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Performance Review


Debriefing is the process by which students interactively review their performance after completing a simulation exercise. The procedure should be guided by session objectives, course material, and student comments and questions. Instructors should serve as a resource and interject goals and outcomes of the scenario in a positive manner.

But debriefing doesn’t always have to be led by an instructor. Students can also lead a debriefing session provided they've received some training on the process. Student debriefing allows students to take a more active role in the learning process, which reinforces the goals of the simulation. It also prevents the debriefing from becoming a lecture. Instructor-led debriefings have the potential to become subjective and judgmental, which can involve negative statements, such as “You did (or did not) do X.” or “You should’ve done X.”

Determining Objectives
Proper debriefing requires clearly defining objectives for a given simulation. Was it a complicated airway scenario? Or was it a dynamic cardiology scenario to prep the student for the National Registry exam?

Once the objectives are clear, the simulation instructor must focus on them during the debriefing discussion. The goal is to help students think about what they did, how they did it and how they can improve. Ideally, scenarios should be limited to the critical points outlined in the objectives. Overloading the exercise with extraneous points may overwhelm students.

Location & Time
Simulation programs sometimes consist of separate simulation and debriefing areas, which works well if you have enough personnel to manage both areas. Other programs use the same area for simulation and debriefing, which allows instructors to keep all students in the same room, and allows for additional hands-on instructor demonstration and student practice. In either case, the optimal time for debriefing is immediately after the scenario is completed, because it will still be fresh in the students’ and instructors’ minds.

No matter the location, time management is critical. Because debriefings usually last longer than the scenario, be sure to schedule twice as much time for the debriefing as for the exercise so students can critique their performance and the instructors can review critical points.

And if you run out of time, don’t leave your students hanging if they still have questions! Write down each question and answer them before the end of the day. Allow for wrap-up time at the end of the day as well when all students are gathered together.

Getting Started
Prior to starting a debriefing session, all instructors must ask themselves two basic yet important questions: 1) Did the students manage all critical points, and 2) was the patient managed properly? If you answer “yes” to both questions, congratulate your students (and yourself) for doing a good job.

To start a simulation debriefing, ask an open-ended question, such as:

  • How do you feel about your simulation experience?
  • What did you think about the scenario?
  • What are a few of the highlights of the care that you provided to your patient?
  • What went well during your scenario?
  • What would you do differently if you could do it over again?

After asking one of these questions, wait for the students to recall their performance. If the discussion doesn’t start spontaneously after a couple minutes, ask the team leader for their comments.

Remember: Students accept criticism from their peers better than they do from instructors. They are also fairly critical of their own performance, so the instructor must steer the discussion in a positive direction.

Initiating Corrections
If something goes wrong during a simulation, the instructor must make sure the student understands their mistake so they can learn from it.

For example: You’re running a scenario that calls for a defibrillation, and the student forgets to clear everyone before administering the shock.

In response, positively address the oversight: “Nice job on the airway and CPR, but we need to make sure everyone is clear and not in contact with the patient before we administer a defibrillation. Are there any questions?”

Important: Do not interrupt the scenario and/or say something hurtful that criticizes the student or makes them hesitant to continue with the exercise.

The Debrief File
High-fidelity manikin software has the capability to print a report that can be used as an outline and/or checklist of key points that occurred during the scenario. The instructor can add critical points or actions to this report for discussion during the debriefing, if needed.

Tip: During the debrief, avoid reading straight from the report and/or using it to state what was or wasn’t done during the simulation. Instead, take a moment to review the file as the students regroup after the scenario.

Simulation on Video
Many simulation centers incorporate video into their debriefings, which allows students to observe their actions and recount what occurred during critical points of a simulation. However, some people don’t like being photographed or videotaped, especially while their performance is being evaluated. To address students’ concerns, make sure they understand that the video and subsequent playback is for their benefit; it’s a learning tool that won’t be replayed elsewhere or for any other reason. It’s also an illustrative tool to highlight critical points, but it should not be the sole method of debriefing.

Student Surveys
To improve and maintain your simulation program, give your students a survey immediately after the simulation experience to allow them to comment on the program. Limit your survey to about five questions specifically dedicated to the simulation. You may also want to ask how they felt the debriefing aided in their learning process.

When students perceive a simulation program as a positive learning experience, they’re more likely to retain the knowledge and skills learned from that program. The debriefing portion of simulation is critical to this perception. Through positive instructor/student interaction during the debrief, simulation programs will produce students who not only enjoyed their experience, but are well educated and well prepared to face myriad emergency medical situations.

Disclosure: The author has reported no conflicts of interest with the sponsor of this supplement.

This article originally appeared in an editorial supplement to the September 2010 issue of JEMS as “Performance Review: An overview of student debriefing."


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