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Healthcare Simulation Standards of Best PracticeTM The Debriefing Process

      Abstract

      KEYWORDS

      As the science of simulation continues to evolve, so does the need for additions and revisions to the Healthcare Simulation Standards of Best PracticeTM. Therefore, the Healthcare Simulation Standards of Best PracticeTM are living documents.

      Standard

      All simulation-based educational (SBE) activities must include a planned debriefing process. This debriefing process may include any of the activities of feedback, debriefing, and/or guided reflection. This facilitated process is accomplished using multiple techniques and must be based on theoretical frameworks and/or evidence-based concepts. The debriefing process needs to be adaptable to all simulation-based modalities. In this standard, the term ``process" refers to feedback, debriefing, and/or guided reflection except when indicated.
      The process aims to identify and resolve gaps in knowledge, skills, attitudes, and communication related to the individual, team, and/or system. The goal of the debriefing process is to assist in the development of insights, improve future performance, and promote the transfer and integration of learning to practice. Although the planned session for implementing the debriefing process should not be an additional lecture opportunity, much learning occurs during this time.

      Background

      Learning is dependent on the integration of experience and conscious consideration or reflection of the activity. Conscious reflection, the self-monitoring or insightfulness that occurs within or after an SBE, allows learners the opportunity to identify knowledge gaps and understand contradictions between one's vision or actions and actual practice
      • Lioce L.
      • Downing D.
      • Chang T.P.
      • Robertson J.M.
      • Andersoon M.
      • Diaz D.A.
      • Spain A.E.
      Healthcare Simulation Dictionary.

      Schön, D. A. (1984). The reflective practitioner: How professionals think in action(Vol. 5126): Basic books.

      • Rodgers C.
      Defining reflection: Another look at John Dewey and reflective thinking.
      • Rudolph J.W.
      • Simon R.
      • Rivard P.
      • Dufresne R.L.
      • Raemer D.B.
      Debriefing with good judgment: combining rigorous feedback with genuine inquiry.
      . Conscious reflection assists an individual in developing insights by connecting thoughts, beliefs, and action

      Schön, D. A. (1984). The reflective practitioner: How professionals think in action(Vol. 5126): Basic books.

      ,
      • Benner P.
      From novice to expert: Excellence and power in clinical nursing practice.
      • Dewey J.
      How we think: A restatement of the relation of reflective thinking to the educative process.
      • Kolbe M.
      • Grande B.
      • Spahn D.R.
      Briefing and debriefing during simulation-based training and beyond: Content, structure, attitude and setting.

      Schön, D. A. (1987). Educating the reflective practitioner.

      • McMullen M.
      • Wilson R.
      • Fleming M.
      • Mark D.
      • Sydor D.
      • Wang L.
      • Zamora J.
      • Phelan R.
      • Burjorjee J.E.
      Debriefing-on-Demand”: A Pilot Assessment of Using a “Pause Button” in Medical Simulation.
      . The debriefing process of an SBE activity can be integrated at designated points (debriefing-on-demand) and/or as a post-scenario activity.
      The debriefing process includes three different strategies or techniques (feedback, debriefing, and/or guided reflection). It is important to note that no particular strategy or technique is necessarily preferential and more than one may be implemented. The type or combination of techniques (blended approach) selected depends on the level or type of learner, desired learning, and/or evaluation outcomes of the simulation-based experience
      • Cheng A.
      • Grant V.
      • Robinson T.
      • Catena H.
      • Lachapelle K.
      • Kim J.
      • Adler M.
      • Eppich W.
      The promoting excellence and reflective learning in simulation (PEARLS) approach to health care debriefing: A faculty development guide.
      • Cheng A.
      • Morse K.J.
      • Rudolph J.
      • Arab A.A.
      • Runnacles J.
      • Eppich W.
      Learner-centered debriefing for health care simulation education: lessons for faculty development.
      • Committee I.S.
      INACSL standards of best practice: SimulationSM simulation glossary.
      .
      • Feedback is a unidirectional process where “information [is] transferred between learner, facilitator, simulator, or peer(s) with the intention of improving the understanding of concepts or aspects of performance.” (p. 18)
        • Lioce L.
        • Downing D.
        • Chang T.P.
        • Robertson J.M.
        • Andersoon M.
        • Diaz D.A.
        • Spain A.E.
        Healthcare Simulation Dictionary.
        . Feedback can be delivered by a facilitator, a technological device, a computer, a standardized patient (or a simulated person), or by other learners as long as it is part of the learning process
        • Lioce L.
        • Downing D.
        • Chang T.P.
        • Robertson J.M.
        • Andersoon M.
        • Diaz D.A.
        • Spain A.E.
        Healthcare Simulation Dictionary.
        ,
        • Lefroy J.
        • Watling C.
        • Teunissen P.W.
        • Brand P.
        Guidelines: the do's, don'ts and don't knows of feedback for clinical education.
        ,
        • Verkuyl M.
        • Lapum J.L.
        • Hughes M.
        • McCulloch T.
        • Liu L.
        • Mastrilli P.
        • Romaniuk D.
        • Betts L.
        Virtual gaming simulation: Exploring self-debriefing, virtual debriefing, and in-person debriefing.
        .
      • Debriefing is a bidirectional, “formal, collaborative, reflective process within the simulation learning activity” (p. 14)
        • Lioce L.
        • Downing D.
        • Chang T.P.
        • Robertson J.M.
        • Andersoon M.
        • Diaz D.A.
        • Spain A.E.
        Healthcare Simulation Dictionary.
        . The debriefing encourages learners’ reflective thinking and can be integrated at designated points within an SBE activity or as a post-scenario activity. A debriefing session can be divided into several phases. During the description phase, learners are reminded of the objectives of the simulation and purpose of the debriefing. The reaction/defuse phase allows learners to explore their reactions to the experience. During the analysis/discovery phase, the facilitator assists the learners’ exploration into the experiences, facilitates understanding of material, and helps identify knowledge gaps. The summary/application phase provides an opportunity to recap the experience, identify insights, and allows exploration of how the knowledge, skills, and attitudes of the experience could be transferred to the actual patient care environment
        • Sawyer T.
        • Eppich W.
        • Brett-Fleegler M.
        • Grant V.
        • Cheng A.
        More than one way to debrief: a critical review of healthcare simulation debriefing methods.
        ,
        • Al Sabei S.D.
        • Lasater K.
        Simulation debriefing for clinical judgment development: A concept analysis.
        .
      • Guided reflection is a process by which facilitators encourage learners to explore the critical elements of an experience in an effort to gain understanding and insight. Guided reflection, an intellectual and affective activity, promotes the linkage of theory with practice and research (p. 20). Guided reflection can be integrated into a debriefing or be accomplished through an exercise following the SBE event such as journaling and open discussions (p. 20)
        • Lioce L.
        • Downing D.
        • Chang T.P.
        • Robertson J.M.
        • Andersoon M.
        • Diaz D.A.
        • Spain A.E.
        Healthcare Simulation Dictionary.
        .
      Clinical reasoning and reflective thinking are promoted by the appropriate integration of feedback, debriefing, and/or guided reflection
      • Al Sabei S.D.
      • Lasater K.
      Simulation debriefing for clinical judgment development: A concept analysis.
      • De Beer M.
      • Mårtensson L.
      Feedback on students' clinical reasoning skills during fieldwork education.
      • Miraglia R.
      • Asselin M.E.
      Reflection as an educational strategy in nursing professional development: An integrative review.
      . The debriefing process promotes understanding, enhances learning, increases competence in clinical performance, and supports transfer of knowledge, skills, and attitudes
      • Forneris S.G.
      • Neal D.O.
      • Tiffany J.
      • Kuehn M.B.
      • Meyer H.M.
      • Blazovich L.M.
      • Holland A.
      • Smerillo M.
      Enhancing clinical reasoning through simulation debriefing: A multisite study.
      • Reierson I.Å.
      • Haukedal T.A.
      • Hedeman H.
      • Bjørk I.T.
      Structured debriefing: What difference does it make?.
      • Ryoo E.N.
      • Ha E.-H.
      The importance of debriefing in simulation-based learning: comparison between debriefing and no debriefing.
      while fostering self-confidence, -awareness, and -efficacy
      • Verkuyl M.
      • Hughes M.
      • Atack L.
      • McCulloch T.
      • Lapum J.L.
      • Romaniuk D.
      • St-Amant O.
      Comparison of self-debriefing alone or in combination with group debrief.
      ,
      • Morgan P.
      • Tarshis J.
      • LeBlanc V.
      • Cleave-Hogg D.
      • DeSousa S.
      • Haley M.
      • Herold-Mcllroy J.
      • Law J.
      Efficacy of high-fidelity simulation debriefing on the performance of practicing anaesthetists in simulated scenarios.
      . The focus of this process is the acknowledgement and integration of best practices to promote safe, quality patient care, and foster the development of the learner's professional and clinical role.
      • Kolbe M.
      • Grande B.
      • Spahn D.R.
      Briefing and debriefing during simulation-based training and beyond: Content, structure, attitude and setting.
      ,
      • Fanning R.M.
      • Gaba D.M.
      The role of debriefing in simulation-based learning.
      . Therefore, the benefit of this process depends on the skills of the facilitator and/or the design of an automated system
      • Forneris S.G.
      • Neal D.O.
      • Tiffany J.
      • Kuehn M.B.
      • Meyer H.M.
      • Blazovich L.M.
      • Holland A.
      • Smerillo M.
      Enhancing clinical reasoning through simulation debriefing: A multisite study.
      ,
      • Palaganas J.C.
      • Fey M.
      • Simon R.
      Structured debriefing in simulation-based education.
      . The guidance and critique provided during the debriefing process by the facilitator or other system (e.g., artificial intelligence) ensures the best possible learning outcomes
      • Cheng A.
      • Grant V.
      • Robinson T.
      • Catena H.
      • Lachapelle K.
      • Kim J.
      • Adler M.
      • Eppich W.
      The promoting excellence and reflective learning in simulation (PEARLS) approach to health care debriefing: A faculty development guide.
      ,
      • Fey M.K.
      • Scrandis D.
      • Daniels A.
      • Haut C.
      Learning through debriefing: Students' perspectives.
      • Jeffries P.R.
      • Dreifuerst K.T.
      • Kardong-Edgren S.
      • Hayden J.
      Faculty development when initiating simulation programs: Lessons learned from the national simulation study.
      • Lyons R.
      • Lazzara E.H.
      • Benishek L.E.
      • Zajac S.
      • Gregory M.
      • Sonesh S.C.
      • Salas E.
      Enhancing the effectiveness of team debriefings in medical simulation: More best practices.
      .
      The ultimate goal of the debriefing process is to promote reflective thinking. Reflection, the conscious consideration of the meaning and implication of an action, includes the assimilation of knowledge, skills, and attitudes with pre-existing knowledge
      • Rodgers C.
      Defining reflection: Another look at John Dewey and reflective thinking.
      ,
      • Rudolph J.W.
      • Simon R.
      • Rivard P.
      • Dufresne R.L.
      • Raemer D.B.
      Debriefing with good judgment: combining rigorous feedback with genuine inquiry.
      ,
      • Dismukes R.K.
      • Gaba D.M.
      • Howard S.K.
      So many roads: facilitated debriefing in healthcare.
      . Reflection can lead to new interpretations by the learners; this cognitive reframing or looking at a situation from a different perspective is essential to learning and the development and maintenance of professional competencies
      • Rodgers C.
      Defining reflection: Another look at John Dewey and reflective thinking.
      ,
      • Dismukes R.K.
      • Gaba D.M.
      • Howard S.K.
      So many roads: facilitated debriefing in healthcare.
      .
      Facilitator(s) are challenged to maintain a safe learning or evaluation environment during the debriefing process
      • Sawyer T.
      • Eppich W.
      • Brett-Fleegler M.
      • Grant V.
      • Cheng A.
      More than one way to debrief: a critical review of healthcare simulation debriefing methods.
      . This safe environment must be maintained while they observe the behavior of the learner(s), encourage open discussion, provide appropriate feedback, facilitate reflective thinking, and generate solutions to unanticipated situations. The acquisition and progression in the expertise of these skills is a continuous process that demands constant attention, practice, and development. This can be achieved in multiple ways including attending courses, mentoring, certification and/or credentialing, peer feedback, and/or self-analysis
      • Cheng A.
      • Eppich W.
      • Grant V.
      • Sherbino J.
      • Zendejas B.
      • Cook D.A.
      Debriefing for technology-enhanced simulation: A systematic review and meta-analysis.
      ,
      • Fraser K.L.
      • Meguerdichian M.J.
      • Haws J.T.
      • Grant V.J.
      • Bajaj K.
      • Cheng A.
      Cognitive Load Theory for debriefing simulations: implications for faculty development.
      .
      Potential outcomes of following this standard include the learners’ ability to attain changes in learning outcomes or behavior(s) transfer of learning to practice
      • Ryoo E.N.
      • Ha E.-H.
      The importance of debriefing in simulation-based learning: comparison between debriefing and no debriefing.
      ,
      • Palaganas J.C.
      • Fey M.
      • Simon R.
      Structured debriefing in simulation-based education.
      ,
      • Killingley J.
      • Dyson S.
      Student midwives' perspectives on efficacy of feedback after objective structured clinical examination.
      .

      Criteria Necessary to Meet this Standard

      The debriefing process is:
      • 1
        Planned and incorporated into the simulation-based experience in an appropriate manner in order to guide the learner(s) in achieving the desired learning or evaluation outcomes.
      • 2
        Constructed, designed and/or facilitated by a person(s) or system capable and/or competent in providing appropriate feedback, debriefing, and/or guided reflection.
      • 3
        Conducted in a manner that promotes self, team, and/or systems analysis. This process should encourage reflection, exploration of knowledge, and identification of performance/system deficits while maintaining psychological safety and confidentiality.
      • 4
        Planned and structured in a purposeful way based on theoretical frameworks and/or evidenced-based concepts.
      Criterion 1: The debriefing process is planned and incorporated into the simulation-based experience in an appropriate manner in order to guide the learner(s) in achieving the desired learning outcomes.
      Required Elements:
      • The debriefing process should:
        • Be preceded with a prebriefing/briefing and an SBE (Follow the Healthcare Simulation Standards of Best PracticeTM (HSSOBPTM) Prebriefing: Preparation and Briefing)
          • Al Sabei S.D.
          • Lasater K.
          Simulation debriefing for clinical judgment development: A concept analysis.
          ,
          • Gray M.
          • Rogers D.
          • Glynn B.
          • Twomey T.
          A multi-level approach to pre-briefing and debriefing in a pediatric interdisciplinary simulation.
          .
        • Be integrated within or conducted after an SBE activity (Follow the HSSOBPTM Simulation Design)
          • Sawyer T.
          • Eppich W.
          • Brett-Fleegler M.
          • Grant V.
          • Cheng A.
          More than one way to debrief: a critical review of healthcare simulation debriefing methods.
          ,
          • Al Sabei S.D.
          • Lasater K.
          Simulation debriefing for clinical judgment development: A concept analysis.
          ,
          • Gray M.
          • Rogers D.
          • Glynn B.
          • Twomey T.
          A multi-level approach to pre-briefing and debriefing in a pediatric interdisciplinary simulation.
          .
        • Be learner-centered and structured according to the educational and experience level of the learner(s) and/or team
          • Al Sabei S.D.
          • Lasater K.
          Simulation debriefing for clinical judgment development: A concept analysis.
          ,
          • Reierson I.Å.
          • Haukedal T.A.
          • Hedeman H.
          • Bjørk I.T.
          Structured debriefing: What difference does it make?.
          .
        • Be individualized, specific, based on observable behavior, evidenced- based, and timely
          • Cheng A.
          • Morse K.J.
          • Rudolph J.
          • Arab A.A.
          • Runnacles J.
          • Eppich W.
          Learner-centered debriefing for health care simulation education: lessons for faculty development.
          ,
          • Reierson I.Å.
          • Haukedal T.A.
          • Hedeman H.
          • Bjørk I.T.
          Structured debriefing: What difference does it make?.
          ,
          • Grossman S.
          • Conelius J.
          Simulation pedagogy with nurse practitioner students: impact of receiving immediate individualized faculty feedback.
          .
        • Ensure resources are available to support content, provide clarification, and assist with critical reflection
          • Verkuyl M.
          • Hughes M.
          • Atack L.
          • McCulloch T.
          • Lapum J.L.
          • Romaniuk D.
          • St-Amant O.
          Comparison of self-debriefing alone or in combination with group debrief.
          ,
          • Verkuyl M.
          • Hughes M.
          • Tsui J.
          • Betts L.
          • St-Amant O.
          • Lapum J.L.
          Virtual gaming simulation in nursing education: A focus group study.
          .
        • Be adaptable allowing for modifications in the approach and the reframing
          • Sawyer T.
          • Eppich W.
          • Brett-Fleegler M.
          • Grant V.
          • Cheng A.
          More than one way to debrief: a critical review of healthcare simulation debriefing methods.
          ,
          • Cheng A.
          • Eppich W.
          • Kolbe M.
          • Meguerdichian M.
          • Bajaj K.
          • Grant V.
          A conceptual framework for the development of debriefing skills: A journey of discovery, growth, and maturity.
          .
        • Occur in multiple phases to allow deeper exploration of the learners’ performance and thinking process
          • Sawyer T.
          • Eppich W.
          • Brett-Fleegler M.
          • Grant V.
          • Cheng A.
          More than one way to debrief: a critical review of healthcare simulation debriefing methods.
          ,
          • Gray M.
          • Rogers D.
          • Glynn B.
          • Twomey T.
          A multi-level approach to pre-briefing and debriefing in a pediatric interdisciplinary simulation.
          ,
          • Verkuyl M.
          • Hughes M.
          • Tsui J.
          • Betts L.
          • St-Amant O.
          • Lapum J.L.
          Virtual gaming simulation in nursing education: A focus group study.
          .
      Criterion 2: The debriefing process is constructed, designed and/or facilitated by a person(s) or technology-enhanced system capable and/or competent in providing appropriate feedback, debriefing, and/or guided reflection.
      Required Elements:
      • The facilitator, facilitators (when codebriefing is conducted) and/or developer of the technology-enhanced system should:
        • Be skilled in evidence-based practices related to the debriefing process.
        • Be knowledgeable and familiar with the case or procedure and its objectives as well as the expected or desired performance of the learner(s)
          • Sawyer T.
          • Eppich W.
          • Brett-Fleegler M.
          • Grant V.
          • Cheng A.
          More than one way to debrief: a critical review of healthcare simulation debriefing methods.
          ,
          • Palaganas J.C.
          • Fey M.
          • Simon R.
          Structured debriefing in simulation-based education.
          .
        • Demonstrate proficiency and strive for continued competence through professional development in the process of providing feedback, debriefing, and/or guided reflection
          • Cheng A.
          • Grant V.
          • Robinson T.
          • Catena H.
          • Lachapelle K.
          • Kim J.
          • Adler M.
          • Eppich W.
          The promoting excellence and reflective learning in simulation (PEARLS) approach to health care debriefing: A faculty development guide.
          ,
          • Killingley J.
          • Dyson S.
          Student midwives' perspectives on efficacy of feedback after objective structured clinical examination.
          .
        • Be recognized by the learner(s) as a credible source
          • Sawyer T.
          • Eppich W.
          • Brett-Fleegler M.
          • Grant V.
          • Cheng A.
          More than one way to debrief: a critical review of healthcare simulation debriefing methods.
          ,
          • Rojas D.E.
          • Parker C.G.
          • Schams K.A.
          • McNeill J.A.
          Implementation of best practices in simulation debriefing.
          .
        • Allow adequate time to assist the learner(s) in achieving the activity's desired outcomes, address critical elements, and discuss identified performance or systems gaps
          • Sawyer T.
          • Eppich W.
          • Brett-Fleegler M.
          • Grant V.
          • Cheng A.
          More than one way to debrief: a critical review of healthcare simulation debriefing methods.
          ,
          • Palaganas J.C.
          • Fey M.
          • Simon R.
          Structured debriefing in simulation-based education.
          ,
          • Dubé M.M.
          • Reid J.
          • Kaba A.
          • Cheng A.
          • Eppich W.
          • Grant V.
          • Stone K.
          Pearls for systems integration: a modified pearls framework for Debriefing systems-focused simulations.
          . The amount of time allocated to the debriefing process is multifactorial, including, but not limited to variables such as the objectives of the SBE, and the performance of the learner(s). The time allocation does not have a set relationship to the preceding activity.
        • Consider group size that supports the debriefing process and allows engagement with each learner
          • Gordon R.M.
          Debriefing virtual simulation using an online conferencing platform: Lessons learned.
          . Group size may vary depending upon the setting. All learners may actively participate in the scenario, while others may observe and still participate in the debrief. Learners may be in-person, remote via local classroom video, or participating in a virtual learning experience using a web-based conferencing platform, etc.
        • Use Socratic approach, inquiry, open-ended and/or reflective questions, and advocacy to guide the conversation within the group to promote review, self-awareness, and critical and reflective thinking
          • Reierson I.Å.
          • Haukedal T.A.
          • Hedeman H.
          • Bjørk I.T.
          Structured debriefing: What difference does it make?.
          ,
          • Palaganas J.C.
          • Fey M.
          • Simon R.
          Structured debriefing in simulation-based education.
          ,
          • Alexander M.
          • Durham C.F.
          • Hooper J.I.
          • Jeffries P.R.
          • Goldman N.
          • Kesten K.S.
          • Kardong-Edgren S.
          • Kesten K.S.
          • Spector N.
          • Tagliareni E.
          • Radtke B.
          • Tillman C.
          NCSBN simulation guidelines for prelicensure nursing programs.
          .
        • Incorporate communication skills such as active listening, a non-judgmental demeanor, and silence to encourage learner(s) input, self-analysis, and reflection
          • Ryoo E.N.
          • Ha E.-H.
          The importance of debriefing in simulation-based learning: comparison between debriefing and no debriefing.
          ,
          • Palaganas J.C.
          • Fey M.
          • Simon R.
          Structured debriefing in simulation-based education.
          ,
          • Gordon R.M.
          Debriefing virtual simulation using an online conferencing platform: Lessons learned.
          .
        • Provide an unbiased critique of performance with the intent to correct errors, promote understanding, facilitate comprehension, and promote insightfulness
          • Reierson I.Å.
          • Haukedal T.A.
          • Hedeman H.
          • Bjørk I.T.
          Structured debriefing: What difference does it make?.
          ,
          • Verkuyl M.
          • Hughes M.
          • Tsui J.
          • Betts L.
          • St-Amant O.
          • Lapum J.L.
          Virtual gaming simulation in nursing education: A focus group study.
          .
        • Provide both positive and constructive analysis that consolidates the teaching message and/or reinforces positive behavior
          • Sawyer T.
          • Eppich W.
          • Brett-Fleegler M.
          • Grant V.
          • Cheng A.
          More than one way to debrief: a critical review of healthcare simulation debriefing methods.
          .
        • Identify performance gaps or process issues based on the expected outcomes of the simulation-based experience
          • Rojas D.E.
          • Parker C.G.
          • Schams K.A.
          • McNeill J.A.
          Implementation of best practices in simulation debriefing.
          ,
          • Dubé M.M.
          • Reid J.
          • Kaba A.
          • Cheng A.
          • Eppich W.
          • Grant V.
          • Stone K.
          Pearls for systems integration: a modified pearls framework for Debriefing systems-focused simulations.
          .
      Criterion 3: The debriefing process is conducted in a manner that promotes self, team, and/or systems analysis. This process should encourage reflection, exploration of knowledge, and resolution of performance/system gaps while maintaining psychological safety and confidentiality.
      Required Elements:
      • The process should:
        • Be conducted in an environment with adequate facilities to allow for privacy, open discussion, trust, review, and confidentiality
          • Reierson I.Å.
          • Haukedal T.A.
          • Hedeman H.
          • Bjørk I.T.
          Structured debriefing: What difference does it make?.
          ,
          • Palaganas J.C.
          • Fey M.
          • Simon R.
          Structured debriefing in simulation-based education.
          .
        • Incorporate multiple points of view, such as self, peer, small/large group, external observers, standardized patients, operations/technology specialists, or automated performance analysis and feedback systems
          • Grossman S.
          • Conelius J.
          Simulation pedagogy with nurse practitioner students: impact of receiving immediate individualized faculty feedback.
          ,
          • Verkuyl M.
          • Hughes M.
          • Tsui J.
          • Betts L.
          • St-Amant O.
          • Lapum J.L.
          Virtual gaming simulation in nursing education: A focus group study.
          .
        • Be conducted in an environment with appropriate access to support learners in the case of an unexpected distress or outcome(s)
          • Kolbe M.
          • Grande B.
          • Spahn D.R.
          Briefing and debriefing during simulation-based training and beyond: Content, structure, attitude and setting.
          ,
          • Rudolph J.W.
          • Raemer D.B.
          • Simon R.
          Establishing a safe container for learning in simulation: the role of the presimulation briefing.
          .
        • Be focused on learner(s’) behavior and related to the objectives of the activity
          • Lefroy J.
          • Watling C.
          • Teunissen P.W.
          • Brand P.
          Guidelines: the do's, don'ts and don't knows of feedback for clinical education.
          ,
          • Reierson I.Å.
          • Haukedal T.A.
          • Hedeman H.
          • Bjørk I.T.
          Structured debriefing: What difference does it make?.
          .
        • Guide the learner(s) toward comprehension and understanding to achieve the desired objectives and outcomes
          • Forneris S.G.
          • Neal D.O.
          • Tiffany J.
          • Kuehn M.B.
          • Meyer H.M.
          • Blazovich L.M.
          • Holland A.
          • Smerillo M.
          Enhancing clinical reasoning through simulation debriefing: A multisite study.
          ,
          • Fey M.K.
          • Scrandis D.
          • Daniels A.
          • Haut C.
          Learning through debriefing: Students' perspectives.
          ,
          • Gray M.
          • Rogers D.
          • Glynn B.
          • Twomey T.
          A multi-level approach to pre-briefing and debriefing in a pediatric interdisciplinary simulation.
          .
        • Allow the observation and discussion of the learner's response and/or behavior to improve performance particularly when the learner is unaware of a deficit. The discussion must also allow for clarification of the frames or context that may not be known by the observer
          • Rudolph J.W.
          • Raemer D.B.
          • Simon R.
          Establishing a safe container for learning in simulation: the role of the presimulation briefing.
          ,
          • Luft J.
          • Ingram H.
          The Johari window: A graphic model of awareness in interpersonal interactions.
          .
      Criterion 4: The debriefing process is planned and structured in a purposeful way based on theoretical frameworks and/or evidenced-based concepts.
      Required Elements:
      • The debriefing process should:
        • Be selected depending on the complexity of the scenario, contexts, learner(s), time available, and the learning objectives
          • Cheng A.
          • Grant V.
          • Robinson T.
          • Catena H.
          • Lachapelle K.
          • Kim J.
          • Adler M.
          • Eppich W.
          The promoting excellence and reflective learning in simulation (PEARLS) approach to health care debriefing: A faculty development guide.
          .
        • Be structured and incorporate various phases
          • Cheng A.
          • Morse K.J.
          • Rudolph J.
          • Arab A.A.
          • Runnacles J.
          • Eppich W.
          Learner-centered debriefing for health care simulation education: lessons for faculty development.
          ,
          • Sawyer T.
          • Eppich W.
          • Brett-Fleegler M.
          • Grant V.
          • Cheng A.
          More than one way to debrief: a critical review of healthcare simulation debriefing methods.
          ,
          • Ryoo E.N.
          • Ha E.-H.
          The importance of debriefing in simulation-based learning: comparison between debriefing and no debriefing.
          ,
          • Palaganas J.C.
          • Fey M.
          • Simon R.
          Structured debriefing in simulation-based education.
          ,
          • Dubé M.M.
          • Reid J.
          • Kaba A.
          • Cheng A.
          • Eppich W.
          • Grant V.
          • Stone K.
          Pearls for systems integration: a modified pearls framework for Debriefing systems-focused simulations.
          .
        • Facilitate analysis or critique of the team, system, or the learner themself
          • Cheng A.
          • Morse K.J.
          • Rudolph J.
          • Arab A.A.
          • Runnacles J.
          • Eppich W.
          Learner-centered debriefing for health care simulation education: lessons for faculty development.
          ,
          • Cheng A.
          • Eppich W.
          • Grant V.
          • Sherbino J.
          • Zendejas B.
          • Cook D.A.
          Debriefing for technology-enhanced simulation: A systematic review and meta-analysis.
          ,
          • Dubé M.M.
          • Reid J.
          • Kaba A.
          • Cheng A.
          • Eppich W.
          • Grant V.
          • Stone K.
          Pearls for systems integration: a modified pearls framework for Debriefing systems-focused simulations.
          .
        • Allow for flexibility based on different learners, identified objectives and outcomes, timeframe, and the simulation setting
          • Cheng A.
          • Grant V.
          • Robinson T.
          • Catena H.
          • Lachapelle K.
          • Kim J.
          • Adler M.
          • Eppich W.
          The promoting excellence and reflective learning in simulation (PEARLS) approach to health care debriefing: A faculty development guide.
          .
        • Be designed to promote critical thinking and reflection
          • Palaganas J.C.
          • Fey M.
          • Simon R.
          Structured debriefing in simulation-based education.
          ,
          • Cheng A.
          • Eppich W.
          • Grant V.
          • Sherbino J.
          • Zendejas B.
          • Cook D.A.
          Debriefing for technology-enhanced simulation: A systematic review and meta-analysis.
          ,
          • Gordon R.M.
          Debriefing virtual simulation using an online conferencing platform: Lessons learned.
          .
        • Be designed to encourage learners to search for evidence-based solutions
          • Benner P.
          From novice to expert: Excellence and power in clinical nursing practice.
          ,
          • Palaganas J.C.
          • Fey M.
          • Simon R.
          Structured debriefing in simulation-based education.
          ,
          • Gordon R.M.
          Debriefing virtual simulation using an online conferencing platform: Lessons learned.
          .
        • Foster the learner(s’) ability to apply/transfer the knowledge, skills and attitudes obtained during SBE to actual clinical settings
          • Al Sabei S.D.
          • Lasater K.
          Simulation debriefing for clinical judgment development: A concept analysis.
          ,
          • Rivière E.
          • Jaffrelot M.
          • Jouquan J.
          • Chiniara G.
          Debriefing for the transfer of learning: the importance of context.
          .
        • Acknowledge that each learner's perspective is valid and may not be fully understood without exploration
          • Rudolph J.W.
          • Raemer D.B.
          • Simon R.
          Establishing a safe container for learning in simulation: the role of the presimulation briefing.
          ,
          • Luft J.
          • Ingram H.
          The Johari window: A graphic model of awareness in interpersonal interactions.
          ,
          • Oriot D.
          • Alinier G.
          Pocket book for simulation debriefing in healthcare.
          .
      Resources
      Even if a debriefing model does not formally integrate the Socratic approach, the facilitator should incorporate the strategy of asking essential questions
      • Alexander M.
      • Durham C.F.
      • Hooper J.I.
      • Jeffries P.R.
      • Goldman N.
      • Kesten K.S.
      • Kardong-Edgren S.
      • Kesten K.S.
      • Spector N.
      • Tagliareni E.
      • Radtke B.
      • Tillman C.
      NCSBN simulation guidelines for prelicensure nursing programs.
      .
      • Current models/structures for debriefing include but are not limited to the following:
        • Debriefing for Meaningful Learning (DML)
          • Dreifuerst
          • T. K.
          Getting started with debriefing for meaningful learning.
        • Debriefing with Good Judgment
          • Rudolph J.W.
          • Simon R.
          • Rivard P.
          • Dufresne R.L.
          • Raemer D.B.
          Debriefing with good judgment: combining rigorous feedback with genuine inquiry.
          ,
          • Rudolph J.W.
          • Simon R.
          • Dufresne R.L.
          • Raemer D.B.
          There's no such thing as “nonjudgmental” debriefing: a theory and method for debriefing with good judgment.
        • Diamond
          • Jaye P.
          • Thomas L.
          • Reedy G.
          The Diamond’: a structure for simulation debrief.
        • Gather, Analyze, Summarize (GAS)
          • Phrampus
          • E. P.
          • O'Donnell J.M
          Debriefing using a structured and supported approach.
        • PEARLS for System Integration (PSI) Frameworks
          • Eppich W.
          • Cheng A.
          Promoting Excellence and Reflective Learning in Simulation (PEARLS): development and rationale for a blended approach to health care simulation debriefing.
          ,
          • Cheng A.
          • Grant V.
          • Robinson T.
          • Catena H.
          • Lachapelle K.
          • Kim J.
          • Adler M.
          • Eppich W.
          The promoting excellence and reflective learning in simulation (PEARLS) approach to health care debriefing: A faculty development guide.
        • Promoting Excellence and Reflective Learning in Simulation (PEARLS)
          • Cheng A.
          • Grant V.
          • Robinson T.
          • Catena H.
          • Lachapelle K.
          • Kim J.
          • Adler M.
          • Eppich W.
          The promoting excellence and reflective learning in simulation (PEARLS) approach to health care debriefing: A faculty development guide.
        • Plus-Delta
          • Fanning R.M.
          • Gaba D.M.
          The role of debriefing in simulation-based learning.
          ,
          • O'Brien C.
          • Leeman K.
          • Roussin C.
          • Casey D.
          • Grandinetti T.
          • Lindamood K.
          Using Plus-Delta-Plus Human Factors Debriefing to Bridge Simulation and Clinical Environments.
        • Review the event, Encourage team participation, Focused feedback, Listen to each other, Emphasize key points, Communicate clearly, and Transform the future (REFLECT)
          • Zinns L.E.
          • Mullan P.C.
          • O'Connell K.J.
          • Ryan L.M.
          • Wratney A.T.
          An evaluation of a new debriefing framework: REFLECT.
        • The 3D Model of Debriefing (Defusing, Discovering, and Deepening)

          Zigmont, J. J., Kappus, L. J., & Sudikoff, S. N. (2011). The 3D model of debriefing: Defusing, discovering, and deepening.Paper presented at the Seminars in perinatology.

        • The Critical Incident Stress Debriefing Model
          • Mitchell J.T.
          • Everly G.
          Critical incident stress debriefing (CISD).
      • Current frameworks to assist in providing feedback (this list is not exhaustive) are:
        • Learning Conversations
          • Norris E.M.
          • Bullock I.
          A ‘Learning conversation’ as a style of feedback.
        • Situation-Based-Impact-Intent (SBII)
          • Weitzel S.R.
          Feedback that works: How to build and deliver your message.
        • Instruments/tools for assessment of the debriefing process include (this list is not exhaustive):
      • Debriefing Assessment for Simulation in Healthcare (DASH)
        • Brett-Fleegler M.
        • Rudolph J.
        • Eppich W.
        • Monuteaux M.
        • Fleegler E.
        • Cheng A.
        • Simon R.
        Debriefing assessment for simulation in healthcare: Development and psychometric properties.
        ,

        Center for Medical Simulation. Debriefing Assessment for Simulation in Healthcare (DASH). Retrieved from https://harvardmedsim.org/debriefing-assessment-for-simulation-in-healthcare-dash/

        (https://harvardmedsim.org/debriefing-assessment-for-simulation-in-healthcare-dash/)
      • Debriefing for Meaningful Learning Evaluation Scale
        • Bradley C.S.
        • Dreifuerst K.T.
        Pilot testing the debriefing for meaningful learning evaluation scale.
      • Feedback Assessment for Clinical Education (FACE)
        • Onello R
        • Rudolph JW
        • R. S
        Feedback for Clinical Education (FACE) Rater's Handbook (Vol. 2020).
        (https://harvardmedsim.org/feedback-assessment-clinical-education.php)
      • Objective Structured Assessment of Debriefing (OSAD)
        • Zamjahn J.B.
        • Baroni de Carvalho R.
        • Bronson M.H.
        • Garbee D.D.
        • Paige J.T.
        eAssessment: development of an electronic version of the Objective Structured Assessment of Debriefing tool to streamline evaluation of video recorded debriefings.
      • Peer Assessment Debriefing Instrument (PADI)
        • Saylor J.L.
        • Wainwright S.F.
        • Herge A.E.
        • Pohlig R.T.
        Peer-assessment debriefing instrument (PADI): Assessing faculty effectiveness in simulation education.
      • Simulation Effectiveness Tool – Modified (SET-M)
        • Leighton K.
        • Ravert P.
        • Mudra V.
        • Macintosh C.
        Updating the simulation effectiveness tool: Item modifications and reevaluation of psychometric properties.
        (https://caehealthcare.com/media/files/Simulation-Effectiveness-Tool.pdf)

      Original INACSL Standard

      The INASCL Board of Directors. (2011). Standard VI: The debriefing process. Clinical Simulation in Nursing, 7(4S), s16-s17. http: //dx.doi.org/10.1016/j.ecns.2011.05.010.

      Subsequent Standard

      Subsequent INACSL Standards Decker, S., Fey, M., Sideras, S., Caballero, S., Boese, T., Franklin, A. E., ., & Meakim, C. (2013). Standards of best practice: Simulation standard VI: The debriefing process. Clinical Simulation in Nursing, 9(6), S26-S29.
      INACSL Standards Committee (2016, December). INACSL standards of best practice: SimulationSM Debriefing. Clinical Simulation in Nursing, 12(S), S21-S25. http://dx.doi.org/10.1016/j.ecns.2016.09.008

      About the International Nursing Association for Clinical Simulation and Learning (INACSL)

      The International Nursing Association for Clinical Simulation and Learning (INACSL) is the global leader in transforming practice to improve patient safety through excellence in health care simulation. INACSL is a community of practice for simulation where members can network with simulation leaders, educators, researchers, and industry partners. INACSL also provided the original living documents INACSL Standards of Best Practice: SimulationSM, an evidence-based framework to guide simulation design, implementation, debriefing, evaluation, and research. The Healthcare Simulation Standards of Best PracticeTM are provided with the support and input of the international community and sponsored by INACSL.

      References

        • Lioce L.
        • Downing D.
        • Chang T.P.
        • Robertson J.M.
        • Andersoon M.
        • Diaz D.A.
        • Spain A.E.
        Healthcare Simulation Dictionary.
        Agency for Healthcare Research and Quality, Rockville, MD2020: 2nd ed (Vol. AHRQ Publication No. 20-0019))
      1. Schön, D. A. (1984). The reflective practitioner: How professionals think in action(Vol. 5126): Basic books.

        • Rodgers C.
        Defining reflection: Another look at John Dewey and reflective thinking.
        Teachers college record. 2002; 104: 842-866
        • Rudolph J.W.
        • Simon R.
        • Rivard P.
        • Dufresne R.L.
        • Raemer D.B.
        Debriefing with good judgment: combining rigorous feedback with genuine inquiry.
        Anesthesiology clinics. 2007; 25: 361-376
        • Benner P.
        From novice to expert: Excellence and power in clinical nursing practice.
        Addison-Wesley, Menlo Park, CA1984
        • Dewey J.
        How we think: A restatement of the relation of reflective thinking to the educative process.
        Houghton Mifflin, 1933
        • Kolbe M.
        • Grande B.
        • Spahn D.R.
        Briefing and debriefing during simulation-based training and beyond: Content, structure, attitude and setting.
        Best Practice & Research Clinical Anaesthesiology. 2015; 29: 87-96
      2. Schön, D. A. (1987). Educating the reflective practitioner.

        • McMullen M.
        • Wilson R.
        • Fleming M.
        • Mark D.
        • Sydor D.
        • Wang L.
        • Zamora J.
        • Phelan R.
        • Burjorjee J.E.
        Debriefing-on-Demand”: A Pilot Assessment of Using a “Pause Button” in Medical Simulation.
        Simulation in Healthcare. 2016; 11: 157-163
        • Cheng A.
        • Grant V.
        • Robinson T.
        • Catena H.
        • Lachapelle K.
        • Kim J.
        • Adler M.
        • Eppich W.
        The promoting excellence and reflective learning in simulation (PEARLS) approach to health care debriefing: A faculty development guide.
        Clinical Simulation in Nursing. 2016; 12: 419-428
        • Cheng A.
        • Morse K.J.
        • Rudolph J.
        • Arab A.A.
        • Runnacles J.
        • Eppich W.
        Learner-centered debriefing for health care simulation education: lessons for faculty development.
        Simulation in Healthcare. 2016; 11: 32-40
        • Committee I.S.
        INACSL standards of best practice: SimulationSM simulation glossary.
        Clinical Simulation in Nursing. 2016; 12: S39-S47
        • Lefroy J.
        • Watling C.
        • Teunissen P.W.
        • Brand P.
        Guidelines: the do's, don'ts and don't knows of feedback for clinical education.
        Perspectives on Medical Education. 2015; 4: 284-299
        • Verkuyl M.
        • Lapum J.L.
        • Hughes M.
        • McCulloch T.
        • Liu L.
        • Mastrilli P.
        • Romaniuk D.
        • Betts L.
        Virtual gaming simulation: Exploring self-debriefing, virtual debriefing, and in-person debriefing.
        Clinical Simulation in Nursing. 2018; 20: 7-14
        • Sawyer T.
        • Eppich W.
        • Brett-Fleegler M.
        • Grant V.
        • Cheng A.
        More than one way to debrief: a critical review of healthcare simulation debriefing methods.
        Simulation in Healthcare. 2016; 11: 209-217
        • Al Sabei S.D.
        • Lasater K.
        Simulation debriefing for clinical judgment development: A concept analysis.
        Nurse Education Today. 2016; 45: 42-47
        • De Beer M.
        • Mårtensson L.
        Feedback on students' clinical reasoning skills during fieldwork education.
        Australian Occupational Therapy Journal. 2015; 62: 255-264
        • Miraglia R.
        • Asselin M.E.
        Reflection as an educational strategy in nursing professional development: An integrative review.
        Journal for Nurses in Professional Development. 2015; 31: 62-72
        • Forneris S.G.
        • Neal D.O.
        • Tiffany J.
        • Kuehn M.B.
        • Meyer H.M.
        • Blazovich L.M.
        • Holland A.
        • Smerillo M.
        Enhancing clinical reasoning through simulation debriefing: A multisite study.
        Nursing Education Perspectives. 2015; 36: 304-310
        • Reierson I.Å.
        • Haukedal T.A.
        • Hedeman H.
        • Bjørk I.T.
        Structured debriefing: What difference does it make?.
        Nurse Education in Practice. 2017; 25: 104-110
        • Ryoo E.N.
        • Ha E.-H.
        The importance of debriefing in simulation-based learning: comparison between debriefing and no debriefing.
        CIN: Computers, Informatics, Nursing. 2015; 33: 538-545
        • Verkuyl M.
        • Hughes M.
        • Atack L.
        • McCulloch T.
        • Lapum J.L.
        • Romaniuk D.
        • St-Amant O.
        Comparison of self-debriefing alone or in combination with group debrief.
        Clinical Simulation in Nursing. 2019; 37: 32-39
        • Morgan P.
        • Tarshis J.
        • LeBlanc V.
        • Cleave-Hogg D.
        • DeSousa S.
        • Haley M.
        • Herold-Mcllroy J.
        • Law J.
        Efficacy of high-fidelity simulation debriefing on the performance of practicing anaesthetists in simulated scenarios.
        British Journal of Anaesthesia. 2009; 103: 531-537
        • Fanning R.M.
        • Gaba D.M.
        The role of debriefing in simulation-based learning.
        Simulation in Healthcare. 2007; 2: 115-125
        • Palaganas J.C.
        • Fey M.
        • Simon R.
        Structured debriefing in simulation-based education.
        AACN Advanced Critical Care. 2016; 27: 78-85
        • Fey M.K.
        • Scrandis D.
        • Daniels A.
        • Haut C.
        Learning through debriefing: Students' perspectives.
        Clinical Simulation in Nursing. 2014; 10: e249-e256
        • Jeffries P.R.
        • Dreifuerst K.T.
        • Kardong-Edgren S.
        • Hayden J.
        Faculty development when initiating simulation programs: Lessons learned from the national simulation study.
        Journal of Nursing Regulation. 2015; 5: 17-23
        • Lyons R.
        • Lazzara E.H.
        • Benishek L.E.
        • Zajac S.
        • Gregory M.
        • Sonesh S.C.
        • Salas E.
        Enhancing the effectiveness of team debriefings in medical simulation: More best practices.
        The Joint Commission Journal on Quality and Patient Safety. 2015; 41: 115-125
        • Dismukes R.K.
        • Gaba D.M.
        • Howard S.K.
        So many roads: facilitated debriefing in healthcare.
        Simulation in Healthcare. 2006; 1: 23-25
        • Cheng A.
        • Eppich W.
        • Grant V.
        • Sherbino J.
        • Zendejas B.
        • Cook D.A.
        Debriefing for technology-enhanced simulation: A systematic review and meta-analysis.
        Medical Education. 2014; 48: 657-666
        • Fraser K.L.
        • Meguerdichian M.J.
        • Haws J.T.
        • Grant V.J.
        • Bajaj K.
        • Cheng A.
        Cognitive Load Theory for debriefing simulations: implications for faculty development.
        Advances in Simulation. 2018; 3: 28
        • Killingley J.
        • Dyson S.
        Student midwives' perspectives on efficacy of feedback after objective structured clinical examination.
        British Journal of Midwifery. 2016; 24: 362-368
        • Gray M.
        • Rogers D.
        • Glynn B.
        • Twomey T.
        A multi-level approach to pre-briefing and debriefing in a pediatric interdisciplinary simulation.
        Pediatric Neonatal Nursing Open Journal. 2016; 3: 1-27
        • Grossman S.
        • Conelius J.
        Simulation pedagogy with nurse practitioner students: impact of receiving immediate individualized faculty feedback.
        Creative Nursing. 2015; 21: 100-109
        • Verkuyl M.
        • Hughes M.
        • Tsui J.
        • Betts L.
        • St-Amant O.
        • Lapum J.L.
        Virtual gaming simulation in nursing education: A focus group study.
        Journal of Nursing Education. 2017; 56: 274-280
        • Cheng A.
        • Eppich W.
        • Kolbe M.
        • Meguerdichian M.
        • Bajaj K.
        • Grant V.
        A conceptual framework for the development of debriefing skills: A journey of discovery, growth, and maturity.
        Simulation in Healthcare. 2020; 15: 55-60
        • Rojas D.E.
        • Parker C.G.
        • Schams K.A.
        • McNeill J.A.
        Implementation of best practices in simulation debriefing.
        Nursing Education Perspectives. 2017; 38: 154-156
        • Dubé M.M.
        • Reid J.
        • Kaba A.
        • Cheng A.
        • Eppich W.
        • Grant V.
        • Stone K.
        Pearls for systems integration: a modified pearls framework for Debriefing systems-focused simulations.
        Simulation in Healthcare. 2019; 14: 333-342
        • Gordon R.M.
        Debriefing virtual simulation using an online conferencing platform: Lessons learned.
        Clinical Simulation in Nursing. 2017; 13: 668-674
        • Alexander M.
        • Durham C.F.
        • Hooper J.I.
        • Jeffries P.R.
        • Goldman N.
        • Kesten K.S.
        • Kardong-Edgren S.
        • Kesten K.S.
        • Spector N.
        • Tagliareni E.
        • Radtke B.
        • Tillman C.
        NCSBN simulation guidelines for prelicensure nursing programs.
        Journal of Nursing Regulation. 2015; 6: 39-42
        • Rudolph J.W.
        • Raemer D.B.
        • Simon R.
        Establishing a safe container for learning in simulation: the role of the presimulation briefing.
        Simulation in Healthcare. 2014; 9: 339-349
        • Luft J.
        • Ingram H.
        The Johari window: A graphic model of awareness in interpersonal interactions.
        Group Processes. 1963; (Retrieved from): 50-125
        • Rivière E.
        • Jaffrelot M.
        • Jouquan J.
        • Chiniara G.
        Debriefing for the transfer of learning: the importance of context.
        Academic Medicine. 2019; 94: 796-803
        • Oriot D.
        • Alinier G.
        Pocket book for simulation debriefing in healthcare.
        Springer, 2018
        • Dreifuerst
        • T. K.
        Getting started with debriefing for meaningful learning.
        Clinical Simulation in Nursing. 2015; 11: 268-275
        • Rudolph J.W.
        • Simon R.
        • Dufresne R.L.
        • Raemer D.B.
        There's no such thing as “nonjudgmental” debriefing: a theory and method for debriefing with good judgment.
        Simulation in Healthcare. 2006; 1: 49-55
        • Jaye P.
        • Thomas L.
        • Reedy G.
        The Diamond’: a structure for simulation debrief.
        The Clinical Teacher. 2015; 12: 171-175
        • Phrampus
        • E. P.
        • O'Donnell J.M
        Debriefing using a structured and supported approach.
        The comprehensive textbook of healthcare simulation. Springer, 2013: 73-84
        • Eppich W.
        • Cheng A.
        Promoting Excellence and Reflective Learning in Simulation (PEARLS): development and rationale for a blended approach to health care simulation debriefing.
        Simulation in Healthcare. 2015; 10: 106-115
        • Cheng A.
        • Grant V.
        • Robinson T.
        • Catena H.
        • Lachapelle K.
        • Kim J.
        • Adler M.
        • Eppich W.
        The promoting excellence and reflective learning in simulation (PEARLS) approach to health care debriefing: A faculty development guide.
        Clinical Simulation in Nursing. 2016; 12: 419-428
        • O'Brien C.
        • Leeman K.
        • Roussin C.
        • Casey D.
        • Grandinetti T.
        • Lindamood K.
        Using Plus-Delta-Plus Human Factors Debriefing to Bridge Simulation and Clinical Environments.
        in: Paper presented at the International Pediatric Simulation Symposia and Workshop (IPSSW), Boston, MA, USA2017
        • Zinns L.E.
        • Mullan P.C.
        • O'Connell K.J.
        • Ryan L.M.
        • Wratney A.T.
        An evaluation of a new debriefing framework: REFLECT.
        Pediatric Emergency Care. 2020; 36: 147-152
      3. Zigmont, J. J., Kappus, L. J., & Sudikoff, S. N. (2011). The 3D model of debriefing: Defusing, discovering, and deepening.Paper presented at the Seminars in perinatology.

        • Mitchell J.T.
        • Everly G.
        Critical incident stress debriefing (CISD).
        An Operations Manual for the Prevention of Traumatic Stress Among Emergency Service and Disaster Workers. Second Edition. Chevron Publishing Corporation, 1997 (Revised)
        • Norris E.M.
        • Bullock I.
        A ‘Learning conversation’ as a style of feedback.
        MedEdPublish. 2017; 6
        • Weitzel S.R.
        Feedback that works: How to build and deliver your message.
        Center for Creative leadership, 2008
        • Brett-Fleegler M.
        • Rudolph J.
        • Eppich W.
        • Monuteaux M.
        • Fleegler E.
        • Cheng A.
        • Simon R.
        Debriefing assessment for simulation in healthcare: Development and psychometric properties.
        Simulation in Healthcare. 2012; 7: 288-294
      4. Center for Medical Simulation. Debriefing Assessment for Simulation in Healthcare (DASH). Retrieved from https://harvardmedsim.org/debriefing-assessment-for-simulation-in-healthcare-dash/

        • Bradley C.S.
        • Dreifuerst K.T.
        Pilot testing the debriefing for meaningful learning evaluation scale.
        Clinical Simulation in Nursing. 2016; 12: 277-280
        • Onello R
        • Rudolph JW
        • R. S
        Feedback for Clinical Education (FACE) Rater's Handbook (Vol. 2020).
        Center for Medical Simulation, 2015 (Online)
        • Zamjahn J.B.
        • Baroni de Carvalho R.
        • Bronson M.H.
        • Garbee D.D.
        • Paige J.T.
        eAssessment: development of an electronic version of the Objective Structured Assessment of Debriefing tool to streamline evaluation of video recorded debriefings.
        Journal of the American Medical Informatics Association. 2018; 25: 1284-1291
        • Saylor J.L.
        • Wainwright S.F.
        • Herge A.E.
        • Pohlig R.T.
        Peer-assessment debriefing instrument (PADI): Assessing faculty effectiveness in simulation education.
        Journal of allied health. 2016; 45: 27E-30E
        • Leighton K.
        • Ravert P.
        • Mudra V.
        • Macintosh C.
        Updating the simulation effectiveness tool: Item modifications and reevaluation of psychometric properties.
        Nursing Education Perspectives. 2015; 36: 317-323