Into the black-box of learning in simulation debriefing: A qualitative research study

Abstract

Background: Simulated learning activities are on the rise worldwide. Debriefing is viewed as a central element in simulated learning to enhance learning. Still, the question of how students learn in debriefing is underexplored. Aim, design and method: The paper offers a contribution to the academy to better understand debriefing by presenting an in-depth, qualitative analysis of the practice of debriefing, carried out with 40 first-year nursing students (n=40) in relation to roleplay simulation, training in clinical decisionmaking and patient involvement. The simulation sessions were carried out at a university hospital in Copenhagen, Denmark during clinical practice periods. Findings: Using theoretical conceptualizations from learning theorist Knud Illeris as sensitizing concepts, the paper points to the emergence of intended as well as unintended learning processes. In addition, it highlights the importance of focusing on facilitators' empowering as well as disempowering impact on students' motivation to engage in debriefing learning processes. An important finding is that the curricular overload leads to a prioritization of learning outcome related to natural science at the expense of "softer" competencies, e.g. patient involvement. The analysis also finds that students' motivation to process their real-life clinical experiences tends to be neglected. The conclusion thus points to a profound dilemma, unidentified in the literature, of learning ambitions in debriefing: the tension between attaining the formal learning objective and thus facilitating a tightly structured and focused debriefing on the one side, and the wish to develop critical and independent thinking on the other.

Student-Centered Reflection During Debriefing

“…Results highlighted discussion with faculty and peers, indicating hearing other's stories and perspectives fostered students' reflection. This was found in other studies on perceptions of simulation, especially if there is a lack of supportive and constructive feedback 28,29. The positive and negative influence of peers on reflection was also prominent.…”

“…This was found in other studies on perceptions of simulation, especially if there is a lack of supportive and constructive feedback. 28,29 The positive and negative influence of peers on reflection was also prominent. Although the impact of the facilitator is well documented in the literature, little is known regarding peer impact on students' reflection during simulation.…”

“…Although previous studies identified the positive impact of discussion with peers, there is little information on the negative influences of peers on reflection. 28,29 There is a need to explore this negative influence further to help facilitators mitigate this during simulation debriefings.…”

Using in silico process simulation tools in pharmacy education: Considerations for pivoting to online learning

“…Adjusted inputs, simulation outputs and hypotheses, using the simulation process flow tool, can be deposited in shared repositories for asynchronous evaluation in addressing the late phase learning milestone. Considering the findings of Frandsen & Lehn-Christiansen, (Frandsen & Lehn-Christiansen, 2020), we suggest that ideally the final debriefing would be a synchronous activity, fostering a positive semi-structured environment to promote student questioning and clarify learning objectives at that point.…”

Facilitator competency rubric in nursing simulations: transcultural adaptation and validation of the German version

“…An experienced mentor should evaluate the facilitator's competency at least once per semester, and this evaluation should be flanked by the facilitator performing self-assessments of their own competency [12]. A higher motivation to facilitate simulations in nursing is associated with higher competencies [13].…”