“Learning without reflection is a waste. Reflection without learning is dangerous.”-Confucius

Debriefing is arguably the most crucial part of a simulation activity. It allows the learner the opportunity to self-reflect on performance and choices made. This reflection can include understanding actions or skills related to the cognitive and affective domains.

Debriefing fosters an opportunity for the learner to understand, analyze and self-evaluate their performance during a simulation activity. In an effective debriefing, learners can identify what they felt and thought and how it led to their actions in a simulation exercise.

Debriefing shouldn’t be confused with feedback, which is an instructor-driven overview of observations. Debriefing is learner-centered discussion and self-reflection that results in a positive, outcome-driven learning experience.
In contrast, feedback typically consists of telling the learner what went right and what went wrong. And although feedback can occur in debriefing it should be tempered through the learners reflecting on their own performance and the choices that were made during the simulation activity.

Simulation education is considered a safe learning environment, and debriefings shouldn’t be punitive in nature nor should they allow for belittling of a learner by the instructor or peers. This is a paramount rule to engage the learner while fostering understanding and learning in a vulnerable setting.

Planning

The first step is to orient the learners on the concepts of debriefing and the rules of participation to ensure they’re engaged and understand the process. This will help to ensure there’s a safe learning environment.

This can be accomplished and addressed by introducing an overall policy when the group of students first convenes and then reviewing highlights at every briefing prior to a simulation activity.

Brainstorming debriefing questions based on the activity’s learning objectives can also help streamline the debriefing and allow for standardized learner engagement. Some basic considerations for the debriefing should include:

Group size: How many learners are participating? The more participants, the more facilitation that needs to be accomplished.

Simulation objectives: Were the objectives met by the performance in the simulation activity? The debrief should focus and map to the objectives of the simulation; extraneous discussion or information may distract from learner self-reflection.

Evaluation: Which type of assessment is this, formative or summative? Typically, a summative assessment is pass or fail activity and isn’t considered a formative simulation whereby learning is to take place. If this is a summative assessment, debriefing isn’t indicated.

Evidence-based practice: How will you incorporate evidence-based practice into the debriefing? Discussing research with a health profession librarian can assist with being informed about current evidence-
based practice.

Time: There’s no research data to support a specific amount of time being required for an effective debriefing. In fact, time can be highly variable depending on the activity, experience level of learners, and the facilitator. It’s important that learners take time to reflect on their actions and understand the learning objectives for the activity.

Digital recordings: Will audio/video recordings be incorporated into the debriefing? This is a much-debated topic, as it opens up concerns related to privacy. Should A/V be used, there should be a program policy in place about the use of digital recordings. The policy should also address confidentiality and video retention.

Basic Methods

There are multiple methods or styles of debriefing. Debriefing is an art and choosing a style is a personal choice. Facilitators may use different methods depending on the objectives or theme of the simulation activity. No matter which method is used, it’s important that the debriefing is mapped to the simulation outcome goals and performance objectives.

All debriefing activities should allow learners to express their feelings (i.e., defuse) about the event, analyze (i.e., self-reflect) on their performance, and then summarize their take-home message (i.e., learning).

Take-home messages should include how to sustain the things that were done correctly and modifying the actions that were performed incorrectly during the activity.

The Gather, Analyze and Summarize (GAS) method is a debriefing method which can be quickly mastered by most educators. The educator will facilitate the session while learners gather and discuss their feelings and experience about the encounter.

The learners then analyze by self-reflecting on their performances during the encounter. Finally, they will summarize what they have learned during the encounter

Advocacy-Inquiry is a method that identifies the actions of the learners and then inquires, using open-ended questions, to allow for self-reflection on why actions were taken during the simulation activity.

Plus/Delta is a common and easier method of performing a debriefing using the “what went right” and “what went wrong” approach. The approach consists simply of asking “how was this for you?” and then moving to what the participant felt was right and wrong and why.

There are many other debrief methods; however, these may require actual educator training on the techniques and methods to utilize them safely and properly. The key of any debriefing is to facilitate the debrief and keep it learner-centered and safe. The debriefing is not an educator-centered activity.

Challenges

There are some common challenges every educator will face while facilitating a debriefing of learners.

Some learners may become disengaged and others may become too engaged during the debriefing. Both scenarios affect learners and the quality of the debriefing. The facilitator must be adept and drawing in disengaged learners while reeling in the overzealous learner so that all are engaged equally.

Time is also another great challenge affecting educators. Educational schedules are tight and reduced staff and other distractors cut into the time available for effective debriefing.

The educator must be diligent in scheduling a meaningful debriefing as part of the simulation encounter. Failing to allot the proper time robs the learner of self-reflection and understanding of performance, and it robs the educator from identifying “why” a specific behavior was performed by the learner.

Evaluation

One aspect of debriefing that’s very important and often overlooked is the evaluation of the actual debriefings themselves. Consider it a debriefing of the debriefing.

This can be assessed by not only the learners, but by peer faculty as well. The end goal is to get a 360-degree view of the entire encounter. The evaluation of the debriefing itself provides valuable feedback for process improvement for the educator.

Again, as with the debriefing, there are multiple tools and best practices which can be beneficial to educators for the quality improvement of their debriefings and ensure learning is taking place during simulations.

Conclusion

Anyone delivering simulation-based education should have an understanding of the best practices of facilitating a debriefing so learners can be impacted in a meaningful way that enhances their learning.

Facilitating a debriefing is a learned skill that takes practice and with experience it can be mastered over time. Every educator must understand it takes time to master this delicate skill and not one method is suited for every educator or learning environment.

An effort made in expanding your knowledge of debriefing techniques will help educators assist learners in understanding and improving their performance. We encourage every educator to incorporate best practices of debriefing into their simulation practice. 

Resources

• Decker S, Fey M, Sideras S, et al. Standards of best practice: Simulation standard VI: The debriefing process. Clinical Simulation in Nursing. 2013;9(6):S26-S29.

• Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthc. 2007;2(2):115-125.

• Rudolph JW, Simon R, Raemer DB, et al. Debriefing as formative assessment: Closing performance gaps in medical education. Acad Emerg Med. 2008;15(11):1010-1016.

• Sawyer T, Eppich W, Brett-Fleegler M, et al. More than one way to debrief: A critical review of healthcare simulation debriefing methods. Simul Healthc. 2016;11(3):209-217.

• Waxman KT. The development of evidence-based clinical simulation scenarios: Guidelines for nurse educators. J Nurs Educ. 2010;49(1):29-35.