Debrief

The next stage in the development process is the debrief which follows the virtual gaming simulation. The debrief is a series of questions that focus on the learning process. It is a time for learners to explore their experiences during the virtual simulation, reflect on their decisions throughout the game, and identify any gaps in knowledge.

Debriefing can be carried out in a number of ways either individually by the learner or facilitated by the educator. Different types of debriefing may include self, group, facilitated asynchronous, or synchronous virtual, or a combination of the various methods. It is important to choose the best method for the virtual simulation you created and the learners’ needs.

An example of combining two formats for debriefing for the virtual simulation could include a self-debrief and group debrief. For example, if the learner is playing the virtual simulation prior to class, a self-debrief is beneficial to capture their initial thoughts and experiences playing the game. The self-debrief may be a series of reflective questions that are recommended to be completed immediately after the virtual simulation. Then, at the next class you can complete a group debrief. The group debrief can be guided by the self-debrief questions. This process will refer back to the learning outcomes of the virtual simulation and identify participant’s learning needs. 

Insights from the Student Team

Question: Can you elaborate on a time when you engaged in both a VGS self-debrief and a group debrief? How did participating in both of these add to your learning experience?

I remember playing a VGS and being really frustrated with the wording of one of the decision point questions. Having previously worked on creating VGS, I knew how much attention goes into crafting the script, which helped temper my frustration during my self-debrief. During the group debrief, a few other students mentioned the same issue, and it was such a feeling of relief to know that my thinking was not entirely out to lunch.  ~ David Beazely

When I was completing my third-year virtual placement, we had the opportunity to engage in the Pediatric Patient with an Acute Injury and Post-Operative Event VGS. During the self-debrief time I was able to reflect on how the experience made me feel, including decisions that I was unsure about and those that I was confident in. What I found great about the self-debrief time was it gave me the opportunity to identify my learning gaps from the incorrect decision points. It also allowed me to identify unanswered questions which I could ask the group. During the group debrief time, we were all encouraged to share our thoughts and ask questions. This was a great opportunity to hear the thoughts of my peers and reflect on the questions they had, some of which really made me think critically about the experience and its application for my future clinical practice.  ~ Esther Bodach

I remember when I first completed the Meal Assistance VGS and did a self-debrief. It was nice to have the time to go through the game at my own pace and revisit the decision points while I was reflecting. I wrote down my thoughts and questions, and the next day I had the opportunity to share my reflection at the group debrief in class. It was interesting to hear about the different points my peers brought up that I did not consider prior. This process helped me generate new ideas and further prepared me for clinical practice.  ~ Caitlin Cosgrove

During a self-debrief, it is more of a reflective process since you analyze your thoughts and feelings towards the VGS and you ponder on the reason why you made those choices during the game and how this VGS will inform your own practice going forward. Whereas, in a group debrief, it is more of a collaborative planning process and how our individual experiences of the game made the group feel as a collective. Group debriefs are beneficial in recognizing patterns because, depending on the similarity or differences in our choices and emotions, we can compare our results and identify trends or gaps to enhance our learning.  ~ Starr Ferguson

During this past semester, I had the opportunity to do a self debrief for the Prenatal Nursing Care simulation. While playing this VGS, I found myself going to other sources to learn more about prenatal health. For example, I had to figure out what preeclampsia means, as I did not understand that term while watching the gaming scenario. Using the Perry’s Maternal textbook, I found out the meaning which helped me understand that it is important to assess preeclampsia in the urine sample. So, from doing the self debrief, it gave me the opportunity to identify my learning gaps from the incorrect decision points I made in the game. As we did a group debrief in class, we had the opportunity to talk about the simulation, and we as a class figured that we struggled with a calculation that was present in the simulation (ie: Naegele’s Rule). It was a calculation that I too felt a bit confusing at first, and so I was happy that I was not the only one feeling this way. The professor taught us step by step on how to calculate it, and it indeed helped all of us a lot.  ~ Kevin George

Another example includes having a group debrief first, when planning to play the virtual simulation together as a large group. After the debrief discussion, you can provide the learners a self-debrief to encourage further reflection on their experience and feedback during the group virtual simulation and discussion.

During the debrief, whether in-person or virtually, it is important to ensure the psychological safety of all the participants. Similar to the pre-brief, psychological safety is enhanced when clear instructions and expectation of the learners’ participation are provided regarding the process of the debrief.

Consider the following questions when planning your debriefing activity:

  • Is it a self-debrief or a group debrief? If it is a group debrief, how large is the group?
  • Do you expect all students to complete a self-debrief?
  • Will all students be expected to discuss their experience during the group debrief?
  • Do you expect each learner to participate in sharing their thoughts on each question or will it be voluntary?

It is also important to explain the policies regarding confidentiality, privacy, and conduct during the debrief. As a facilitator, encouraging open dialogue, acknowledging responses, and being attentive to learners’ needs provides an opportunity for learners to share their thoughts and feelings. When students are aware of what is expected during the debrief, this fosters a safe learning environment to share their experiences, enhance student satisfaction, and facilitate student achievement in the learning process (Goldsworthy & Verkuyl 2021; Turner &Harder 2018).

The INACSL Standards Committee (2021) standards of best practice in debriefing identifies various debriefing models an educator could utilize during the virtual simulation to facilitate the debriefing process/session with your learners. For example, PEARLS, Debriefing for Meaningful Learning (DML), Debriefing for Good Judgement, and 3D Model of Debriefing are common formats. However, there are several debriefing formats. The INACSL Standards of Best Practice: Simulation Debriefing outline various debriefing formats to choose from depending on your virtual simulation goals and learner needs. Check with your institution which debriefing tools they may use to provide consistency across your programs. 

For the VGS Model, the debriefing format PEARLS (Promoting Excellence and Reflective Learning in Simulation) and 3D debriefing model will be used to demonstrate how to create your debriefing questions.

PEARLS Framework

The PEARLS framework focuses on learner self-assessment, focused facilitation, and providing direct feedback (Eppich & Cheng, 2015). It begins with Setting the Scene by explaining what will occur during the debrief (e.g., purpose, goals, structure) and creating a safe environment for learners to share their thoughts and experiences. Following this initial discussion, you will then begin the debriefing process working through the PEARLS phases as described below:

(Eppich & Cheng, 2015)

 

Virtual Gaming Simulation (VGS) Model

Here are some examples of PEARLS debriefing questions for the VGS Model:

3D Debriefing Model

Another debriefing tool is the 3D Debriefing Model.  It is divided into the following phases: Defusing, Discovering, and Deepening.

(Zigmont et al, 2011)

Virtual Gaming Simulation (VGS) Model

Here are some examples of 3D Model debriefing questions that would be used for the VGS Model:

Educator Tip

The following educator tips can help you successfully facilitate the debriefing process with your learners:

  • Being prepared and knowledgeable of the virtual gaming simulation key concepts.
  • Orienting yourself to the virtual simulation platform is important.
  • Creating a feedback outline to assist you throughout the debriefing process.
  • Providing clear instructions, explaining the purpose of the debrief, and highlighting learning objectives with the learners.
  • Fostering a psychologically safe environment for your learners to share their thoughts and feelings by actively listening and acknowledging their responses.
  • Using open-ended questioning to facilitate active participation.
  • Encouraging learners to self-reflect and assist them in understanding their decisions and choices made during their experience.
  • Providing objective, non-judgemental feedback, reinforcing key learning concepts, and discuss strategies for improvement for future practice.

Here is an example of debriefing questions used in the Health History Virtual Gaming Simulation.

 

Insights from the Student Team

Question: In your experience when participating in a VGS, what factors made you feel safe and what factors made you feel confident to contribute ideas during the VGS debrief time?

When playing a VGS, I learn more from the incorrect choices I make rather than the correct ones. Comprehensive rationales for incorrect decisions are something that helps me feel more comfortable and confident later in the debriefing sessions. A comprehensive rationale acts as a detour to help guide me toward the correct choice rather than a complete dead-end. The debrief then becomes more about sharing how we all take different paths to reach the same destination.  ~ David Beazely

In my experience, when participating in a VGS debrief time there were several factors which made me feel safe to contribute ideas. One major factor was when the instructor prefaced that everything discussed in the room would remain in the room and would not be shared. As well, when I spoke up and my peers seemed interested and affirming my ideas, this also made me feel safe. Factors that made me feel confident to express my ideas was knowledge of the topic which many times was the result of completing the pre-simulation readings, also having the desire to learn from my peers and knowing that ideas not shared cannot be responded to.  ~ Esther Bodach

While participating in the Home Visit VGS, the Faculty Lead immediately made me feel safe in the group debrief by verbalizing the rules. They let us know right away that it was a safe and confidential space where you can share your thoughts and feelings freely. I think it was important for me to hear the Faculty Lead create this verbal contract because debriefs can make people feel vulnerable or judged. ~ Caitlin Cosgrove

Everyone on the team is very open-minded and we all encourage each other to share new ideas. It was a great experience working on a team where everyone’s contribution is valued, and where there is a mutual respect for all members.  ~ Starr Ferguson

In my experience while participating in the VGS, during the first meeting, I recollect the faculty letting us know that this is a safe space, and that we should not feel afraid to let out our thoughts and feelings during the debrief time. I also notice that my fellow student researchers respect each other, and provide encouragement like “that’s a great idea,” and things like that. It has indeed made me feel more confident to contribute any ideas I had during the VGS debrief time.  ~ Kevin George

Additional Resources

International Nursing Association for Clinical Simulation and Learning (INACSL): Healthcare Simulation Standards of Best Practice™

The Healthcare Simulation Standards of Best PracticeTM The Debriefing Process provides guidance on the debriefing process. The standard addresses debriefing activities which can include providing feedback and fostering participant reflection of their simulation experience.

The Healthcare Simulation Standards of Best PracticeTM Facilitation outlines key strategies on how to create a structured process for the participants’ learning and virtual simulation experience.

 

References

Decker, S., Alinier, G., Crawford, S. B., Gordon, R. M., Jenkins, D., & Wilson, C. (2021). Healthcare Simulation Standards of Best PracticeTM The Debriefing Process. Clinical Simulation in Nursing58, 27–32. https://doi.org/10.1016/j.ecns.2021.08.011

Persico, L., Belle, A., DiGregorio, H., Wilson-Keates, B., & Shelton, C. (2021). Healthcare Simulation Standards of Best PracticeTM Facilitation. Clinical Simulation in Nursing58, 22–26. https://doi.org/10.1016/j.ecns.2021.08.010

Attributions

Health History Interview – Virtual Gaming Simulation by Jennifer Lapum, Michelle Hughes, Joy Garmaise-Yee, Sara Richie, Sherry Espin, Don Rose, Susana Neves-Silva, Oona St-Amant, and Anneke Rumens is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

Using Virtual Gaming Simulation: An Educator’s Guide by Margaret Verkuyl, Sandy Goldsworthy, and Lynda Atack is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

Virtual Simulation: An Educator’s Toolkit by Centennial College is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.

References

Badowski, D., & Wells-Beede, E. (2022). State of prebriefing and debriefing in virtual simulation. Clinical Simulation in Nursing, 62, 42–51. https://doi.org/10.1016/j.ecns.2021.10.006

Eppich, W., & Cheng, A. (2015). Promoting excellence and reflective learning in simulation (PEARLS): Development and rationale for a blended approach to health care simulation debriefing. Simulation in Healthcare: Journal of the Society for Medical Simulation, 10(2), 106. https://doi.org/10.1097/SIH.0000000000000072

Goldsworthy, S., & Verkuyl, M. (2021). Facilitated virtual synchronous debriefing: A practical approach. Clinical Simulation in Nursing, 59, 81-84. http://doi.org/10.1016/j.ecns.2021.06.002

INACSL Standards Committee, Decker, S., Alinier, G., Crawford, S.B., Gordon, R.M., & Wilson, C. (2021, September). Healthcare simulation standards of best practiceTM The debriefing process. Clinical Simulation in Nursing, 58, 27–32. https://doi.org/10.1016/j.ecns.2021.08.011

Turner, S., & Harder, N. (2018). Psychological safe environment: A concept analysis. Clinical Simulation in Nursing, 18, 47-55. http://doi.org/10.1016/j.ecns.2018.02.004

Zigmont JJ, Kappus LJ, Sudikoff SN. (2011, April). The 3D model of debriefing: defusing, discovering, and deepening. Semin Perinatol. 35(2): 52–58. https://doi.org/10.1053/j.semperi.2011.01.003