Debriefing

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”.

Using silence

• 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.