“Thinking on your feet”—a qualitative study of debriefing practice

Background: Debriefing is a significant component of simulation-based education (SBE). Regardless of how and
where immersive simulation is used to support learning, debriefing has a critical role to optimise learning outcomes.
Although the literature describes different debriefing methods and approaches that constitute effective debriefing,
there are discrepancies as to what is actually practised and how experts or experienced debriefers perceive and
approach debriefing. This study sought to explore the self-reported practices of expert debriefers.
Methods: We used a qualitative approach to explore experts’ debriefing practices. Peer-nominated expert debriefers
who use immersive manikin-based simulations were identified in the healthcare simulation community across Australia.
Twenty-four expert debriefers were purposively sampled to participate in semi-structured telephone interviews lasting
45–90 min. Interviews were transcribed and independently analysed using inductive thematic analysis.
Results: Codes emerging through the data analysis clustered into four major categories: (1) Values: ideas and beliefs
representing the fundamental principles that underpinned interviewees’ debriefing practices. (2) Artistry: debriefing
practices which are dynamic and creative. (3) Techniques: the specific methods used by interviewees to promote a
productive and safe learning environment. (4) Development: changes in interviewees’ debriefing practices over time.
Conclusions: The “practice development triangle” inspired by the work of Handal and Lauvas offers a framework for
our themes. A feature of the triangle is that the values of expert debriefers provide a foundation for associated artistry
and techniques. This framework may provide a different emphasis for courses and programmes designed to support
debriefing practices where microskill development is often privileged, especially those microskills associated with
techniques (plan of action, creating a safe environment, managing learning objectives, promoting learner reflection
and co-debriefing). Across the levels in the practice development triangle, the importance of continuing professional
development is acknowledged. Strengths and limitations of the study are noted.