Please also see case studies. If you have a scenario or case study that you would like to contribute to the SimEd resource portal, please contact us. Here you will find some useful scenarios that have been developed for health professionals and learners.
Please also see scenarios. If you have a scenario or case study that you would like to contribute to the SimEd resource portal, please contact us. Here you will find some useful case studies that have been developed for health professionals and learners.
The brief sets the scene for the simulation, makes the learners aware of what is required of them, and addresses safety and fidelity issues. For inexperienced simulation learners the brief is essential to set up the success of the simulation.
Even for experienced learners, the brief still plays an important role. Policies, procedures, protocols, clinical guidelines and any other resources should be provided in advance for learners to prepare for the session. Learners will be motivated to prepare for the session, especially when they face the prospect of performing in front of their peers.
A brief should address all of the following:
- Set up a safe learning environment – psychological and physical
- Orientation to simulation setting/equipment
- Use of video recording/streaming (if relevant)
- Set the rules for debriefing prior to the simulation
- Identify learning objectives
- Assessment details (if learners are being assessed)
- Provide information about the scenario, the participant tasks and role expectations
- Provide opportunity for participants to clarify points and ask questions
- State if a time out option is available
- Starting cue
Tips for preparing a simulation brief
Don’t give away all of the scenario details in the brief, just provide the information that would usually be available in the context of the simulation. This might be a handover, a referral letter, or a patient medical record.
Some learners will try to predict the scenario events and will be waiting for the patient to ‘crash’. It may be useful to tell learners that this is not going to happen and that there are no surprises in the scenario. This will allow them to focus on the scenario and maximise their learning.
If there is a surprise in the scenario, give a broad description of the events, such as stating that the scenario is about clinical decision making and that the learners will be required to recognise and respond to the patient’s condition.
If learners enter a simulation with an inadequate brief they may be confused about the situation or their role, not understand the setting or equipment, and will be difficult to engage. Providing learners with the information they need to immerse themselves in the situation but still engage in active learning will maximise the value of the simulation experience.
Written by Karen Hall: Swinburne University
The use of simulators alone does not equate to high quality training and it is the role of feedback and debriefing that enables the learner to integrate their learning experience (Imperial College London,2012). Debriefing provides the process whereby the students develop their clinical reasoning through reflection and metacognition (Mariani, Cantrell, Meakim, Prieto, & Dreifuerst, 2013). It is the tool that links theory to practice and research and enables students to critically think and to intervene professionally in complex situations (Anderson et al., 2012; Jeffries, 2005). Debrief is elevated to the most important component of the simulation-based learning experience (Decker et al., 2013). Despite debriefing being common practice post simulation, conflicting views exist as to what is most appropriate or best practice.
Type of debriefing
Video-assisted debriefing once seen as gold standard for debrief may not provide any advantages over facilitator only debrief. A systematic review by Levett-Jones & Lapkin (2012) found that in 4 out of the 6 randomized reviewed control studies there was no statistically significant difference between facilitator and video assisted debriefing in achieving learning outcomes. Similar results were established in the findings of a systematic review on simulation-based training (Lorello, Cook, Johnson, & Brydges, 2014)
Debrief “in simulation” versus debrief “post simulation”
Overall post simulation debriefing was more effective than the debriefing that occurred during simulation ( Dufene &Young ,2014;Levett-Jones & Lapkin, 2012).
Environment in which the debrief takes place
There is significant evidence that experiential learning causes feelings of anxiety in the learner (Decker et al, 2013) .Therefore it remains important to create a safe environment for participant debrief. (Decker et al, 2013).
It should be made clear that there is an expectation of confidentiality as to the simulation scenarios, the participant’s actions and debrief discussions. Rules of conduct must be clear concerning constructive, honest and respectful feedback. Sufficient time is to be allocated in the early phase of reaction in debrief to elicit emotional and cultural responses (Chung 2013), personal responses and experiential reflections. There is also a need for both participants and observers to be active in the debrief process (Decker et al, 2013).
This is further supported by Rudolf (2009) “a psychologically safe environment allows people to share and reflect their feelings, assumptions and opinions as well as to speak up and discuss difficult topics” This can be addressed by stating upfront that simulation can be confusing or developing a contract with rules for engagement and confidentiality (Dreifuerst 2012,p.327; Gardner ,2013). Ideally this should all take place in an area away from the simulation experience (Pivec ,2011).
The person who should facilitates the debrief
International Nursing Association for Clinical Simulation and Learning (INACSL) in their best practice guidelines (2011) for debriefing states that the simulation debrief is to be done by the person who observes the clinical experience with the aim of closing the gap between desired and actual performance (Decker et al., 2013; Edgecombe et al., 2013).
Training of the debrief facilitator
Debriefing facilitators require skill In both diagnosing learning needs of participants and the ability to adjust the level of facilitation needed for the group .In order to achieve this they should have formal training and assessment in debrief (Decker et al., 2013). Competency should be validated through input from learners, those experienced in debrief and assessment instruments.
Identification of learning outcomes
Debriefing should be based on the pre-set learning outcomes of the simulation experience (Decker et al., 2013).The learning objectives set the expectations for the debrief and define the standard of performance expected of the learner ( Rudolph, Simon, Raemer, & Eppich, 2008)
Method of debrief
Debriefing should be based on a structured framework for debrief. It should allow for progression through the identified phases of debrief: reaction, analysis and summary or other similar phases and frames identified (Decker et al., 2013; Mariani et al., 2013).
Table 3: Debrief Models
Study of models found in the literature based on (Pivec, 2011.,Dreifuerst, 2012., Gardner, 2013.,Lusk,2013)
Model or Author Identified Phases
National League for Nursing
Simulation Innovation Resource
The Mayo Clinic Model for
(Mayo Clinic, n.d.)
(Decker, 2009, Jeffries, 2010)
What went well
What would like to change
How to change
(Decker, 2009, Jeffries, 2010)
Statement of observation followed by probing question of inquiry/why?
Systematic reflection and analysis
Intensification and personalization
Generalization and application
(Owens and Follows, 2006)
Fanning & Gaba
3D Model of Debriefing
(Zigmont, Kappus, & Sudikoff,
Edgecombe ,K., Seaton, P., Monahan, K., Meyer, S., La Page ,S., & Erlam, G,2013
Set learning goals ,
How did it go,:
Review learning points,
Plan ahead future practice
Conclusion and best practice guidelines
In summary best practice for debrief has been graded using the Joanna Briggs hierarchy of evidence (2014).
- Debriefing after simulation based learning for health care students leads to the significant increase in the confidence of their ability to care for the unstable patient (Buckley et al., 2012; Dufrene & Young, 2014)(Level 4d and Level 1b)
- Facilitator only debriefing is as effective as facilitator and video assisted debriefing in achieving learning outcomes (Levett-Jones & Lapkin, 2012, 2013; Lorello et al., 2014; Reed et al., 2013)(Level 1a,Level 1b,Level 2c)
- Debriefing is more effective when it immediately follows the simulated clinical experience in terms of knowledge and confidence (Dufrene & Young, 2014; Levett-Jones & Lapkin, 2012)(Level 1b,Level 1a)
- There is a need to create a safe environment and confidentiality for debriefing to be effective in simulation based learning.(Decker et al., 2013; Dreifuerst, 2012)(Level 5b,Level 2d,)
- The debrief facilitator should be formally trained in debriefing (Decker et al., 2013; Dufrene & Young, 2014) .(level 5b,level 1a)
- The debrief facilitator’s competency should be assessed through input from learners, practice in simulated environments and assessment instruments (Decker et al., 2013; Gardner, 2013)(level 5b,Level5b)
- The person who observes the simulation should be the person who facilitates the debrief. (Decker et al., 2013; Dufrene & Young, 2014; Edgecombe et al., 2013)(Level 5b,Level 1b ,Level 1b)
- Debriefing should be based on the pre-set learning outcomes.(Decker et al., 2013; . Rudolph et al., 2008; Rudolph et al., 2013)(Level 5b,level 5b)
- Debriefing should be based on a structured framework, however researchers differ about which framework is most effective (Decker et al., 2013; Dreifuerst, 2012; Gardner, 2013; Mariani et al., 2013; Jaeger,2012) (Level 5b,level 2d,Level 5c,Level 2c Level 1b)
Buckley, S., Hensman, M., Thomas, S., Dudley, R., Nevin, G., & Coleman, J. (2012). Developing interprofessional simulation in the undergraduate setting: Experience with five different professional groups. Journal of Interprofessional Care, 26(5), 362-369. doi: doi:10.3109/13561820.2012.685993
Chung,H.S.,Dieckmann,P.,Saul,B.I.(2013). It Is Time to Consider Cultural Differences in Debriefing.Society for Simulation in Healthcare 8, 166-170.
Decker, S., Fey, M., Sideras, S., Caballero, S., Rockstraw, L., Boese, T., Borum, J. C. (2013). Standards of Best Practice: Simulation Standard VI: The Debriefing Process. Clinical Simulation in Nursing, 9(6), S26-S29.
Dufrene, C., & Young, A. (2014). Successful debriefing — Best methods to achieve positive learning outcomes: A literature review. Nurse education today, 34(3), 372-376.
Edgecombe,K., Seaton, P., Monahan, K., Meyer, S., LaPage, S., & Erlam, G. (2013). Clinical Simulation in Nursing:A literature review and guidelines for practice. Aotearoa: AKO National Centre for tertiary teaching excellence.
Gardner, R. (2013). Introduction to debriefing. Seminars in Perinatology, 37(3), 166-174. doi: 10.1053/j.semperi.2013.02.008
Health Workforce Australia, H. W. (2010). Use of simulated Learning environments(SLE)in Professional Entry Level Curricula of selected professions in Australia. Adelaide: HWA.gov.au Retrieved from http://www.hwa.gov.au/sites/uploads/simulated-learning-environments-2010-12.pdf
Imperial College of London(2012).The London handbook of debreifing.London:National Health services.
Kelly, M. A., Hager, P., & Gallagher, R. (2014). What Matters Most? Students' Rankings of Simulation Components That Contribute to Clinical Judgment. Journal of Nursing Education, 53(2), 97-101. doi: http://dx.doi.org/10.3928/01484834-20140122-08
Levett-Jones, T., & Lapkin, S. (2012). The effectiveness of debriefing in simulation-based learning for health professionals: A systematic review. 2014.
Levett-Jones, T., & Lapkin, S. (2013). A systematic review of the effectiveness of simulation debriefing in health professional education. Nurse education today.
Lorello, G. R., Cook, D. A., Johnson, R. L., & Brydges, R. (2014). Simulation-based training in anaesthesiology: a systematic review and meta-analysis. British Journal of Anaesthesia, 112(2), 231-245. doi: http://dx.doi.org/10.1093/bja/aet414
Mariani, B., Cantrell, M. A., Meakim, C., Prieto, P., & Dreifuerst, K. T. (2013). Structured Debriefing and Students' Clinical Judgment Abilities in Simulation. Clinical Simulation in Nursing, 9(5), e147-e155. doi: http://dx.doi.org/10.1016/j.ecns.2011.11.009
Pivec, C. R.J, (2011). Debriefing after simulation:Guidelines for Faculty students. (Master of Arts in Nursing), St Catherine University, St Paul,Minnesota. Retrieved from http://sophia.stkate.edu/cgi/viewcontent.cgi?article=1013&context=ma_nursing&sei-redir=1&referer=http%3A%2F%2Fwww.bing.com%2Fsearch%3Fq%3Ddebriefing%2520after%2520simulation%2520guideline%26FORM%3DTSHPLB%26PC%3DMATP%26QS%3Dn#search=%22debriefing%20after%20simulation%20guideline%22 (14)
Reed, S. J., Andrews, C. M., & Ravert, P. (2013). Debriefing Simulations: Comparison of Debriefing with Video and Debriefing Alone. Clinical Simulation in Nursing, 9(12), e585-e591. doi: http://dx.doi.org/10.1016/j.ecns.2013.05.007
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. doi: 10.1111/j.1553-2712.2008.00248.x
Rudolph, J. W. P., Foldy, E. G. P., Robinson, T. R. N., Kendall, S. M. A., Taylor, S. S. P., & Simon, R. E. (2013). Helping Without Harming: The Instructor's Feedback Dilemma in Debriefing-A Case Study. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 8(5), 304-316.
What were you expecting for the session?
What I didn’t expect is how real the scenario felt. You could feel the students working with the simulated patient as if it was a real hospital setting. It was like being a fly on the wall as the students conducted their patient assessments and educations.
What were your concerns/worries going into the session?
I was concerned that simulation would be stressful for the students, especially allied health students who do not have many opportunities to participate in simulation. Whilst the students were challenged, the environment that was created was supportive and facilitated learning. The mutual respect and curiosity demonstrated by the participants contributed to this learning environment.
What support did you need (and did you get enough support)?
Simulation is resource intensive. The simulation required two simulated patients, two facilitators, 1 to 2 confederate positions and a technician! However the opportunities for learning are priceless!
What preparation did you have to do?
It was important to observe a simulation session and understand some of the theory before co-facilitating a session. Learning from an experienced facilitator provides you with some example questions to ask and understanding of how the group will run. Writing a small part of the scenario also reinforced the planning that is required from pre-reading for the participants, giving instructions to the simulated patient and ensuring the resources are in place to run the scenario.
Did it go as planned?
Yes, the simulations did go as planned. The overall theme of the day was team work, communication and the importance of interprofessional practice. The feedback from the students indicated that they too identified the importance of team work, communication and interprofessional practice in patient care. Interestingly the simulation experience was slightly different for the two student groups. Depending on the disciplines present, actions of the students and interactions with the simulated patient the same scenario can provide students with a slightly different experience.
Why do it at all? (What were your motivations?)
Simulation offers a learner-centred, active teaching strategy that provides a controlled environment in which students can practise and learn without harm to patients or themselves. Team-based simulation promotes interprofessional practice and improves communication and teamwork.
Post simulation debriefing is an essential component of the simulation based education learning activity, where by the facilitator guides the participants through an evidenced based approach to facilitate consolidation of the simulations aim and goals.
The post simulation debriefing space needs to be set in a safe and private learning environment where participants are facing one another to share thoughts and insights without risk of reprisal or humiliation.
Effective debriefing is key to learning from the clinically simulated context, validated methods such as ‘Debriefing for Meaningful Learning’ DML™ or ‘Gather Analyse Summarise’ GAS™ are examples utilised to guide participant dialogue. The approach is important to begin by allowing participants to let go of emotions, have every person involved in the discussion as a facilitator, use words and body language to bring the focus to the debrief, bring the discussion to ‘what happened’.
Ensure all participants are on the same page in regard to the aim of the simulation therefore meaningful critical thought processes can begin about why decisions were made, what assessments were carried out and what outcomes came from these.
Facilitators must craft questions to advocate on behalf of the participant whilst also exploring why certain interventions or decisions were made. Use Socratic dialog to spark deeper thought processes for example: Tell me more about that? What did this mean to you? When you saw that what did you think about?
Ensure learners actions and thinking match, many times they do the right things for the wrong reasons, peel back the layers as far as you can to explore thought processes.
As a facilitator challenge participants assumptions, acknowledge and expand their thinking and actions. Make evident thinking like a clinician, inspire a spirit of inquisitive reflective thinking.
Encourage learner thinking to individualise care to the needs of the patient at the same time applying consistency of care across populations. The ultimate goal of debriefing is to encourage participants to personally reflect on their approach to clinical practice and inspire improvement.
Therese Worme is an educator for La Trobe Rural Health School.
There are some great video's on effective debriefing to help support educators when running a simulation. Here are the links to some handy video resources.
Found a great video or resource? Make sure you share it with us at SimEd by contributing.
Introduction to Debriefing
Presented by the author of the Neonatal Stabilization Scenarios, Kris Karlsen PhD, Advanced Practice Registered Nurse/NNP-BC and Medical Director of Simulation for The S.T.A.B.L.E. Program, JoDee Anderson, MD, MEd., Neonatologist.
Simulation in Health Care: Debriefing in Healthcare Simulation Basic Skills
The Royal College of Physicians and Surgeons of Canada presents: Simulation in Health Care Video Series
Learn the foundational principles for simulation-based education, assessment and research from renowned simulation experts.
These learning resources will appeal to all educators who are interested in simulation in health care.
Debriefing with good judgement
Here you'll find another video resource from Danielle Hart MD explaining debriefing with good judgement. This video has great references which are also worth looking at. Danielle provides a great overview of how to debrief.
Narrative theory suggests that humans respond favourably to messages presented a narrative framework as we organise our experiences and memory in the form of stories. Narrative or storytelling is one of the earliest means of retaining knowledge and distributing it to others (Fiore, Johnston, & McDaniel, 2007).
The macro-narrative of a scenario is the overall storyline or sequence of events in the scenario. The micro-narrative is the story of each participant in the scenario.
Each individual will have a different experience and understanding of scenario events. By forming their own micro-narrative, scenario participants need to organise the sequence, meaning, priority and significance of scenario events, which requires critical and reflective thinking.
In their book chapter from Toward a science of distributed learning, Fiore, Johnston and McDaniel (2007) present an overview of the features of narrative and how to introduce these when debriefing simulation based exercises. They argue that to correctly interpret the simulation story, one must be able to identify and understand critical events and their consequences. The debriefer will require a knowledge of narrative features, and issues to be mindful of, such as participants developing excuses and alibis, to be able to lead a structured debrief.
This is thought-provoking reading for those involved in scenario design or debriefing and offers some valuable suggestions for improving the learning value of simulation-based experiences.
Fiore, S. M., Johnston, J., & McDaniel, R. (2007). Narrative theory and distributed training: Using the narrative form for debriefing distributed simulation-based exercises.