Debriefing in Healthcare Simulation is a period of time that follows an experiential learning activity during which learners/teams reflect, review and discuss the activity with the goal of improving individual and team clinical skills and judgment. The Healthcare Simulation Dictionary 3.0 defines debriefing as a process in which people who have had an experience are lead through a purposive discussion of that experience; a learning conversation between instructors and trainees that follows a simulation; facilitated or guided reflection in the cycle of experiential learning; and a formal, collaborative, reflective process within the simulation learning activity (Lioce et al., 2024, pg. 17). This HealthySimulation.com article by Founder/CEO Lance Baily will take a deeper look at the healthcare simulation debriefing process and provide some debriefing models available from clinical educators around the world.
What is Debriefing in Clinical Simulation?
The origins of healthcare simulation debriefing began in the military, where individuals returned from a mission would give a report about the mission. The information provided could then be used to strategize for future missions or to reduce psychological damage from a traumatic event. In healthcare simulation, debriefing is used to foster discussions in a non-threatening environment, capture and leverage “golden or ah-ha” moments, seek similar real-world experiences, and help apply the experience to real-world practice.
Debriefing is considered a reflective practice since it is a method used to scrutinize a learner’s own assumptions and professional work practices (Kolb 1984). People make sense of external stimuli through internal frames of reference. During debriefing, learners and educators identify these frames of reference or mental models, and the learner decides if the frame of reference is appropriate or changes should be made. Ultimately, this may lead to a future change in behavior, which in turn leads to an improvement in clinical practice.
Factors to Include in Debriefing
Several factors affect the nature of a clinical simulation in healthcare simulation debriefing. These factors include the objectives of the simulation, complexity of the scenario, experience level of the learners, familiarity of learners with the sim environment, time available for the session, audiovisual recording systems, and individual personalities of participants. Creation of a safe learning space is a critical consideration for psychological safety since participation in healthcare simulations can have a significant emotional impact on learners, which should begin with the orientation and again in the clinical simulation pre-brief. One definition of psychological safety in the Healthcare Simulation Dictionary (Lioce et al., 2024) states a feeling (explicit or implicit) within a simulation-based activity that participants are comfortable participating, speaking up, sharing thoughts, and asking for help as needed without concern for retribution or embarrassment (pg. 50).
Socratic Questions to open a clinical simulation debrief often include basic what or how questions to understand what has happened in the clinical simulation scenario. Many questions are open-ended and should always be non-judgmental. Healthcare simulation participants should be encouraged and made to feel that their contributions are valued.
View the HealthySimulation.com Webinar Healthcare Simulation Debriefing Strategies & Courses from Top Experts at The Debriefing Academy to learn more!
Healthcare simulation faculty often reflect back learner statements to reiterate points or to open up a discussion. Healthcare Simulation Debriefing should occur immediately after the clinical simulation scenario. Note, debriefing is all about the learners who should do most of the talking and not about the educator. Clinical simulation and debriefing are used extensively to improve team communication, dynamics, and efficiency. Psychological safety is crucial and critical as a foundation for any successful healthcare simulation debrief and must always be prioritized.
Medical Simulation Debriefing Tool Samples
Plus Delta (Klair, M. B., 2000. The mediated debrief of problem flights. Facilitation and debriefing in aviation training and operations. Aldershot: Ashgate, 72-92.): The Plus/Delta debriefing process is a simple, structured method where participants identify “plus” factors (things that went well or should be continued) and “delta” factors (things that need improvement or change) to provide constructive feedback and drive continuous improvement after a simulated event or activity. Using open-ended questions like, “What went well and what would you do differently?”, facilitators guide participants to self-assess and analyze their performance, fostering a supportive environment for learning and action.
Gather, Analyze, Summarize Method (GAS)(Phrampus & O’Donnell, 2013): An aspect to consider in debriefing includes the use of the gather, analyze, and summarize (GAS) debriefing tool. This tool allows even novice debriefers to rapidly gain skill in debriefing while remaining comfortable with the process. The ability to maintain a student-centric, safe environment where gaps in knowledge, skill, or performance are identified and addressed is central to the method.
- Gather data by actively listening to participants to understand their perspective
- Analyze
- Facilitate student reflection and analysis of their actions.
- Identify positive aspects of team or individual behaviors that require change.
- Summarize
- Facilitate identification and review of lessons learned.
Debriefing with Good Judgment(Rudolph et al, 2007): Drawing on theory and empirical findings from a 35-year research program in the behavioral sciences on how to improve professional effectiveness through reflective practice, Rudolph et al (2007) developed a model of Debriefing with Good Judgment. The model specifies a rigorous reflection process that helps trainees surface and resolve pressing clinical and behavioral dilemmas raised by the simulation. Based on the authors’ own experience using this approach in approximately 2000 debriefings, it was found that the “debriefing with good judgment” approach often sparks self-reflection and behavior change in trainees.
- Holds learners to high standards while maintaining high regard for the learners
- Instructor’s thinking is transparent
- Employs varied conversational strategies, such as advocacy inquiry, to uncover and resolve dilemmas and assumptions
- such as Harvard and Stanford.
Debriefing for Meaningful Learning(Dreifeurst, 2009): The aim of the DML method is to foster clinical reasoning by encouraging learners to think about something in a logical, sensible way by first recalling an event and then reflecting upon the event. Debriefers use Socratic questioning to help learners identify the frames of reference that led them to make a particular decision. Dreifuerst’s method is based on three theories: constructivism, Schon’s Theory of Reflection, and Biological Sciences Curriculum Study (BSCS) E5 Learning Strategy.
Debriefing for Meaningful Learning focuses on three aspects of reflection:
- Reflection-in-action focuses on critical decision-making points, which emphasize assimilation and accommodation (the process of taking in and fully understanding information or ideas).
- Reflection-on-action focuses on things to do differently next time, which emphasizes accommodation. During the DML debriefing, learners are encouraged to break down the experience with the goal of identifying correct and incorrect thinking.
- Reflection-beyond-action, which focuses on anticipation and preparing for the next clinical encounter.
PEARLS Framework(Eppich & Cheng, 2015): The Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework is a blended approach to healthcare simulation debrief, which can be applied flexibly in different environments. The PEARLS model of debrief features many of the other common segments of other healthcare simulation debrief modalities. Five phases of PEARLS healthcare simulation debrief are:
- Setting the Scene
- Reaction phase
- Description phase
- Analysis phase
- Summary phase
View the new HealthySimulation.com Community Debriefing Group to discuss this topic with your Global Healthcare Simulation peers!
Bubble Briefs(Hall & Turner, 2018): The “Bubble Briefs” consist of a framework of non-technical skills and human factors questions that may be pertinent during the debrief. Bubble briefs use eight cards that provide human factor topics to those observing the scenario. They include topics such as leadership, teamwork and resource allocation, communication, situational awareness, and handover.
Each card has several open questions to give recommendations on what to observe during the simulation and how to ask questions and analyze behavior during a debrief. Before a Simulation session, the participants are shown the Bubble Briefs and have an explanation of human factors and non-technical skills. Prior to a given simulation scenario, the Bubble Briefs are chosen by faculty depending on the learning objectives of the scenario.
- Framework of non-technical skills and human factors.
- Leadership, teamwork and resource allocation, communication, situational awareness, and handover.
Objective Structured Assessment of Debriefing (OSAD)(Arora et al., 2012): The Objective Structured Assessment of Debriefing (OSAD) is a validated, behaviorally anchored rating scale tool developed to evaluate the quality of debriefing in medical education. It assesses an 8-domain framework including Approach, Learning environment, Learner engagement, Reaction, Reflection, Analysis, Diagnosis, and Application. The tool uses a 5-point scale to rate performance in each category, providing feedback to debriefers to enhance their skill and improve the quality of future debriefings.
SHARP(Ahmed et al., 2013): SHARP contains the absolute basic principles of what to cover when conducting a debriefing. SHARP is an acronym that comprises five ‘prompts’ to guide trainers and trainees in providing/receiving a structured debrief. SHARP stands for
- Set learning objectives
- How did it go
- Address concerns
- Review learning points
- Plan ahead.
SHARP is a practical tool that can be used when there is not enough time to carry out a detailed debriefing that uses all the comprehensive information provided in the Objective Structured Assessment of Debriefing (OSAD) tool. This tool can be used in the OR before cases, after cases, to address concerns, and to plan ahead.
Debrief as a Learning Conversation(Davis & Denning, 2016): The learning conversation was developed initially by two educators for the Advanced Life Support group: Dr Davis and Dr Denning to provide effective feedback to students on resuscitation courses. Components include:
- Make opening gambit (phrases)
- Jointly explore any issues that emerge
- Include impressions/suggestions from rest of group
- Share your thoughts using advocacy with inquiry
- Check whether anyone has any other issues that they want to discuss
- Summarize
Diamond Debriefing Method(Jaye et al., 2015): Diamond debrief method is based on the debrief framework technique which is made up of: description, analysis and application. Diamond debrief also consists of aspects of the advocacy-inquiry approach and of debrief with good judgment. Diamond debrief is designed to allow the exploration of non-technical elements of a healthcare simulation in debrief.
A free resource of Pocket Book for Simulation Debriefing in Healthcare by Oriot and Alinier (2018).
Learn More About How to Avoid Common Healthcare Simulation Debriefing Pitfalls!
