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.)