Hi there,

I've been spending quite a bit of time over the past few weeks thinking about simulation as part of a broader clinical education programme and, in particular, the importance of debriefing as part of any simulation activity. I know that debriefing wasn't on my radar when I initially started thinking about simulation (thanks to Ben for suggesting that I look into it), so thought it might be useful to highlight this aspect of clinical simulation, not only as part of a discrete simulation activity, but also as a continuous thread, tying all the other components of simulation together as part of a coherent programme.

The resources below aren't going to show you how to do that; one of the advantages of simulation is that it can look so different depending on the context, so a single, unifying concept is unlikely. But I found that thinking about a philosophy and framework for debriefing was also influencing how I thought about other aspects of the simulation programme. For example, the emphasis on learner self-assessment, and genuine attempts to understand the trainees, are important foundations for the development of clinical reasoning, as well as trusting relationships that underpin successful outcomes in any simulation programme.

As always, I hope that this is useful to you.


Brazil, V. & Symond, B. (2021). Plus-delta debriefing. Simulcast Journal Club Podcast. Episode 131. Available at https://simulationpodcast.com/131-journal-club-podcast-july-2021-plus-delta-debriefing/

In this journal-club-style podcast, the team at Simulcast discuss three papers, only the first of which deals with the topic of debriefing. Which means that it's a very short overview of the plus-delta debriefing method, a simple and pragmatic approach to debriefing where the central aim is to ask the group what went well, and what didn't go well. This simplicity has the benefit of fewer barriers to implementation, suggesting it as a good option to consider.

The paper being discussed is Cheng, et al. (2021). Embracing informed learner self-assessment during debriefing: The art of plus-delta.Advances in Simulation, 6(1), 22. One of the aspects of the conversation that stood out for me is the reliance that plus-delta has on learner self-assessment which, depending on your perspective, may make this approach more, or less, suitable for undergraduate education.

The rest of the episode deals with unrelated papers, so if it's just the simulation debriefing that's of interest you can stop listening after the first 10 minutes or so.


Rudolph, J. W., Simon, R., Dufresne, R. L., & Raemer, D. B. (2006). There’s No Such Thing as “Nonjudgmental” Debriefing: A Theory and Method for Debriefing with Good Judgment. Simulation in Healthcare, 1(1), 7. https://doi.org/10/ghcws8

Sharing critical judgments is an essential part of learning in simulation and debriefing. Instructors often avoid giving voice to critical thoughts and feelings because they do not want to appear confrontational and they worry that criticism might lead to hurt feelings or defensiveness on the part of the trainee. Voicing critical judgment poses a dilemma for many instructors: “How can I deliver a critical message and share my expertise while avoiding negative emotions, preserving social ‘face’ and maintaining my relationship with the trainee?” This paper offers an approach to debriefing that addresses this dilemma.

There are three elements in the debriefing with good judgement model:
  1. Trainees' frames (i.e. knowledge, assumptions, and feelings) drive their actions, which lead to clinical outcomes. A better understanding of the trainees’ frames can help the instructor reframe them with the aim of achieving better outcomes.
  2. Instructors have a genuine curiosity about the trainees’ frames, where the trainees’ mistakes are puzzles to be solved, instead of errors to be corrected.
  3. Instructors use a conversational framework to highlight their own judgement and the trainees’ frames, using advocacy and inquiry.


Bajaj K, Meguerdichian M, Thoma B, Huang S, Eppich W, Cheng A. The PEARLS Healthcare Debriefing Tool. Academic Medicine. 2018, 93(2), 336.

The PEARLS framework for debriefing is a useful guide for clinical educators looking to provide focused feedback to trainees with the aim of improving future performance, in a safe learning environment.

Healthcare debriefings are facilitated conversations following a clinical or simulated event that aim to improve future clinical practice. Debriefings should contribute to a safe learning environment, actively engage participants, and focus on learning and improvement. The various approaches to healthcare debriefing may confuse educators. The PEARLS (Promoting Excellence And Reflective Learning in Simulation) framework addresses this problem by integrating three common educational strategies: learner self-assessment, focused facilitation (including advocacy-inquiry), and providing information or direct feedback/teaching.

The PEARLS framework for debriefing includes the following phases and objectives:
  • Setting the scene to create a safe context for learning.
  • Explore feelings and reactions.
  • Description and fact clarification.
  • Analysis and exploration of performance domains. The performance domains in this phase are further described in the framework.
  • Summary and takeaways.


I also thought it worth highlighting the following items that I came across during my research on debriefing. There's a lot of information available on debriefing in general but I thought that the two pieces below were sufficiently thought-provoking so as to include them as well.
  • Despite a different history and tradition, the concepts of feedback and debriefing have enough commonality and theoretical overlap that educators might consider merging these concepts. See more here: Tavares, W., Eppich, W., Cheng, A., Miller, S., Teunissen, P. W., Watling, C. J., & Sargeant, J. (2020). Learning Conversations: An Analysis of the Theoretical Roots and Their Manifestations of Feedback and Debriefing in Medical Education. Academic Medicine, 95(7), 1020–1025. https://doi.org/10/gn4gd6
  • While the simulation literature tends to focus on trainer-led debriefing you may also be interested in exploring the idea of self-debriefing, where trainees guide their own sessions (note that this is different to self-assessment). See more here: Pottle, J. (n.d.). Self-debriefing in healthcare simulation. Oxford Medical Simulation.


In line with the idea that we'd like to build more of a community of practice within and around the In beta project, we're going use the newsletter to promote activities in the broader physiotherapy education field, which have a community feel to them.

Healthpunk Vol. 2 call for stories
In 2021 Filip Maric and colleagues in the Bachelor programme in physiotherapy at UiT The Arctic University of Norway published the Physiopunk Volume 1 collection of physiotherapy student essays. The project was such a success that Filip has put together another team and expanded the vision of the project to include disciplines outside of physiotherapy, and institutions outside of his own.

This evolution led to a renaming of the project to Healthpunk and Filip and his team are now soliciting submissions of stories from health professional students from around the world, for inclusion in the second volume in the series.

Drawing on the philosophies and genres emerging around speculative fiction and diverse international futurism, we suggest healthpunk as an approach that can help us envision hopeful yet radically different possibilities for future healthcare beyond the parameters, logics, and politics of our siloed clinical environments and scopes of practice. We see this call for stories as an invitation to let go of established conventions and imagine otherwise healthcares filled with creativity and genuine care for the health of everyone we share this planet with.

You can find out more in the Call for stories pageat OpenPhysio.
What's your big takeaway, and how does that connect to what you're going to be doing in the real world?

Stephanie Lancaster (2017)
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