Essential elements of educational debriefing in clinical simulation
DOI:
https://doi.org/10.22201/fm.30617243e.2025.4.111Keywords:
debriefing, clinical simulation, reflective learningAbstract
Educational debriefing is a central element in clinical simulation, as it is a structured process that transforms the simulation experience into meaningful learning through critical reflection. This review article explores its essential components, from its origins in military and aviation contexts to its current application in health sciences education. It is described as a guided conversation following a simulation, aimed at analyzing what occurred during the scenario to strengthen both clinical and metacognitive skills.
Key aspects are addressed, such as the ideal timing and setting for debriefing, its duration, widely used models like PEARLS, Diamond, GAS, 3D, among others, the necessary competencies of the debriefer, and the various participants involved in the conversation. The importance of selecting relevant educational objectives, the phases for implementation, and strategies for evaluating debriefing quality using tools such as DASH, SET-M, and OSAD are discussed. It also covers the knowledge, skills, abilities, and other attributes that debriefers must possess to carry out this activity, as well as how they can be trained for it. Finally, the article discusses key challenges in its application, including managing psychological safety and the facilitator’s cognitive load.
This article offers a starting guide for clinical educators, emphasizing the ongoing training of debriefers and the need to adapt to diverse educational settings.
References
Bañuelos-Ortiz, E., Vargas-Aguilar, D. M., García-Ezquerro, C., Cortés-Martínez, L., Martínez-Nápoles, A. R., & Morales-Maza, J. (2020). Debriefing: un recurso necesario en el aprendizaje / Debriefing: a necessary resource in learning. Anestesia en México, 32(3), 19–27.
Berger-Estilita, J., Lüthi, V., Greif, R., & Abegglen, S. (2021). Communication content during debriefing in simulation-based medical education: An analytic framework and mixed-methods analysis. Medical Teacher, 43(12), 1381–1390. https://doi.org/10.1080/0142159X.2021.1948521
Center for Medical Simulation. (2019). Evaluación del Debriefing para la Simulación en Salud (EDSS): Manual del Evaluador (versión traducida y validada lingüística y culturalmente al español). Center for Medical Simulation.
Cheng, A., Eppich, W., Grant, V., Sherbino, J., Zendejas, B., & Cook, D. A. (2014). Debriefing for technology-enhanced simulation: A systematic review and meta-analysis. Medical Education, 48(7), 657–666. https://doi.org/10.1111/medu.12432
Cheng, A., Eppich, W., Kolbe, M., Meguerdichian, M., Bajaj, K., & Grant, V. (2020). A conceptual framework for the development of debriefing skills: A journey of discovery, growth, and maturity. Simulation in Healthcare, 15(1), 55–60. https://doi.org/10.1097/SIH.0000000000000398
Cheng, A., Palaganas, J., Eppich, W., Rudolph, J., Robinson, T., & Grant, V. (2015). Co-debriefing for simulation-based education: A primer for facilitators. Simulation in Healthcare, 10(2), 69–75. https://doi.org/10.1097/SIH.0000000000000077
Dieckmann, P., Friis, S. M., Lippert, A., & Østergaard, D. (2009). The art and science of debriefing in simulation: Ideal and practice. Medical Teacher, 31(7), e287–e294. https://doi.org/10.1080/01421590902866218
Eppich, W., & Cheng, A. (2015). Promoting Excellence and Reflective Learning in Simulation (PEARLS): Development and rationale for a blended approach to health care simulation debriefing. Simulation in Healthcare, 10(2), 106–115. https://doi.org/10.1097/SIH.0000000000000072
Fanning, R. M., & Gaba, D. M. (2007). The role of debriefing in simulation-based learning. Simulation in Healthcare, 2(2), 115–125. https://doi.org/10.1097/SIH.0b013e3180315539
Gardner, R. (2013). Introduction to debriefing. Seminars in Perinatology, 37(3), 166–174. https://doi.org/10.1053/j.semperi.2013.02.008
Imperial College London. (2010). The London Handbook for Debriefing: Enhancing Performance Debriefing in Clinical and Simulated Settings.
Imperial College London INACSL Standards Committee. (2016). INACSL standards of best practice: SimulationSM-Debriefing. Clinical Simulation in Nursing, 12(S), S21–S25. https://doi.org/10.1016/j.ecns.2016.09.008
Jaye, P., Thomas, L., & Reedy, G. (2015). The Diamond: A structure for simulation debrief. The Clinical Teacher, 12(3), 171–175. https://doi.org/10.1111/tct.12300
Johnson, B. K. (2019). Simulation observers learn the same as participants: The evidence. Clinical Simulation in Nursing, 33, 26–34. https://doi.org/10.1016/j.ecns.2019.04.006
Kolbe, M., Eppich, W., Rudolph, J., Meguerdichian, M., Catena, H., Cripps, A., Grant, V., & Cheng, A. (2019). Managing psychological safety in debriefings: a dynamic balancing act.
BMJ Simulation and Technology Enhanced Learning, 5(2), 87–94. https://doi.org/10.1136/bmjstel-2019-000470
Kolbe, M., Grande, B., & Spahn, D. R. (2015). Briefing and debriefing during simulation-based training and beyond: Content, structure, attitude and setting. Best Practice & Research Clinical Anaesthesiology, 29(1), 87–96. https://doi.org/10.1016/j.bpa.2015.01.002
McMullen, M., Wilson, R., Fleming, M., Mark, D., Sydor, D., Wang, L., Zamora, J., Phelan, R., & Burjorjee, J. E. (2016). “Debriefing-on-demand”: A pilot assessment of using a “pause button” in medical simulation. Simulation in Healthcare, 11(3), 157–163. https://doi.org/10.1097/SIH.0000000000000140
Olvera-Cortés, H. E., Argueta-Muñoz, F. D., Hershberger del Arenal, R., Hernández-Gutiérrez, L. S., & Gutiérrez-Barreto, S. E. (2022). Evidencias de validez de la versión en español del Simulation Effectiveness Tool - Modified (SET-M) aplicado en telesimulación. Educación Médica, 23(2), 100730. https://doi.org/10.1016/j.edumed.2022.100730
Oriot, D., & Alinier, G. (2018). Pocket book for simulation debriefing in healthcare. Springer International Publishing. https://doi.org/10.1007/978-3-319-59882-6
Rudolph, J. W., Simon, R., Dufresne, R. L., & Raemer, D. B. (2006). There’s no such thing as “nonjudgmental” debriefing: A theory and method for debriefing with good judgment. Simulation in Healthcare, 1(1), 49–55. https://doi. org/10.1097/01266021-200600110-00006
Rudolph, J. W., Simon, R., Raemer, D. B., & Eppich, W. J. (2008). Debriefing as formative assessment: Closing performance gaps in medical education. Academic Emergency Medicine, 15(11), 1010–1016. https://doi.org/10.1111/j.1553-2712.2008.00248.x
Sawyer, T., Eppich, W., Brett-Fleegler, M., Grant, V., & Cheng, A. (2016). More than one way to debrief: A critical review of healthcare simulation debriefing methods. Simulation in Healthcare, 11(3), 209–217. https://doi.org/10.1097/SIH.0000000000000148
Seelandt, J. C., Walker, K., & Kolbe, M. (2021). “A debriefer must be neutral” and other debriefing myths: A systemic inquiry-based qualitative study of taken-for-granted beliefs about clinical post-event debriefing. Advances in Simulation, 6, 7. https://doi.org/10.1186/s41077-021-00161-5
Tangpaisarn, T., Phrampus, P. E., & O’Donnell, J. M. (2025). Debriefing. En Navigating healthcare simulation (pp. 67–77). Springer. https://doi.org/10.1007/978-3-031-81265-1_9
Zigmont, J. J., Kappus, L. J., & Sudikoff, S. N. (2011). The 3D Model of Debriefing: Defusing, Discovering, and Deepening. Seminars in Perinatology, 35(2), 52–58. https://doi.org/10.1053/j.semperi.2011.01.003
