有意義的反饋於擬真教學上之應用

Application of Debriefing for Meaningful Learning in Simulation-Based Education

擬真教學於醫護教育的應用已被證實是有效的方法來協助學生接軌課室與臨床現場的落差，擬真教學後的反饋（debriefing）更是擬真教學是否成功的關鍵靈魂。美國馬凱特大學的Dreifuerst教授所發展的有意義的反饋（Debriefing for Meaningful Learning; DML）是以理論為基礎的反饋方式。受過正式培訓課的debriefer於帶領學生進行debriefing的過程中，透過結構化的E-6學習環教學模式步驟引導學生經由重複的反思循環，讓學生於擬真教學的情境中思考所經歷的過程及在行動背後的理由及知識，並了解思考及行動兩者間的聯結，最後展現在護理的臨床推理上及從護理的角度之思考模式「thinking like a nurse」。因為DML是屬於結構性的反饋，進行時要依照Dreifuerst教授所發展E-6 DML教師指引手冊的步驟執行，不包括擬真教學的時間，通常是60分鐘左右。學生於擬真教學活動進行前，應先複習與此情境擬真教案的相關先備知識，擬真教學後，debriefer會引導學生如何依序使用學生版本的反饋工作表，最後會透過行動中反思（reflection-inaction）、行動後反思（reflection-on-action）及超越行動的反思（reflection-beyond -action）等活動，引導學生思考在此擬真案例中學到的重點，如何改進以達到更好的結果，以及未來在類似的情況下應該如何會讓病人的照護更好。

The use of simulation-based education in healthcare has been shown to be an effective strategy for bridging the gap between classroom learning and clinical practice. Debriefing following simulation teaching is crucial to determining the success of simulation-based education. Debriefing for Meaningful Learning (DML), developed by Professor Dreifuerst at Marquette University, is a theoretically grounded approach to debriefing. Trained debriefers lead students through structured debriefing sessions, following the E-6 Learning Cycle Model, guiding them through a reflective process to analyze their experiences, actions, reasoning, and the underlying knowledge gained from the simulation scenario. This process helps students understand the connection between their thoughts and actions, ultimately enhancing clinical reasoning and fostering a ''thinking like a nurse'' mindset.
The DML debriefing process should be conducted following the steps outlined in the E-6 DML Debriefer's Guide, developed by Professor Dreifuerst, excluding the simulation teaching time, which typically lasts around 60 minutes. Before participating in simulation activities, students should review relevant preparatory knowledge related to the simulation scenario. After simulation sessions, debriefers guide students through the use of debriefing worksheets, encouraging reflection-in-action, reflection-on-action, and reflection-beyond-action to help students identify key learnings, areas for improvement, and strategies for enhancing patient care in future situations.