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Simul Healthc. 2013 Oct;8(5):304-16. doi: 10.1097/SIH.0b013e318294854e.

Helping without harming: the instructor's feedback dilemma in debriefing--a case study.

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From the Center for Medical Simulation (J.W.R., R.S.); Massachusetts General Hospital (J.W.R., R.S.); Harvard Medical School (J.W.R., R.S.); New York University, Wagner School of Public Service (E.G.F.); Alberta Childrens Hospital (T.R.); Wellesley College (S.K.); and Worcester Polytechnic Institute, School of Business (S.S.T.).



Simulation instructors often feel caught in a task-versus-relationship dilemma. They must offer clear feedback on learners' task performance without damaging their relationship with those learners, especially in formative simulation settings. Mastering the skills to resolve this dilemma is crucial for simulation faculty development.


We conducted a case study of a debriefer stuck in this task-versus-relationship dilemma.


The "2-column case" captures debriefing dialogue and instructor's thoughts and feelings or the "subjective experience."


The "learning pathways grid" guides a peer group of faculty in a step-by-step, retrospective analysis of the debriefing. The method uses vivid language to highlight the debriefer's dilemmas and how to surmount them.


The instructor's initial approach to managing the task-versus-relationship dilemma included (1) assuming that honest critiques will damage learners, (2) using vague descriptions of learner actions paired with guess-what-I-am-thinking questions, and (3) creating a context she worried would leave learners feeling neither safe nor clear how they could improve. This case study analysis identified things the instructor could do to be more effective including (1) making generous inferences about the learners' qualities, (2) normalizing the challenges posed by the simulation, (3) assuming there are different understandings of what it means to be a team.


There are key assumptions and ways of interacting that help instructors resolve the task-versus-relationship dilemma. The instructor can then provide honest feedback in a rigorous yet empathic way to help sustain good or improve suboptimal performance in the future.

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