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Practising forethought: the role of mental simulation
  1. Huon Snelgrove1,
  2. Asanga Fernando2,3
  1. 1Department of Education and Development, GAPS Simulation and Learning Centre, St George’s Healthcare NHS Trust, London, UK
  2. 2GAPS Simulation and Learning Centre, St George’s University Hospitals NHS Foundation Trust, London, UK
  3. 3Macmillan Cancer Liaison Psychiatrist, Macmillan Cancer Psychological Support Team, Cancer Services, St George’s University Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Mr Huon Snelgrove, Education and Development (GAPS), GAPS Simulation and Learning Centre, St George’s Healthcare NHS Trust, London SW17 ORE, UK; huon.snelgrove{at}nhs.net

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Did you know that forethought can be practised? Asking someone how he or she may ‘remember’ the future is an odd question. Particularly so in the clinical simulation community where recall analysis and reminiscence are emphasised over anticipation and prescience. Pre-Briefing is usually a poor relative of debriefing—or so it seems.

There are ample studies that ‘feed forward’ with ‘feedback’ have a stimulus more powerful in learning than other variables in education.1 Surprisingly this is not so clear for the ‘debrief’. The reason is partly because the terms ‘debrief’ and ‘feedback’ are used so interchangeably. And unlike healthcare, aviation and the military, the word ‘debrief’ is not part of the mainstream educational research vocabulary.

Recent reviews in the healthcare simulation literature attempt to clarify the nature and function of the debrief. Sawyer et al make the distinction that ‘debriefing’ is intrinsically ‘interactive’ and diagnostic, whereas ‘feedback’ is ‘one-way conveyance of information.2 Fanning and Gaba refer to the debrief as the ‘heart and soul’ of lifelong learning.3 But these views may be both reductive and overstating the case.

In science, theory directs what researchers and educators do and hindsight analysis legitimises theories by reflection in action and on action.4 5 Consequently models of how to debrief proliferate in health education and become paradigmatic in describing what constitutes good teaching or effective learning, or both. And here is the quandary. In these descriptions of debriefings construed as collective epiphanies a more complex and multidimensional idea of learning risks being collapsed into one which is essentially retrospective and episodic. In the kindred field of counselling, we learn that this overemphasis can be unhelpful, if not detrimental.6 Indeed, a pointed criticism of current models of reflection is that they do not sufficiently acknowledge the place of anticipation and …

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