Table 1 Problems addressing complexity and resilience in IPSE, the suggested potential solutions as debriefing techniques and their corresponding evaluations

I Being unaware of complexity

 1 How should debriefing topics chosen when addressing complexity?

1.1

Using plus/delta

 + / − 

Considered valuable, but too time consuming

1.2

Only focusing on the team-level

 − 

Individual focus impossible to leave out

 2 How do the students get a clearer picture of the complexity within the scenario?

2.1

Exploring why things turned out the way they did

 + 

Shows students’ perspective shows potentially multiple contributing factors

2.2

Inquiring into the consequences for the team or the patient

 + 

Avoids only looking at adherence to guidelines, but helps students see what the actual outcomes of decisions and actions were

2.3

Exploring expressions of “messiness”

 + 

An expression of complexity helps students clarify what is behind this and normalise

2.4

Exploring basis for “uncertainty”

 + 

Potentially an expression of complexity helps students clarify what is behind this and normalise

2.5

Asking for “adaptations”

 − 

As an open question this does not seem to make sense for students

2.6

Exploring different perspectives by asking chain of follow-up questions

 + 

Follow questions to a particular student by asking the team for perspectives, returning to the student to get reflections on team’s perspectives. Secures interprofessional perspectives and reinforce learning

II Not recognizing resilience

 3 How can the students learn from success?

3.1

Asking for what students did well or were good at as an open question

 − 

Students uncomfortable focused on standards that they did not achieve and therefore cannot produce anything they were good at

3.2

Asking for “contributions”

 + 

Easier for students to answer, less pressure in a contribution, brings forth multiple contributions more easily not just one right one

3.3

Exploring how success was achieved

 + 

Not necessarily just because standards were followed, helps students become aware of strengths

3.4

Using video

 + / − 

Considered very beneficial, but too time consuming and strenuous for facilitator

 4 How can the students learn from struggles, perceived failures or bouncing back

4.1

Informing about messiness and resilience in introduction of the day

 + 

Important to prepare students for idea that they may experience uncertainty and “messiness”, and that this is normal

4.2

Asking what the students would have done differently as an open question

 − 

Students compare to standard going straight to the one right thing that should have been done, without exploring multiple perspectives and variations

4.3

Asking for "challenges" as an open question

 + 

Students more readily reflect on what actually happened within the scenario

4.4

Asking for how challenges were overcome

 + 

This is KEY. Successful or attempted. This potentially highlights already existing capacity for resilience

4.5

Exploring several possible solutions

 + 

Acknowledges that there may not be only one way of doing things especially if conditions vary

4.6

Avoiding learning from hindsight

 + 

Avoids accepting “insights” from information the students only gained later in the scenario

4.7

Obtaining positive goals

 + 

Above all helpful when students did not succeed in an attempt or intention and after complexity and resilience has been explored. Then, ask how they would like to manage a similar situation in the future

4.8

Asking what a “perfect” solution would look like

-

Aggravates students’ tendency to focus on what they perceived as failures

4.9

Shortening analysis of positive aspects

If students are eager to analyse “negative aspects” it is acceptable to move on to these early on, since exploring perceived failures by exploring complexity and potentially reframing weaknesses is less threatening

III Learnings potentially unclear

 5 How can students achieve valuable learnings?

5.1

Probing for concrete strategies

 + 

Not accepting abstract answers by asking how learnings are planned to be carried out concretely provides clearer learnings and new objectives for the students