It is suggested that postsimulation debriefing, a ‘structured and guided reflection process in which learners actively appraise their cognitive, affective and psychomotor performance’ (Al Sabei & Lasater 2016), is the most important element of the simulation learning process (e.g. Zigmont et al. 2011a, Levett-Jones & Lapkin 2014).

The instructor usually facilitates the debriefing and depending on the learners level either the instructor or a student leads it. Debriefing allow learners to recall what aspects of reality are simulated and how the experience is related to concepts previously learned. Moreover, a structured debriefing promotes reflection, learning to self-correct and assimilate new and previous experiences to improve overall professional competence.(Lavoie, Pepin & Cossette 2015).

The steps in the debriefing include the discussion of feelings and reactions to the scenario, the positive actions and the actions which need development, and a summary about how the scenario is transferred to a clinical practice. Zigmont, Kappus and Sudikoff call the process “3D” for defusing, discovering, and deepening (2011a, b). The process begins with defusion, where the learners freely express their emotional reactions to the simulation experience. The facilitator guides the reflection by providing a safe environment for openness so that the learners can verbalize their thoughts. Learners need to be guided to give feedback in encouraging and positive rather than judgmental and negative way. The strengths and challenges should be drawn out in a non-threatening manner, while at the same time facilitating emotional release, as learners’ emotions can inhibit learning (Dreifuerst 2009.)

In the discovering phase, the instructor encourages the learners to identify specific behaviors in the simulated scenario that facilitated or impeded the clinical intervention. The participating learners describe what they were thinking when they exhibited those behaviors and further discussion occurs in response.

As the learners gain insight into their mental models and optimal behavioral responses, in the deepening phase, the instructor prompts them to connect new learning to larger clinical environments and projecting to future clinical experiences. This scaffolding approach, in which the instructor facilitates the reflective process at each stage of learning in order to advance the learners to the next level of inquiry, intends to solidify the learners’ knowledge and skills (Zigmont et al. 2011a.)

In debriefing is important

  • to ensure that every learner has the opportunity to benefit from the simulation experience, thus significant time should be allocated after every simulation for debriefing,
  • that the performance of the group are reflected together and aligned with the learning objectives by highlighting the positive actions instead of the judgment,
  • that the instructor facilitates the reflection, activates the observers, and asks analytic questions fostering deeper reflection,
  • that it is grounded in theory to provide instructors and learners with a structured process for evaluating performance, encouraging self-evaluation, and building knowledge,
  • that examples of nursing practice related to specific competencies are drawn out and reflected on
  • to know that debriefing can be supported in variety of ways e.g. including audio and video recordings of simulated interviews, allowing instructors to use realistic interactions, identifying both ineffective and effective practice and analyzing the content for key concepts,
  • To notice meaning of real-time feedback as a dual purpose of assessing and reinforcing learner competency. As the learner performs with an SP in a simulation, the observing instructor may interrupt if the learner makes errors. The instructor may ask the learner to provide his or her rationale for taking a certain action or instruct the learner to the proper method of performance. In that way, the learner receives immediate feedback, which reinforces critical thinking and clinical reasoning skills (see also time-in / time-out technique under simulation –chapter)
  • To follow debriefing immediately after simulation involving an SP. The SP can provide feedback to both participating and observer learners by describing experiences during the clinical scenario. That helps the learners become aware of how their actions may affect their patients or clients and influence the outcome of a clinical intervention

Glossary of terms


‘Structured and guided reflection process in which students actively appraise their cognitive, affective and psychomotor performance’ (Al Sabei & Lasater, 2016, p. 46). The steps in the debriefing include the discussion of feelings and reactions to the scenario (a reaction), the positive actions and the actions which need development (an analysis), and a summary; what or how the scenario is transferred to clinical practice.

Patient / Client Vignettes

These short vignettes describe patients/clients with diverse characteristics and diverse needs.  While reading these, consider how you could  incorporate such perspectives into simulation-based learning scenarios.

Man with hearing aid

Transgender person

27 year old lesbian woman

Rosaleen Mc Donagh, a 52-year-old traveller lady was admitted to the medical ward with unstable blood sugars.

Aamil Saab, a 62-year-old Muslim gentleman who has resided in Cork for five years was admitted to the acute coronary unit with a myocardial infraction

Emma, 2 years, suffers from recurrent otitis media i.e. ear infection. She also suffers from recurrent respiratory infections.

Martti 88 years has cardiovascular diseases, including hypertension and diabetes, and has gout.

Learner, Patient and Tutor Testimonials

In this section we have provided real feedback from those involved in the simulation training. We hope these give an insight into some of the process and practices involved

 Bachelor’s Degree Programme in Nursing –students Bella Lee and Roosa Toropainen (Savonia University of Applied Sciences)

Video Guides

Expert opinions from academic and clinical leads discussing their perspective on the importance of cultural awareness in medical simulation training.

Guide to useful links

Who’s Recommendation is thisSource of InformationWhy are these Resources useful
Marja Silén-LipponenIt Is Time to Consider Cultural Differences in Debriefing

Advice center

Oamk SimLab – Simulation environments in Oulu University of Applied Sciences

Oulu University of Applied Sciences has a versatile simulation and studio environment ecosystem – Oamk SimLab, which is used in education, training, and as well for testing future health technology products and welfare services.

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The first studios were established in 2009. At first, we trained teachers as simulation instructors and integrated simulations into emergency training of nurse, midwifery and public health nurse education courses. The second, our focus was to develop patient/ client/ family centred interprofessional (IP) team training by using simulation education. Today we have IP simulation courses integrated in curricula of medical and all health care study programs.

PhD, Senior Lecturer Tiina Tervaskanto-Mäentausta from OAMK made her dissertation some time ago about simulation and is very eager to develop simulation pedagogy more. “Why not to use simulations more in learning to care for the ethnic people, gender and age based questions and everyday life of disabled and older people. We have already integrated simulations to social care education and have some examples of scenarios about ethnic family with children and also scenarios of child protection cases. We also have developed a special “enabled home” environment to train and probe suitable technology to live at home when there are problems in everyday life.”

Tiina also adds that training in SimLab is effective. “ Based on the students’ feedback, training in simulation environment with real life scenarios is effective. Students have so far started to trust and respect on different types of expertise and learned patient/ client/ family centred care and services. In the future society, students need competencies to solve complicated problems of the people, often using mobile connections. More and more important is to learn social skills, how to communicate, how to face people with different background. In simulation students can use all their senses while they act, observe and reflect; the future pedagogy turns more and more into active learning methods and into digital and authentic environments. In Oulu we are connected to OuluHealth Network to share and learn to work together for the healthier future.”

Design from Oulu – Oamk SimLab