Skip to main content

Prebriefing and Debriefing During Simulated Learning Experiences

by Emily Patula and Tess Korte

Simulated learning experiences are a teaching modality that can help foster a safe and controlled setting for trainees to engage in real-world but low-stakes clinical training experiences. Simulation can enhance learner self-efficacy, teamwork and procedural skills, and influence critical reasoning and decision-making.

It is embedded into medical education curricula in various forms including low-fidelity and high-fidelity manikins, virtual reality and computer simulation. For example, low-fidelity manikins are used for CPR training and isolated skill practice such as intubation. High-fidelity manikins more closely mimic the human body with pulses, respirations and pupillary reflexes, and therefore can simulate certain patient conditions and respond to learner interventions.

While simulation can allow trainees to learn and practice new skills, its effectiveness depends on its structure and facilitation methods. To maximize the impact of a simulation-based educational experience, the curriculum should include prebriefing and debriefing. Prebriefing is the process in which facilitators introduce the learning environment, equipment and content to prepare learners before the exercise. Debriefing is a facilitated discussion following the simulation in which participants reflect on their experience amongst each other and the facilitator. Both prebriefing and debriefing are important to help design a psychologically safe environment for learners to fully engage with the learning material without fear of negative consequences such as a bad grade or embarrassment of mistakes. This blog post outlines approaches to both prebriefing and debriefing.   

Evidence-Based Prebriefing Approaches

Prebriefing is an essential first step for running a successful simulation and creating a safe educational environment. The goal of prebriefing is to alleviate learner anxiety and preemptively minimize distractions by familiarizing the learner with the entire simulation process, thus optimizing the experience for both teachers and learners. Prebriefing can take various forms but generally includes four key steps, detailed below:

  1. Session objectives: Facilitator provides a brief overview of the simulation topic, roles and learning objectives. This promotes transparency and eases learner stress.
  2. Fictional contract: Facilitator explains that the simulation has been made as accurate as possible and emphasizes that the learners are responsible for fully engaging and reacting throughout the simulation as if the situation is real.
  3. Logistical overview: Facilitator outlines non-curricular details such as simulation duration, equipment, facility details, breaks and phone policy to minimize distractions and increase learner satisfaction.
  4. Reassurance and respect: Facilitator clarifies whether the simulation is assessed, and if so, outlines the expectations. The learner should focus on their thought processes and reasoning rather than right versus wrong. This respects the learner’s thinking and promotes greater discussion.

Evidence-Based Debriefing Approaches

Debriefing is vital to enhancing learning outcomes. Debriefing gives learners the opportunity to reflect on the exercise with the goal of increasing conceptual understanding and improving future performance of technical and nontechnical skills. Debriefing models can also vary, but generally there are three key steps, detailed below:

  1. Reaction: Facilitator assesses the learner’s emotional response to the curriculum by asking how they feel. This phase serves as a “cool down” allowing learners to unpack emotional responses and decompress before reviewing their technical performance. This can also help facilitators gauge learner orientation and attitudes toward the activity.
  2. Analysis: Facilitator reviews the learning objectives of the curriculum, and learners discuss what happened and why. This helps the learner revisit the rationale behind decisions made and explore gaps in the clinical scenario.
  3. Summary: Learner lists key takeaways from the simulation and reflects on future applications of learned content. This phase reinforces lessons learned and provides learners with a final opportunity to ask questions and ensure comprehension before leaving the simulation lab.
An image of a clinician-educator briefing with a group of trainees in a simulation center
 

Conclusion

Prebriefing and debriefing are tools used to enhance the learner’s simulation experience. Prebriefing sets the tone for the simulation by setting expectations, encouraging discussion and allowing space for mistakes. Debriefing creates a space for reflection and outstanding questions, fostering effective learning and connection-building between curricular content and real-world application. The inclusion of both prebriefing and debriefing during simulated learning experiences can benefit learners by encouraging interpersonal risks and ultimately, promote learning.

Emily Patula is a medical student (Class of 2028) at Saint Louis University School of Medicine. Her areas of professional interest include simulation-based learning, injury prevention and mentoring. Connect with Patula on LinkedIn or by emailing emily.patula@health.slu.edu.

Tess Korte is a medical student (Class of 2028) at Saint Louis University School of Medicine. Her areas of professional interest include simulation-based learning, pediatrics and mentoring. Connect with Korte on LinkedIn or by emailing tess.korte@health.slu.edu.