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0051 Bringing freud into the debrief
  1. Christopher Kowalski,
  2. Zainab Jabur
  1. Maudsley Simulation, South London and Maudsley NHS Foundation Trust, London, UK

Abstract

Context Debriefing in simulation benefits considerably from the exploration of the interpersonal factors at work during a patient or team interaction. Psychodynamic thinking can further enrich this exploration. The emotions provoked by an interaction, when understood and reflected upon, provide valuable insights into participants’ behaviour. Similar thinking can help us understand why teams functioned in a particular way.

Existing debriefing models are limited in their exploration of such concepts. Additionally, participants often struggle to identify and acknowledge these psychodynamic factors – a phenomenon known in psychotherapy as “resistance”. There are specific psychotherapeutic techniques designed to overcome resistance which can be applied to the debrief. We set about examining how psychodynamic thinking and techniques could be applied to the simulation debrief to enhance learning.

Description Most debrief models ask about participants’ emotional experiences. Exploring psychodynamic factors necessitates particular attention to these.

Psychodynamic techniques can be used to push past resistance, helping participants to uncover difficult, perhaps unconscious, feelings and thoughts that could inform the analysis of a particular scenario. Further probing questions that invite participants to consider a patient-clinician interaction in light of previous relationships can help them understand the factors that may be driving their behaviour. This may increase clinicians’ capacity to both work with, and empathise, with patients. The same concepts can be explored when participants are working in teams in order to improve team dynamics.

Conclusion In our work we have found that psychodynamic techniques can be easily incorporated into existing debriefing models. This, however, requires a degree of competency in therapeutic interviewing.

By exploring psychodynamic concepts, a deeper understanding of patient and team interactions is possible. This leads to increased empathy towards patients, improved team-working and greater self-awareness. These outcomes are not solely pertinent to the field of mental health but are relevant to all healthcare settings.

References

  1. Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simulat Healthc 2007;2(2):115–125

  2. Freud S. Group psychology and the analysis of the ego (No. 770). WW Norton & Company, 1975

  3. Hughes P, Kerr I. Transference and countertransference in communication between doctor and patient. Advances in Psychiatric Treatment 2000;6(1):57–64

  4. Groves J. Taking care of the hateful patient. Engl J Med 1978;298:883–7

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