Utilizing Plus/Delta Debriefing to Enhance Learning in Phlebotomy Simulations

Abstract

Simulation provides a bridge between classroom learning and clinical experience encompassing both basic and advanced competencies. It offers a safe learning environment in which students can practice skills using task trainers as well as participate in complex, interprofessional simulations promoting communication and teamwork. As a culminating activity in our phlebotomy course, students video-record themselves performing phlebotomy on a simulated patient. In the simulation center, there are fixed digital video cameras installed in each of the examination rooms. The students begin the simulation by reviewing a brief patient history, including a possible complication (mastectomy, IV in arm, no patient ID) and are instructed to record themselves performing the phlebotomy from the time they greet the patient through caring for the patient after the phlebotomy. The students then review the DVD and perform a plus/delta debriefing, reflecting on what they did well and what they can improve. Debriefing has been identified as the most critical part of simulation. Reflective practitioners who engage in introspection learn to self-correct and think critically. Debriefing also enhances retention of material. In this activity, emphasis was placed on recognition of successes and areas of improvement rather than the skill performance itself. This establishes a relaxed, safe atmosphere conducive to learning. We surveyed 15 students over two semesters. Ninety-three percent either agreed or strongly agreed that the debriefing enhanced their learning experience, 93% either agreed or strongly agreed that it was essential to the mastery of the course content, and several students remarked that it was the most effective portion of the course. Plus/delta debriefing is an effective measure to enhance phlebotomy simulation, and we intent to expand its use into interprofessional simulation.