Medical education high-fidelity simulation allows for deliberate practice in a safe environment. We are able to miss the intubation repeatedly or botch up the management of aspirin overdose without the demise of the patient.  At the end of each session, we gather in a pow wow and debrief….

I have been involved with debriefings, and often wonder what residents are thinking:

  • Do they understand what debriefing means?
  • Do they think this is the time where they are scolded for mistakes?
  • Do they think it is a valuable part of the simulation?

What does debriefing even mean? 

Debriefing is a broad topic, and definitions vary depending on the field of reference such as medical education versus aviation.  My goal is to provide an overview and only discuss what is debriefing within the simulation medical education context.

According to Fanning and Gaba,1 debriefing is “facilitated or guided reflection in the cycle of experiential learning.”  Harvard’s Center for Medical Simulation describes debriefing as a conversation among participants with the ultimate goal to improve performance in real situations. 2  It is a process by which to identify and address gaps in knowledge and skills.3

Debriefing (post-experience analysis) is thought to be one of the most important features of simulation based medical education. Simulation can lead to an experience that is emotional and thought provoking – aka experiential learning. (Think of how you feel when you poorly execute the resuscitation of the manikin in a simulation session.)  Debriefing plays a role in the reflection and analysis of that experiential learning.

The following elements are usually involved in debriefing:

  • Facilitator
  • Participants to debrief
  • Experience
  • Impact of the experience
  • Recollection
  • Report
  • Application

The Participants go through the simulation case (Experience) and develop an Impact from the experience.  During the debriefing they Recollect the impact, and Report upon it.  Although reflection often happens regardless, debriefing allows the Facilitator to organize the reflection in a productive manner.

Think of the last resuscitation that you felt was botched up.  You probably reflected on it alone, hopefully not in the local bar.  Your reflections may have been scattered and perhaps included unproductive self-criticisms that didn’t aid learning.  Compare that to your last simulation session where there was a useful structured reflection with a facilitator, learning points were discussed, and hopefully lessons were retained for a longer period.

Ultimately the goal of debriefing is to engage in a conversation where learning happens. It is an open format for discussion of the events that occurred, how we felt about it, and understanding the thought processes.  It allows for identifying areas where perhaps knowledge or skill was missing so that it can be corrected in the future.  So maybe debriefing is a little touchy-feely, but what’s wrong with a little human contact?!

The purpose of this post was to discuss what is debriefing; future posts will discuss why we debrief.  I would love your thoughts on this subject.  Please feel free to discuss!

Thanks to Dr. Stella Yiu and Dr. Javier Benitez for letting us know about Dr. Hart’s and Dr. Ernest Wang’s videos on Debriefing, respectively:

Fanning R, Gaba D. The role of debriefing in simulation-based learning. Simul Healthc. 2007;2(2):115-125. [PubMed]
Simon R, Raemer D, Rudolph J. Debriefing Assessment for Simulation in Healthcare (DASH)© Rater’s Handbook. Center for Medical Simulation, Boston, Massachusetts. Published 2010.
Raemer D, Anderson M, Cheng A, Fanning R, Nadkarni V, Savoldelli G. Research regarding debriefing as part of the learning process. Simul Healthc. 2011;6 Suppl:S52-7. [PubMed]
Nikita Joshi, MD

Nikita Joshi, MD

ALiEM Chief People Officer and Associate Editor
Clinical Instructor
Department of Emergency Medicine
Stanford University
Nikita Joshi, MD


Emergency Medicine Doctor Associate Editor of ALiEM Gun Sense Advocate #FOAMed #Docs4GunSense #MomsDemandAction Tweets represent my own views and opinions