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The debriefing phase in human patient simulation is considered to be crucial for learning. To ensure good learning conditions, the use of small groups is recommended, which poses a major challenge when the student count is high. The use of large groups may provide an alternative for typical lecture-style education and contribute to a more frequently and repeated training which is considered to be important for achieving simulation competency. The purpose of the present study was to describe nursing students' experiences obtained during the debriefing conducted in small and large groups with the use of a qualitative descriptive approach. The informants had participated in a human patient simulation situation either in large or small groups. Data was collected through the use of five focus-group interviews and analysed by content analysis. The findings showed that independent of group-size the informants experienced the learning strategies to be unfamiliar and intrusive, and in the large groups to such an extent that learning was hampered. Debriefing was perceived as offering excellent opportunities for transferable learning, and activity, predictability and preparedness were deemed essential. Small groups provided the best learning conditions in that safety and security were ensured, but were perceived as providing limited challenges to accommodate professional requirements as a nurse. Simulation competency as a prerequisite for learning was shown not to be developed isolated in conjunction with simulation, but depends on a systematic effort to build a learning community in the programme in general. The faculty needs to support the students to be conscious and accustomed to learning as a heightened experience of learning out of their comfort zone.

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Background. In the use of simulation as a learning approach, a structured debriefing is important for students to achieve learning. The facilitator's feedback style and abilities in facilitating are crucial, and have a great impact on the learning environment. The facilitators should facilitate for student active learning, and provide helpful feedback to empower students as self-regulated learners. The aim of the study was to explore the Steinwachs structure and the Critical Response Process structure when used in debriefing in medical simulation, and how each of them affected the facilitator's role. Method.A multi-method, comparative quasi-experimental design was used.Results. Structuring debriefing in accordance with the Critical Response Process facilitated a facilitator role that coincided with factors highlighted in theory on how to facilitate student active learning and the development self-regulating learners. Structuring debriefing in accordance with the Steinwachs structure revealed that debriefing seemed to be based more on the facilitator's frames and dominance than the students' frames and involvement.Conclusion. The results of this study showed that Critical Response Process (CRP) can be an appropriate structure to use in debriefing in medical simulation.