specifically designed for the purpose, REEFGAME has also been used in the university setting to facilitate student engagement and demonstrate a range of social and ecological concepts.

In this editorial, I thank the guest editors and authors for their excellent and pioneering
work. I set the topic of engagement within a broader area of learning and debriefing,
and  of  the  transformation  of  simulation/game  engagement  into  learning.  I  suggest
some broad areas for research on engagement in simulation/games (in both gameplay
and  debriefing)  and  in  other  realms  of  life.  I  emphasize  that,  only  with  properly
engaged  debriefing  can  a  simulation/game  have  or  maximize  the  positive  learning
outcomes than we aim for. Also, running simulation/games without debriefing them
fully is unethical. I suggest that engagement in debriefing is as (or more) important
as (than) engagement in gameplay, and more worthy of attention and research, given
that the learning happens in the debriefing, not (much) in the game. I end with some
quotes from the articles in this symposium.

Resumen: A pesar de que los congresos médicos suponen una porción importante del trabajo que realizan los intérpretes de conferencias, la bibliografía específica no es abundante, y solo es posible encontrar referencias parciales al trabajo de preparación de este tipo de congresos. A partir de la experiencia personal y compartida con otros intérpretes se pretende ofrecer una perspectiva acerca de formas de trabajo de preparación que han probado su eficacia. Palabras clave: briefing, debriefing, documentación de congresos, interpretación simultánea congresos de medicina, interpretación de conferencias.

Simulation gaming (SG) has been used for learning since their introduction in the 1960’s. Most of the research on learning from SG is focused on academic rather than corporate environments, thereby suggesting a gap in the research on organisational learning (OL) through simulations. The aim of this research was to examine if SG can lead to OL in practice, and which factors play a role therein. Eight semi-structured interviews with global HR and Learning and Development professionals were conducted, whereby the interview results were measured against existing SG literature to formulate grounded theory. The results indicated that SG leads to OL in practice, provided certain factors are taken into account. Lastly, recommendations and limitations were identified for further research and practice. Keywords: Individual learning; Organisational Learning; Grounded theory; Simulation
Gaming; Debriefing.

Introduction As discussed in Chapter 1, mediation is the specialised form, activity or process by which the parties are assisted in their negotiations by a neutral third party, the mediator. The key point is that mediation is a negotiation between two or more parties in conflict, aided by a third party. Fundamental to mediation – or perhaps better described as a subset of it – is negotiation itself. A mediation cannot exist without negotiation. However, when we discuss ‘how to mediate’ we are focusing on the component parts of the process known as mediation. In this chapter the aim is to provide you with an overview of the classical model of mediation and the practical steps within that model. One modified approach to the classical model, co-mediation, will also be explained. (How mediation operates in different fields is the subject of Chapter 4.) In addition, this chapter will provide guidance on how to prepare for a mediation, make detailed reference to intake procedures and conclude with checklists designed to assist any mediator in their preparation for and conduct of mediations. Intake procedures In addition to personal preparations, many mediators engage in an ‘intake procedure’ prior to a mediation. Having an intake procedure when first engaging with clients to a mediation is a form of preparation that deserves its own consideration. This is designed to ensure that the parties are ready to mediate. Some commentators question whether there is a necessity for a pre-mediation intake process or conference (Lancken 2000).

Although games—including board games, video games, and Massive Multiplayer Online Games—have garnered significant attention in recent years for their impact on educational outcomes, a primary focus of this interest is the transfer of knowledge from game to nongame settings. Building on this literature, our research explores how game designs that promote either competitive or collaborative play may lead to differential outcomes including dramatically different and social dynamics. Using video transcribed for speech and gesture, we developed a grounded coding scheme to compare the experiences of a group of 40 early elementary students engaged in a uniquely designed board game, called HIVEMIND, to teach advanced science content to young children ages 6 to 9, which were organized around either (a) individual or (b) collective play. Findings indicate that, in collaborative mode, players were significantly more likely to make positive comments to others, talk on-topic, read instructions t...

This paper outlines the Technology Enhanced Learning (TEL) strategy of the University of the West of England (UWE), UK, and demonstrates examples of simulations that use a mixture of web technologies, social networking and virtual worlds. In particular we discuss in detail a simulation that enables groups of law students to work as partners in simulated law practices in a virtual town that supports a range of casework. We also describe an accident investigation simulation built in the virtual world Second Life where groups of students can experience an accident scenario, investigate it, design safe systems of work to deal with the case and work collaboratively on accident analysis and prevention

Evidenced-based educational practices propose simulation as a valuable teaching and learning strategy to promote situated cognition and clinical reasoning to teach nursing students how to solve problems. A project that uses a structured debriefing activity, the Outcome Present State-Test Model of clinical reasoning following high fidelity patient simulation, is described in this paper. The results of this project challenge faculty to create and manage patient simulation scenarios that coordinate with didactic content and clinical experiences to direct student learning for the best reinforcement of clinical reasoning outcomes. Considerations for the future include incorporating patient simulation activities as part of student evaluation and curriculum development. The arguments for using high fidelity patient simulation in the current educational environment has obvious short term benefits, however, the long term benefit of developing clinical expertise remains to be discovered.

To investigate faculty and residents' perceptions of whether SimWars can serve as a meaningful instructional format for Emergency Medicine residents and to identify strategies to implement SimWars effectively in a residency training program. Methods: In this descriptive interview study, 5 facilitators, 2 contestants, and 8 observers were recruited from an Emergency Medicine residency program at a large, urban, university-based, level-I trauma center. Interview questions were created with the guidance of the social constructivism theory. Participants were interviewed individually. Themes were identified associated with responses to these questions. Results: (1) SimWars can be a meaningful instructional tool; (2) Debriefings and a well-structured rubric are essential; (3) Competition motivates participants to do their best, but can have a negative impact on them; (4) Residents expect to use the clinical skills, patient management and teamwork skills practiced in SimWars; and (5) Residents need more training on teamwork, including Team Strategies and Tools to Enhance Performance and Patient Safety™ (TeamSTEPPS). Conclusions: With its focus on competition, SimWars can be effective in residents' training when debriefings are guided by well-structured rubrics.