Promoting Excellence and Reflective Learning in Simulation (PEARLS): Development and Rationale for a Blended Approach to Health Care Simulation Debriefing
Abstract
STATEMENT: We describe an integrated conceptual framework for a blended approach to debriefing called PEARLS [Promoting Excellence And Reflective Learning in Simulation]. We provide a rationale for scripted debriefing and introduce a PEARLS debriefing tool designed to facilitate implementation of the new framework. The PEARLS framework integrates 3 common educational strategies used during debriefing, namely, (1) learner self-assessment, (2) facilitating focused discussion, and (3) providing information in the form of directive feedback and/or teaching. The PEARLS debriefing tool incorporates scripted language to guide the debriefing, depending on the strategy chosen. The PEARLS framework and debriefing script fill a need for many health care educators learning to facilitate debriefings in simulation-based education. The PEARLS offers a structured framework adaptable for debriefing simulations with a variety in goals, including clinical decision making, improving technical skills, teamwork training, and interprofessional collaboration.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The Promoting Excellence and Reflective Learning in Simulation framework integrates self-assessment, guided discussion, and directive feedback.
“For example, the Promoting Excellence and Reflective Learning in Simulation framework integrates self-assessment, guided discussion, and directive feedback [54].”
From Enhancing Psychiatry Training Using an Agentic AI Simulated Consultation Tool: Prospective Cohort Study (2026) · cites this paper as [54]
Cites
Barry Issenberg, S., Mcgaghie, W. C., Petrusa, E. R., Lee Gordon, D., & Scalese, R. J. (2005) · Medical Teacher · doi:10.1080/01421590500046924 · Cited by 3,966 · see citing works
Ericsson, K. A. (2004) · Academic Medicine · doi:10.1097/00001888-200410001-00022 · Cited by 2,988 · see citing works
Davis, D. A., Mazmanian, P. E., Fordis, M., Van Harrison, R., Thorpe, K. E., & Perrier, L. (2006) · JAMA · doi:10.1001/jama.296.9.1094 · Cited by 2,375 · see citing works
McGaghie, W. C., Issenberg, S. B., Cohen, E. R., Barsuk, J. H., & Wayne, D. B. (2011) · Academic Medicine · doi:10.1097/acm.0b013e318217e119 · Cited by 1,866 · see citing works
Deliberate practice and acquisition of expert performance: a general overview
Anders Ericsson, K. (2008) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2008.00227.x · Cited by 1,827 · see citing works
A critical review of simulation‐based medical education research: 2003–2009
McGaghie, W. C., Issenberg, S. B., Petrusa, E. R., & Scalese, R. J. (2010) · Medical Education · doi:10.1111/j.1365-2923.2009.03547.x · Cited by 1,733 · see citing works
The Role of Debriefing in Simulation-Based Learning
Fanning, R. M., & Gaba, D. M. (2007) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0b013e3180315539 · Cited by 1,714 · cited 1× · see citing works
“The reactions phase begins with an open-ended question such as ‘‘How are you feeling?’’ to allow learners to vent and express their initial thoughts and feelings.(3,6,8,28,57) When only 1 or 2 learners respond to the initial question, a followup question such as ‘‘Other initial reactions?’’ or ‘‘How are the rest of yo…”
BackgroundCognitive load theory in health professional education: design principles and strategies
Van Merriënboer, J. J. G., & Sweller, J. (2010) · Medical Education · doi:10.1111/j.1365-2923.2009.03498.x · Cited by 1,511 · see citing works
Feedback in Clinical Medical Education
Ende, J. (1983) · JAMA · doi:10.1001/jama.1983.03340060055026 · Cited by 1,259 · see citing works
Rudolph, J. W., Simon, R., Dufresne, R. L., & Raemer, D. B. (2006) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/01266021-200600110-00006 · Cited by 1,101 · see citing works
Problem‐based learning: future challenges for educational practice and research
Dolmans, D. H. J. M., de Grave, W. S., Wolfhagen, I. H. A. P., & van der Vleuten, C. P. M. (2005) · Medical Education · doi:10.1111/j.1365-2929.2005.02205.x · Cited by 1,055 · see citing works
Self-Assessment in the Health Professions: A Reformulation and Research Agenda
Eva, K. W., & Regehr, G. (2005) · Academic Medicine · doi:10.1097/00001888-200510001-00015 · Cited by 992 · see citing works
Establishing a Safe Container for Learning in Simulation
Rudolph, J. W., Raemer, D. B., & Simon, R. (2014) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0000000000000047 · Cited by 933 · see citing works
Debriefing with Good Judgment: Combining Rigorous Feedback with Genuine Inquiry
Rudolph, J. W., Simon, R., Rivard, P. E., Dufresne, R. L., & Raemer, D. B. (2007) · Anesthesiology Clinics · doi:10.1016/j.anclin.2007.03.007 · Cited by 809 · see citing works
State of the science in health professional education: effective feedback
Archer, J. C. (2010) · Medical Education · doi:10.1111/j.1365-2923.2009.03546.x · Cited by 783 · see citing works
Does Team Training Improve Team Performance? A Meta-Analysis
Eduardo Salas, A., DiazGranados, D., Klein, C. R., Burke, C. S., Stagl, K. C., Goodwin, G. F., & Halpin, S. M. (2008) · Human Factors The Journal of the Human Factors and Ergonomics Society · doi:10.1518/001872008x375009 · Cited by 779 · see citing works
Debriefing as Formative Assessment: Closing Performance Gaps in Medical Education
Rudolph, J. W., Simon, R., Raemer, D. B., & Eppich, W. (2008) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2008.00248.x · Cited by 779 · see citing works
Self-citationSimulation-Based Training in Anesthesia Crisis Resource Management (ACRM): A Decade of Experience
Gaba, D. M., Howard, S. K., Fish, K. J., Smith, B. E., & Sowb, Y. A. (2001) · Simulation & Gaming · doi:10.1177/104687810103200206 · Cited by 729 · see citing works
Do Team and Individual Debriefs Enhance Performance? A Meta-Analysis
Tannenbaum, S. I., & Cerasoli, C. P. (2012) · Human Factors The Journal of the Human Factors and Ergonomics Society · doi:10.1177/0018720812448394 · Cited by 647 · see citing works
Experiential learning: AMEE Guide No. 63
Yardley, S., Teunissen, P. W., & Dornan, T. (2012) · Medical Teacher · doi:10.3109/0142159x.2012.650741 · Cited by 639 · see citing works
Experiential learning: Transforming theory into practice
Yardley, S., Teunissen, P. W., & Dornan, T. (2012) · Medical Teacher · doi:10.3109/0142159x.2012.643264 · Cited by 589 · see citing works
Improving In-Hospital Cardiac Arrest Process and Outcomes With Performance Debriefing
Edelson, D. P. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.10.1063 · Cited by 481 · see citing works
Value of Debriefing during Simulated Crisis Management: Oral versusVideo-assisted Oral Feedback
Savoldelli, G. L., Naik, V. N., Park, J., Joo, H. S., Chow, R., & Hamstra, S. J. (2006) · Anesthesiology · doi:10.1097/00000542-200608000-00010 · Cited by 430 · see citing works
Debriefing: Toward a Systematic Assessment of Theory and Practice
Lederman, L. C. (1992) · Simulation & Gaming · doi:10.1177/1046878192232003 · Cited by 415 · see citing works
Giving feedback in medical education: Verification of recommended techniques
Hewson, M. G., & Little, M. L. (1998) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.1998.00027.x · Cited by 409 · see citing works
Negative effects of destructive criticism: Impact on conflict, self-efficacy, and task performance.
Baron, R. A. (1988) · Journal of Applied Psychology · doi:10.1037/0021-9010.73.2.199 · Cited by 408 · see citing works
Eva, K. W., Armson, H., Holmboe, E., Lockyer, J., Loney, E., Mann, K., & Sargeant, J. (2012) · Advances in Health Sciences Education · doi:10.1007/s10459-011-9290-7 · Cited by 402 · see citing works
After-Event Reviews: Drawing Lessons From Successful and Failed Experience.
Ellis, S., & Davidi, I. (2005) · Journal of Applied Psychology · doi:10.1037/0021-9010.90.5.857 · Cited by 376 · see citing works
Debriefing Assessment for Simulation in Healthcare
Brett-Fleegler, M. B., Rudolph, J. W., Eppich, W., Monuteaux, M. C., Fleegler, E. W., Cheng, A., & Simon, R. (2012) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0b013e3182620228 · Cited by 369 · see citing works
Self-citationThe 3D Model of Debriefing: Defusing, Discovering, and Deepening
Zigmont, J. J., Kappus, L. J., & Sudikoff, S. N. (2011) · Seminars in Perinatology · doi:10.1053/j.semperi.2011.01.003 · Cited by 345 · see citing works
"The essentials of debriefing in simulation learning: a concept analysis".
Chesak, S. S. (2010) · PubMed · Cited by 337 · see citing works
Research Regarding Debriefing as Part of the Learning Process
Raemer, D. B., Anderson, M., Cheng, A., Fanning, R. M., Nadkarni, V., & Savoldelli, G. L. (2011) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0b013e31822724d0 · Cited by 310 · see citing works
Self-citationThe art and science of debriefing in simulation: Ideal and practice
Dieckmann, P., Friis, S. M., Lippert, A. M., & Østergaard, D. (2009) · Medical Teacher · doi:10.1080/01421590902866218 · Cited by 309 · see citing works
Smith‐Jentsch, K. A., Cannon‐Bowers, J. A., Tannenbaum, S. I., & Eduardo Salas, A. (2008) · Small Group Research · doi:10.1177/1046496408317794 · Cited by 286 · see citing works
How to Facilitate a Debriefing
Steinwachs, B. (1992) · Simulation & Gaming · doi:10.1177/1046878192232006 · Cited by 271 · see citing works
Debriefing Medical Teams: 12 Evidence-Based Best Practices and Tips
Eduardo Salas, A., Klein, C. R., King, H. B., Salisbury, M. L., Augenstein, J. S., Birnbach, D. J., Robinson, D. W., & Upshaw, C. (2008) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/s1553-7250(08)34066-5 · Cited by 252 · see citing works
Promoting Student-Centered Learning in Experiential Education
Estes, C. A. (2004) · Journal of Experiential Education · doi:10.1177/105382590402700203 · Cited by 251 · see citing works
TeamGAINS: a tool for structured debriefings for simulation-based team trainings
Kolbe, M., Weiss, M., Grote, G., Knauth, A., Dambach, M., Spahn, D. R., & Grande, B. (2013) · BMJ Quality & Safety · doi:10.1136/bmjqs-2012-000917 · Cited by 225 · see citing works
Self-assessment in Lifelong Learning and Improving Performance in Practice
Duffy, F. D., & Holmboe, E. S. (2006) · JAMA · doi:10.1001/jama.296.9.1137 · Cited by 217 · see citing works
A Systemic-Constructivist Approach to the Facilitation and Debriefing of Simulations and Games
Kriz, W. C. (2008) · Simulation & Gaming · doi:10.1177/1046878108319867 · Cited by 216 · see citing works
Objective Structured Assessment of Debriefing
Arora, S., Ahmed, M., Paige, J. T., Nestel, D., Runnacles, J., Hull, L., Darzi, A. W., & Sevdalis, N. (2012) · Annals of Surgery · doi:10.1097/sla.0b013e3182610c91 · Cited by 206 · see citing works
Debriefing in Simulated-Based Learning: Facilitating a Reflective Discussion
Arafeh, J. M. R., Hansen, S. S., & Nichols, A. (2010) · Journal of Perinatal & Neonatal Nursing · doi:10.1097/jpn.0b013e3181f6b5ec · Cited by 195 · see citing works
Examining Pediatric Resuscitation Education Using Simulation and Scripted Debriefing
Cheng, A., Hunt, E. A., Donoghue, A. J., Nelson-McMillan, K. L., Nishisaki, A., LeFlore, J. L., Eppich, W., Moyer, M. S., Brett-Fleegler, M. B., Kleinman, M. E., et al. (2013) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2013.1389 · Cited by 192 · see citing works
Self-citationKey elements of debriefing for simulator training
Rall, M., Manser, T., & Howard, S. K. (2000) · European Journal of Anaesthesiology · doi:10.1097/00003643-200008000-00011 · Cited by 163 · see citing works
Siassakos, D. M., Bristowe, K., Draycott, T. J., et al. (2011) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2010.02843.x · Cited by 158 · see citing works
Implementation of an In Situ Qualitative Debriefing Tool for Resuscitations
Mullan, P. C., Wuestner, E. R., Kerr, T., et al. (2012) · Resuscitation · doi:10.1016/j.resuscitation.2012.12.005 · Cited by 152 · see citing works
Comparison of Postsimulation Debriefing Versus In-Simulation Debriefing in Medical Simulation
Heukelom, J. N. V., Begaz, T., & Treat, R. W. (2010) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0b013e3181be0d17 · Cited by 141 · see citing works
Adaptation of the US Army’s After-Action Review for Simulation Debriefing in Healthcare
Sawyer, T., & Deering, S. H. (2013) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0b013e31829ac85c · Cited by 137 · see citing works
So Many Roads: Facilitated Debriefing in Healthcare
Dismukes, R. K., Gaba, D. M., & Howard, S. K. (2006) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/01266021-200600110-00001 · Cited by 137 · see citing works
Ahmed, M., Arora, S., Russ, S., et al. (2013) · Annals of Surgery · doi:10.1097/sla.0b013e31828c88fc · Cited by 136 · see citing works
Concurrent Versus Terminal Feedback: It May Be Better to Wait
Walsh, C. M., Ling, S. C., Wang, C. S., & Carnahan, H. (2009) · Academic Medicine · doi:10.1097/acm.0b013e3181b38daf · Cited by 136 · see citing works
Feedback, the various tasks of the doctor, and the feedforward alternative
Kluger, A. N., & Van Dijk, D. (2010) · Medical Education · doi:10.1111/j.1365-2923.2010.03849.x · Cited by 134 · see citing works
Husebø, S. E., Dieckmann, P., Rystedt, H., Søreide, E., & Friberg, F. (2013) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0b013e31827cbb5c · Cited by 126 · see citing works
Sawyer, T., Sierocka-Castaneda, A., Chan, D. S., Berg, B. W., Lustik, M., & Thompson, M. W. (2012) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0b013e3182578eae · Cited by 124 · see citing works
Evolution of the Pediatric Advanced Life Support course
Cheng, A., Rodgers, D. L., van der Jagt, É. W., Eppich, W., & O’Donnell, J. (2012) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0b013e3182417709 · Cited by 119 · see citing works
Self-citationIdentifying best practice guidelines for debriefing in surgery: a tri-continental study
Ahmed, M., Sevdalis, N., Paige, J. T., Paragi-Gururaja, R., Nestel, D., & Arora, S. (2012) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2011.09.024 · Cited by 112 · see citing works
Key elements of debriefing for simulator training
Rall, M., Manser, T., & Howard, S. K. (2000) · European Journal of Anaesthesiology · doi:10.1046/j.1365-2346.2000.00724-1.x · Cited by 108 · see citing works
Establishing the Climate for a Successful Debriefing
Wickers, M. P. (2009) · Clinical Simulation in Nursing · doi:10.1016/j.ecns.2009.06.003 · Cited by 97 · see citing works
Research Opportunities in Simulation‐based Medical Education Using Deliberate Practice
McGaghie, W. C. (2008) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2008.00246.x · Cited by 87 · see citing works
Hamilton, N. A., Kieninger, A. N., Woodhouse, J., Freeman, B. D., Murray, D. J., & Klingensmith, M. E. (2011) · Journal of surgical education · doi:10.1016/j.jsurg.2011.09.009 · Cited by 70 · see citing works
Actual vs perceived performance debriefing in surgery: practice far from perfect
Ahmed, M., Sevdalis, N., Vincent, C. A., & Arora, S. (2013) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2013.01.007 · Cited by 53 · see citing works
Avoiding tokenism in health professional education
Bearman, M., & Ajjawi, R. (2012) · Medical Education · doi:10.1111/medu.12109 · Cited by 17 · see citing works
Dieckmann, P. (2012) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0b013e31824888b8 · Cited by 15 · see citing works
Deconstructing Debriefing for Simulation-Based Education
Edelson, D. P., & LaFond, C. M. (2013) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2013.325 · Cited by 9 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Virtual Reality Experience: Immersion, Sense of Presence, and Cybersickness
Servotte, J.-C., Goosse, M., Campbell, S. H., Dardenne, N., Pilote, B., Simoneau, I. L., Guillaume, M., Bragard, I., & Ghuysen, A. (2020) · Clinical Simulation in Nursing · doi:10.1016/j.ecns.2019.09.006 · Cited by 288 · see citing works
Fazlollahi, A. M., Bakhaidar, M., Alsayegh, A., Yilmaz, R., Winkler-Schwartz, A., Mirchi, N., Langleben, I., Ledwos, N., Sabbagh, A. J., Bajunaid, K., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.49008 · Cited by 285 · see citing works
Trends and Innovations of Simulation for Twenty First Century Medical Education
Herrera-Aliaga, E., & Estrada, L. D. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.619769 · Cited by 146 · see citing works
“Debriefing transforms the experience into learning through reflection (30).”
BackgroundVirtual reality simulation for nursing education: effectiveness and feasibility
Kiegaldie, D., & Shaw, L. (2023) · BMC Nursing · doi:10.1186/s12912-023-01639-5 · Cited by 145 · see citing works
O’Hare, S., Kajamaa, A., Conn, R., & Gormley, G. (2025) · Instructional Science · doi:10.1007/s11251-025-09734-7 · Cited by 3 · see citing works
“Previous research (Eppich & Cheng, 2015a) has described how a CHAT guided debrief could potentially be incorporated with PEARLs.”
- Authors
- Eppich, W., & Cheng, A.
- Affiliations
- Northwestern University (US)
- Venue
- Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare
- Published
- 2015-04
- Volume
- 10
- Issue
- 2
- Pages
- 106-115
- ISSN
- 1559-2332 (ISSN-L)
- OpenAlex
- W2322141813
- Cited by
- 1,106
- References
- 64
- Citations by year
- 2026: 159 · 2025: 148 · 2024: 136 · 2023: 100 · 2022: 119 · 2021: 132 · 2020: 90 · 2019: 78 · 2018: 55 · 2017: 42 · 2016: 32 · 2015: 12 · 2014: 1
- FWCI
- 34.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Simulation in Healthcare The Journal of the Society for Simulation in Healthcare (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Simulation-Based Education in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Medicine › Surgery › Surgical Simulation and Training
- Keywords
- debriefing, simulation-based education, student self-assessment, directive feedback, reflective learning, clinical decision-making, team training, interprofessional collaboration
- MeSH terms
- Simulation Training, Formative Feedback, Clinical Competence, Education, Medical, Educational Measurement, Humans, Learning, Patient Simulation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
