Debriefing in Healthcare Simulation

Debriefing in Healthcare Simulation: Styles, Techniques, and Concerns

Debriefing is a vital component of healthcare simulation that promotes reflection, learning, and improvement. It involves structured discussions after simulation sessions to analyze performance, explore thought processes, and enhance skills. Various styles and techniques can be employed to facilitate effective debriefing. Additionally, there are concerns that should be considered to ensure the debriefing process is successful. Let’s explore these aspects:

Styles of Debriefing:

  1. Guided Reflection: Facilitators ask open-ended questions to encourage learners to reflect on their actions, thought processes, and emotions. This style fosters critical thinking and metacognitive skills.

  2. Directive Debriefing: Facilitators take an active role, providing feedback, explanations, and suggestions for improvement. This approach offers more structure and guidance.

  3. Summative Debriefing: A comprehensive evaluation of learners’ performance against specific objectives is conducted at the end of the simulation session. Feedback is provided for assessment purposes.

  4. Formative Debriefing: Immediate feedback is provided during the simulation session to enhance learners’ performance. Strengths and areas for improvement are addressed with actionable suggestions.

  5. Peer Debriefing: Learners provide feedback and insights to each other, guided by a facilitator. This approach encourages collaboration and the sharing of diverse perspectives.

  6. Co-Debriefing: Multiple facilitators work together to conduct the debriefing session, enabling a comprehensive analysis of different aspects simultaneously.

Debriefing Techniques:

  1. Plus/Delta: Participants share positive aspects (“pluses”) and areas for improvement (“deltas”) about the simulation experience to encourage balanced discussions.

  2. Three-Phase Debriefing Technique: Simulation is discussed in three stages: description, analysis, and application. Participants provide a factual account, explore thoughts and actions, and discuss application to clinical practice.

  3. Advocacy-Inquiry: The facilitator switches between being an advocate, supporting participants’ actions, and an inquirer, asking questions to delve into thought processes.

  4. Praise-Suggestion-Question (PSQ): Specific praise is given for positive actions, suggestions for improvement are offered, and open-ended questions promote reflection.

  5. Stop-Start-Continue: Participants identify elements to stop, start, or continue in future simulations, reflecting on what worked well, areas for improvement, and important aspects to maintain.

  6. Multiphase Debriefing Techniques: The debriefing process is divided into multiple stages, focusing on different aspects like technical skills, communication, teamwork, or clinical reasoning.

Concerns in Debriefing:


  1. Psychological Safety: Creating a safe and non-judgmental environment is crucial for learners to share their thoughts and experiences without fear of criticism.

  2. Facilitator Competence: Facilitators should possess the necessary knowledge, skills, and experience to conduct effective debriefing sessions.

  3. Time Constraints: Adequate time must be allocated for debriefing to allow for thorough discussions and reflection.

  4. Feedback Delivery: Feedback should be specific, constructive, and focused on observed performance and learning objectives.

  5. Emotional Impact: Debriefing can evoke strong emotions in participants. Facilitators should be mindful of participants’ emotional well-being and provide appropriate support.

  6. Confidentiality: Respecting the confidentiality of the simulation experience and participants’ disclosures is essential to foster trust and open communication.