Feedback and instructional guidance in healthcare simulation debriefings

Abstract: The overall interest of the thesis concerns how students reflect upon and provide feedback on their own performance under the guidance of teachers. This interest is explored in the context of debriefing conversations that followed on simulation-based team training scenarios for healthcare students. The thesis is informed by ethnomethodology and conversation analysis, two closely intertwined perspectives with roots in sociology. The empirical material consists of video recordings of simulation-based training conducted at two Swedish universities. In addition, video data of feedback conversations for students at a Norwegian upper secondary school is used as a basis for investigation and comparison in one of the empirical studies. The thesis addresses questions related to how the teachers, referred to as facilitators in the setting under study, work to elicit and guide student reflection and feedback, how the students approach and accomplish such tasks, and how conceptual models and principles of “good practice” feature in the activities. These questions are scrutinised in three empirical studies. Study 1 shows how video in combination with instructional questions by the facilitators is central to how the students perceive and talk about their own simulation performance. Study 2 demonstrates the characteristics and differences between student and facilitator feedback, and what instructional functions the facilitators’ feedback contributions fulfil in relation to those of the students. Study 3 examines and compares sequences in which students in two different settings assess their own performance in response to teacher questions with the aim to demonstrate the divergence between the real- time organisation of these activities and the models and principles advocated in the pedagogical literature. Overall, the results show that self- and peer feedback are complex activities that present students with difficulties of both interactional and subject-matter character. Teachers therefore have a central role in initiating and setting the agenda for the feedback discussions, keeping them active and on track, directing the students’ attention towards relevant aspects of their own performance, and demonstrating how these aspects are related to principles, standards and discourses of the students’ future professional practice.