Debriefing Assessment for Simulation in Healthcare© (DASH)

Overview

Debriefing clinical simulation experiences is increasingly understood as a crucial step in clarifying and consolidating insights and lessons from simulations. The Debriefing Assessment for Simulation in Healthcare (DASH) is designed to assist in evaluating and developing debriefing skills. Debriefing is a conversation among two or more people to review a simulated event or activity in which participants explore, analyze and synthesize their actions and thought processes, emotional states and other information to improve performance in real situations. High participant engagement is a hallmark of strong debriefings because it leads to deeper levels of learning and increases the likelihood of transfer to the clinical setting.

The DASH evaluates the strategies and techniques used to conduct debriefings by examining concrete behaviors. It is based on evidence and theory about how people learn and change in experiential contexts. The DASH is designed to allow assessment of debriefings from a variety of disciplines and courses, varying numbers of participants, a wide range of educational objectives, and various physical and time constraints.

The DASH is based on an extensive literature review as well as best debriefing practices derived from an expert panel. A bibliography of the literature on which it is based is available here:  DASH Bibliography.

For more information about the DASH:
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DASH Rater Training

The DASH Rater Training Workshop consists of a single 4-4.5 hour webinar session. Instructors explore the instrument in detail and then walk through several iterations of rating debriefers.

Learn more about the DASH Rater Training Workshop


DASH Versions

There are three versions of the DASH. One designed for trained raters, one designed for students to rate their instructors and one designed for instructors to rate themselves.

DASH – Rater1

A  highly reliable instrument designed for use by trained raters.

  • DASH – RV Long Form asks trained raters to rate instructors on the six DASH Elements and the Behaviors associated with each Element. There are a total of 23 Behaviors associated with the Elements. The DASH-RV Long Form takes about 5-7 minutes to complete and provides significant diagnostic information to the instructor.
  • DASH – RV Short Form asks trained raters to rate instructors on the six DASH Elements.

We offer a webinar-based DASH Rater Training Workshop several times per year. People who want to become trained DASH Raters should be experienced debriefers.

DASH – Student2

Designed for students to rate their instructors on the quality of a debriefing.
There are two forms available for the DASH-SV:

  • DASH – SV Long Form asks students to rate instructors on the six DASH Elements and the Behaviors associated with each Element. There are a total of 23 Behaviors associated with the Elements. The DASH-SV Long Form takes about 5-7 minutes to complete and provides significant diagnostic information to the instructor.
  • DASH – SV Short Form asks students to rate instructors on the six DASH Elements. It can be answered in less than 3 minutes but is not as diagnostic as the longer student form.

DASH – Instructor3

Designed to allow an instructor to self-assess.
There are two forms available for the DASH-IV:

  • DASH – IV Long Form asks instructors to rate the six DASH Elements and the Behaviors associated with each Element. There are a total of 23 Behaviors associated with the 6 Elements. The DASH-IV Long Form takes about 5-7 minutes to complete and provides significant diagnostic information to the instructor.
  • DASH – IV Short Form asks instructors to rate on the six DASH Elements. It can be answered in less than 3 minutes but is not as diagnostic as the longer instructor form.

DASH Rater’s Handbook

  • DASH Rater’s Handbook  provides instructions and example instructor behaviors to assist in rating. In order to accurately assess and score the feedback conversation, the DASH Rater’s Handbook and DASH – Rater Version must be used concomitantly.

Copyright Notice

Center for Medical Simulation, Boston, MA 02129, https://harvardmedsim.org.
Permission is granted for you to use the Debriefing Assessment for Simulation in Healthcare (DASH) instrument in your simulation program. As a condition of granting permission to use the DASH, we request that you provide CMS copies of articles, abstracts or reports you publish using the DASH so that we may keep others up to date on how the DASH is being used. Please send citation and a copy of the article to DASH@harvardmedsim.org.


How to Cite the DASH

Simon R, Raemer DB, Rudolph JW. Debriefing Assessment for Simulation in Healthcare (DASH)© Rater’s Handbook. Center for Medical Simulation, Boston, Massachusetts. https://harvardmedsim.org/wp-content/uploads/2017/01/DASH.handbook.2010.Final.Rev.2.pdf. 2010. English, French, German, Japanese, Spanish.

Simon R, Raemer DB, Rudolph JW. Debriefing Assessment for Simulation in Healthcare (DASH)© – Rater Version, Long Form. Center for Medical Simulation, Boston, Massachusetts. https://harvardmedsim.org/dash-rv-long-scoresheet-en-2018/. 2018. English, French, German, Japanese, Spanish.

Simon R, Raemer DB, Rudolph JW. Debriefing Assessment for Simulation in Healthcare (DASH)© – Rater Version, Short Form. Center for Medical Simulation, Boston, Massachusetts. https://harvardmedsim.org/wp-content/uploads/2017/01/DASH.RV.ShortScoresheet.2011.pdf. 2011. English, French, German, Japanese, Spanish.

Simon R, Raemer DB, Rudolph JW. Debriefing Assessment for Simulation in Healthcare (DASH)© – Student Version, Long Form. Center for Medical Simulation, Boston, Massachusetts. https://harvardmedsim.org/wp-content/uploads/2017/01/DASH.SV.Long.2010.Final.pdf. 2010. English, French, Japanese, Spanish.

Simon R, Raemer DB, Rudolph JW. Debriefing Assessment for Simulation in Healthcare (DASH)© – Student Version, Short Form. Center for Medical Simulation, Boston, Massachusetts. https://harvardmedsim.org/wp-content/uploads/2017/01/DASH.SV.Short.2010.Final.pdf. 2010. English, French, German, Japanese, Spanish.

Simon R, Raemer DB, Rudolph JW. Debriefing Assessment for Simulation in Healthcare (DASH)© – Instructor Version, Long Form. Center for Medical Simulation, Boston, Massachusetts. https://harvardmedsim.org/wp-content/uploads/2017/01/DASH.IV.LongForm.2012.05.pdf. 2012. English, French, Japanese, Spanish.

Simon R, Raemer DB, Rudolph JW. Debriefing Assessment for Simulation in Healthcare (DASH)© – Instructor Version, Short Form. Center for Medical Simulation, Boston, Massachusetts. https://harvardmedsim.org/wp-content/uploads/2017/01/DASH.IV.ShortForm.2012.05.pdf. 2012. English, French, German, Japanese, Spanish.


DASH Citations

Dreifuerst KT. Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. J Nurs Educ. 2012 Jun; 51(6): 326-33. PMID: 22495923.

Brett-Fleegler M, Rudolph J, Eppich W, Monuteaux, M., Fleegler, E., Cheng, A., Simon, R. Debriefing Assessment for Simulation in Healthcare: Development and Psychometric Properties. Simul Healthc. 2012 Oct; 7 (5): 288-94. PMID: 22902606.

Morse, Catherine J. “The Effect of Debriefing with Good Judgment on Acute Care Nurse Practitioner Students’ Reflective Ability and Perspective Transformation.” [Doctoral dissertation]. Villanova, Pennsylvania: Villanova University, 2012. Retrieved from http://pqdtopen.proquest.com/pubnum/3552408.html.

Cooper DD, Wilson AB, Huffman GN, Humbert AJ. Medical students’ perception of residents as teachers: comparing effectiveness of residents and faculty during simulation debriefings. J Grad Med Educ. 2012 Dec;4(4):486-9. doi: 10.4300/JGME-D-11-00269.1. PMID: 24294426 . (2014) Erratum: J Grad Med Educ. 2014 March, 6(1):192. https://doi.org/10.4300/1949-8357-6.1.192.

Rudolph J, Raemer D, Simon R. Establishing a safe container for learning in simulation: The role of the pre-simulation briefing. Simul Healthc. 2014 Dec;9(6):339-49. PMID: 25188485.

Jeffries, P. R., Dreifuerst, K. T., Kardong-Edgren, S., & Hayden, J. Faculty Development When Initiating Simulation Programs: Lessons Learned From the National Simulation Study. J Nurs Regul. 2015 Jan; 5(4): 17-23. http://dx.doi.org/10.1016/S2155-8256(15)30037-5.

Policard, F. Optimiser le débriefing d’une séance de simulation en santé. SOiNS CADRES. 2015 May; 24 (94): 51-54. [in French] Retrieved from: http://www.em-consulte.com/article/973285/article/optimiser-le-debriefing-d-une-seance-de-simulation.

Aluisio AR, Daniel P, Grock A, Freedman J, Singh A, Papanagnou D, Arquilla B. Case-based Learning Outperformed Simulation Exercises in Disaster Preparedness Education Among Nursing Trainees in India: A Randomized Controlled Trial. Prehosp Disaster Med. 2016 Oct;31(5):516-23. PMID: 27491847.

Ahmed RA, Atkinson SS, Gable B, Yee J, Gardner AK. Coaching From the Sidelines: Examining the Impact of Teledebriefing in Simulation-Based Training. Simul Healthc. 2016 Oct;11(5): 334-339. PMID: 27388866.

Evain JN, Zoric L, Mattatia L, Picard O, Ripart J, Cuvillon P. Residual anxiety after high fidelity simulation in anaesthesiology: An observational, prospective, pilot study. Anaesth Crit Care Pain Med. 2017 Aug;36(4):205-212. PMID: 27867134.

Bullard MJ, Leuck JA, Howley LD. Unifying interdisciplinary education: designing and implementing an intern simulation educational curriculum to increase confidence in critical care from PGY1 to PGY2. BMC Res Notes. 2017 Nov 6;10(1):563. PMID: 29110695.

Adams T, Newton C, Patel H, Sulistio M, Tomlinson A, Lee W. Resident versus faculty member simulation debriefing. Clin Teach. 2017 Nov 16. PMID: 29144023.

Durand C, Secheresse T, Leconte M. The use of the Debriefing Assessment for Simulation in Healthcare (DASH) in a simulation-based team learning program for newborn resuscitation in the delivery room. Arch Pediatr. 2017 Dec;24(12):1197-1204. [in French]. PMID: 29174008.

Gordon RM. Debriefing Virtual Simulation Using an Online Conferencing Platform: Lessons Learned. Clin Simul Nurs. 2017 Dec; 13(12): 668-674. http://dx.doi.org/10.1016/j.ecns.2017.08.003.

Poland S, Frey JA, Khobrani A, Ondrejka JE, Ruhlin MU, George RL, Gothard MD, Ahmed RA. Telepresent Focused Assessment With Sonography for Trauma Examination Training Versus Traditional Training for Medical Students: A Simulation-Based Pilot Study. J Ultrasound Med. 2018 Feb 1. PMID: 29388234.


Acknowledgements

The Center for Medical Simulation has received no outside funding for the DASH project. The project has been blessed with significant help, writing and translation assistance.

  1. Thanks to Adam Cheng (PI) and the EXPRESS Project for the opportunity and the support to develop the DASH. Special thanks go to the reviewers: Vinay Nadkharni (University of Pennsylvania), Elizabeth Hunt (Johns Hopkins University), Adam Cheng (University of Calgary), Walter Eppich (Northwestern University), Marisa Brett-Fleegler (Harvard University), Monica Kleinman (Harvard University), Kristen Nelson (Johns Hopkins University), Akira Nishisaki (University of Pennsylvania).
  2. Thanks to Kris Dreifurst (Indiana University) who propelled the effort toward developing the DASH Student Versions and ran the initial tryouts of the instrument.
  3. Thanks to Adam Cheng (University of Calgary), Walter Eppich (Northwestern University), Dylan Bould (University of Ottawa), Tobias Everett (University of Toronto) and Ralph MacKinnon (University of Manchester) for leading the effort to adapt previous versions of the DASH to create the Instructor Version.
  4. The DASH was translated into German by Benedict Sandmeyer (University of Munich) with contributions by Florian Hoffmann (University of British Columbia), Walter Eppich (Northwestern University), Marcus Rall (University Hospital Tuebingen) and Michaela Kolbe (ETH Zürich). We are grateful about suggestions for improving formulation and translation. These suggestions should be sent to Benedict Sandmeyer with a copy to Robert Simon (benedikt.sandmeyer@med.uni-muenchen.de; rsimon@mgh.harvard.edu).
  5. The DASH was translated into Japanese by Takanari Ikeyama (Aichi Children’s Health and Medical Center, Japan) in collaboration with Yuko Shiima (Children’s Hospital of Philadelphia), Takashi Shiga (Tokyo Bay Urayasu/Ichikawa Medical Center, Japan), Satoshi Takeda (The Jikei University School of Medicine, Japan), Satoshi Dohi (Showa University, Japan) and Akira Nishisaki (Children’s Hospital of Philadelphia). We are always grateful for suggestions on how to improve the translation. These suggestions should be sent to Takanari Ikeyama with a copy to Robert Simon (takanari_ikeyama@sk00106.achmc.pref.aichi.jp; rsimon@mgh.harvard.edu).
  6. French translation by Florence Policard (IFSI Clermont-Ferrand, Université Paris X Nanterre). Reviewers: Robert Doureradjam & Dr. Georges Savoldelli (SIMULHUG, University Hospitals of Geneva), Dr. Morgan Jaffrelot (CESIM, University of Brest) and Dr. Maria Rudolph (Visiting Scholar, Center for Medical Simulation, Boston). We are always grateful for suggestions on how to improve the translation. These suggestions should be sent to Florence Policard with a copy to Robert Simon (fpolicard@chu-clermontferrand.fr; rsimon@mgh.harvard.edu).
  7. Spanish translation by Sacha Müller-Botti (Hunter New England Simulation Centre, Newcastle, Australia). Reviewer: José María Maestre (Hospital virtual Valdecilla, Santander, España). We are always grateful for suggestions on how to improve the translation. These suggestions should be sent to Sacha Müller-Botti with a copy to Robert Simon (Sacha.Muller@hnehealth.nsw.gov.au; rsimon@mgh.harvard.edu).

DASH Resources

 DASH Rater’s Handbook

 DASH Rater Version – Long Form (RV-Long)

 DASH Rater Version – Short Form (RV-Short)

 DASH Student Version – Long Form (SV-Long)

 DASH Student Version – Short Form (SV-Short)

 DASH Instructor Version – Long Form (IV-Long)

 DASH Instructor Version – Short Form (IV-Short)

 DASH Bibliography

View all DASH RESOURCES                   View all CMS RESOURCES