Debriefing – perhaps the most important component of healthcare simulation and experiential learning – is a facilitated reflection designed to help participants identify and close gaps in their knowledge and skills. Debriefing can take many forms, but it is often led by a facilitator who positions themself as a co-learner and aims to guide the discussion, rather than to lecture as an authority or expert. This results in an interactive, bidirectional, and reflective discussion, thus, placing the participant in a more active role requiring them to critically analyze their own performance retrospectively (rather than passively receiving feedback).
To derive the most benefit and maximize learning from debriefing, several essential elements should be incorporated to facilitate the reflective process:
Creating a safe learning environment
The importance of a supportive and non-threatening environment cannot be overstated. It is crucial for learners to feel psychologically safe to perform or speak without fear of negative consequences. Establishing this safe space begins with the pre-simulation briefing and can be reiterated immediately prior to the debrief. The debrief should take place in a separate room from the simulator to allow tension to diffuse.
Establishing ground rules for the debriefing
Laying out rules at the start of the debrief sets the tone and contributes to creating a safe learning environment. Basic ground rules include requiring all members to actively participate in the discussion, assuring all discussions are confidential, and asserting that the objective of the debrief is one of learning and improvement, not criticism.
Establishing a shared mental model of the events transpired in the simulation
To collectively discuss a simulation experience, it is important for everyone involved in the debrief to have a shared understanding of the sequence of events. This is typically accomplished by allowing participants time to review key events of the scenario and rationales for each decision made.
Keeping sight of the big picture (ie. addressing learning objectives)
Each scenario is designed with key learning objectives in mind, and it is important to address these during the debrief. A debriefing guide that contains the learning objectives, relevant topics of discussion, and room for notes may be useful. Review unanticipated learning objectives generated from the simulation if time permits.
Asking open-ended questions
A key skill that helps to facilitate discussion through reflection and self-assessment on the participants’ behalf. Avoid “yes/no” questions, and instead ask “Can you tell me what happened when…” or “Tell me about this point in the simulation”.
Patience is a virtue for facilitators, as a pause often follows asking an open-ended question. Using silence effectively as a tool allows participants time to critically analyze a situation, form their thoughts, and cogently respond to inquiries.
Many different approaches and models to debriefing exist that differ in their frameworks, conversational style, or level of reflection. The structure for post-event debriefing, however, generally starts with inviting learners to share emotional reactions to the scenario, followed by a deeper analysis and reflection of the events, and finally a summary of lessons learned. Two common and simple approaches are outlined below:
An acronym/cognitive aid that covers the basic principles of a debrief. Advantages of this tool include its adaptability and ease of use for novice facilitators, usefulness in time-limited situations, and it does not require training (however users should familiarize themselves with the tool prior to leading a debrief).
Promoting Excellence and Reflective Learning in Simulation (PEARLS)
Alternatively, the PEARLS Healthcare Debriefing Tool (advocated for by the Royal College Simulation Educators Training) offers a more structured style of debriefing with some scripted language. It integrates three common education strategies used in debriefs: learner self-assessment, facilitating focussed discussion, providing information through directive feedback and/or teaching. For more details and examples of scripted phrases, click here. https://case.edu/nursing/sites/case.edu.nursing/files/2018-05/Article-Eppich-PEARLS.pdf
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Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthc. 2007;2(2):115-125.
So HY, Chen PP, Wong GKC, Chan TTN. Simulation in Medical Education. Journal of the Royal College of Physicians of Edinburgh. 2019;49(1):52-57.
Eppich W, Cheng A. Promoting Excellence and Reflective Learning in Simulation (PEARLS): development and rationale for a blended approach to health care simulation debriefing. Simul Healthc. 2015;10(2):106-115.
Imperial College of London. (2012). The London handbook of debriefing. London: National Health Services.