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Debriefing for technology-enhanced simulation: a systematic review and meta-analysis
Abstract
Objectives: Debriefing is a common feature of technology‐enhanced simulation ( TES ) education. However, evidence for its effectiveness remains unclear. We sought to characterise how debriefing is reported in the TES literature, identify debriefing features that are associated with improved outcomes, and evaluate the effectiveness of debriefing when combined with TES . Methods: We systematically searched databases, including MEDLINE , EMBASE and Scopus, and reviewed previous bibliographies for original comparative studies investigating the use of TES with debriefing in training health care providers. Reviewers, in duplicate, evaluated study quality and abstracted information on instructional design, debriefing and outcomes. Effect sizes ( ES ) were pooled using random‐effects meta‐analysis. Results: From 10 903 potentially eligible studies, we identified 177 studies (11 511 learners) that employed debriefing as part of TES . Key characteristics of debriefing (e.g. duration, educator presence and characteristics, content, structure/method, timing, use of video) were usually incompletely reported. A meta‐analysis of four studies demonstrated that video‐assisted debriefing has negligible and non‐significant effects for time skills ( ES = 0.10) compared with non‐video‐assisted debriefing. Meta‐analysis demonstrated non‐significant effects in favour of expert modelling with short debriefing in comparison with long debriefing (ES range = 0.21–0.74). Among studies comparing terminal with concurrent debriefing, results were variable depending on outcome measures and the context of training (e.g. medical resuscitation versus technical skills). Eight additional studies revealed insight into the roles of other debriefing‐related factors (e.g. multimedia debriefing, learner‐led debriefing, debriefing duration, content of debriefing). Among studies that compared simulation plus debriefing with no intervention, pooled ES s were favourable for all outcomes (ES range = 0.28–2.16). Conclusions: Limited evidence suggests that video‐assisted debriefing yields outcomes similar to those of non‐video‐assisted debriefing. Other debriefing design features show mixed or non‐significant results. As debriefing characteristics are usually incompletely reported, future debriefing research should describe all the key debriefing characteristics along with their associated descriptors.
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“Cheng et al [53] demonstrated that structured debriefing is an influential instructional component, facilitating reflection, performance analysis, and knowledge transfer to clinical contexts.”
From Enhancing Psychiatry Training Using an Agentic AI Simulated Consultation Tool: Prospective Cohort Study (2026) · cites this paper as [53]
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Expert Practice of Video-Assisted Debriefing: An Australian Qualitative Study
Krogh, K., Bearman, M., & Nestel, D. (2015) · Clinical Simulation in Nursing · doi:10.1016/j.ecns.2015.01.003 · Cited by 49
Semler, M. W., Keriwala, R. D., Clune, J. K., Rice, T. W., Pugh, M. E., Wheeler, A. P., Miller, A. N., Banerjee, A., Terhune, K. P., & Bastarache, J. A. (2015) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201501-030oc · Cited by 51
A prospective comparison of live and video-based assessments of colonoscopy performance
Scaffidi, M. A., Grover, S. C., Carnahan, H., Yu, J. J., Yong, E., Nguyen, G. C., Ling, S. C., Khanna, N. V., & Walsh, C. M. (2017) · Gastrointestinal Endoscopy · doi:10.1016/j.gie.2017.08.020 · Cited by 49
Twelve tips for facilitating and implementing clinical debriefing programmes
Coggins, A., Zaklama, R., Szabo, R. A., Diaz‐Navarro, C., Scalese, R. J., Krogh, K., & Eppich, W. (2020) · Medical Teacher · doi:10.1080/0142159x.2020.1817349 · Cited by 51
“As educators, we typically use debriefing as a learning tool following simulated events, with common discussion points including decision making, communication and teamwork (Harden and Laidlaw 2012; Cheng et al. 2014).”
MethodSelf-citationCheng, A., Kessler, D. O., MACKINNON, R. J., Chang, T. P., Nadkarni, V., Hunt, E. A., Duval‐Arnould, J., Lin, Y., Cook, D. A., Pusic, M. V., et al. (2016) · BMJ Simulation & Technology Enhanced Learning · doi:10.1136/bmjstel-2016-000124 · Cited by 50
Self-citationKaba, A., & Barnes, S. (2019) · Advances in Simulation · doi:10.1186/s41077-019-0107-8 · Cited by 46
Simulation in Pediatric Emergency Medicine Fellowships
Doughty, C. B., Kessler, D. O., Zuckerbraun, N. S., Stone, K. P., Reid, J. R., Kennedy, C. S., Nypaver, M. M., & Auerbach, M. A. (2015) · PEDIATRICS · doi:10.1542/peds.2014-4158 · Cited by 45
“20 h 23/63 (37) Division(s) leading PEM fellows simulation PEM 61/66 (92) Pediatric critical care 21/66 (32) General emergency medicine 30/66 (45) Multidisciplinary groups 14/66 (21) Pediatrics, neonatology, anesthesiology, OB/GYN, and nursing 3/66 (4) Support available Technical assistant on site 47/62 (76) Dedicated…”
BackgroundEducational Interventions to Enhance Situation Awareness
Walshe, N., Crowley, C. M., O’Brien, S., Browne, J. P., & Hegarty, J. M. (2019) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0000000000000376 · Cited by 47
The Changing Landscape of Simulation-Based Education
Morse, C., Fey, M. K., Kardong‐Edgren, S., Mullen, A., Barlow, M., & Barwick, S. (2019) · AJN American Journal of Nursing · doi:10.1097/01.naj.0000577436.23986.81 · Cited by 44
Brogaard, L., Lauridsen, K. G., Løfgren, B., Krogh, K., Paltved, C., Boie, S., & Hvidman, L. E. (2021) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.14263 · Cited by 44
Simulation training for primary caregivers in the neonatal intensive care unit
Arnold, J. L., & Diaz, M. C. G. (2016) · Seminars in Perinatology · doi:10.1053/j.semperi.2016.08.007 · Cited by 44
Effectiveness of Video-Assisted Debriefing in Health Education: An Integrative Review
Ali, A. A., & Miller, E. (2018) · Journal of Nursing Education · doi:10.3928/01484834-20180102-04 · Cited by 44
Clinical event debriefing: a review of approaches and objectives
Twigg, S. (2020) · Current Opinion in Pediatrics · doi:10.1097/mop.0000000000000890 · Cited by 44
McMullen, M., Wilson, R. A., Fleming, M. L., Mark, D. G., Sydor, D. T., Wang, L., Zamora, J., Phelan, R., & Burjorjee, J. E. (2016) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0000000000000140 · Cited by 43
“Despite this, little investigation has been performed with respect to best practices of debriefing, relating specifically to timing and method.(5,6)”
BackgroundFrameworks and quality measures used for debriefing in team-based simulation: a systematic review
Endacott, R., Gale, T. C. E., O’Connor, A., & Dix, S. (2018) · BMJ Simulation & Technology Enhanced Learning · doi:10.1136/bmjstel-2017-000297 · Cited by 43
Kolbe, M., Grande, B., Lehmann‐Willenbrock, N., & Seelandt, J. (2022) · BMJ Quality & Safety · doi:10.1136/bmjqs-2021-014393 · Cited by 43
Systematic review of clinical debriefing tools: attributes and evidence for use
Phillips, E. C., Smith, S. E., Tallentire, V. R., & Blair, S. E. E. (2023) · BMJ Quality & Safety · doi:10.1136/bmjqs-2022-015464 · Cited by 41
Boet, S., Pigford, A.-A. E., Fitzsimmons, A., Reeves, S., Triby, E., & Bould, M. D. (2016) · Journal of Interprofessional Care · doi:10.1080/13561820.2016.1181616 · Cited by 41
“Reflective content arose from discussions on topics that are not traditionally encouraged in debriefing (i.e., the debriefing process and simulation fidelity) (Cheng et al., 2014).”
BackgroundMethodInfluentialAn Evaluation of a New Debriefing Framework: REFLECT
Zinns, L. E., Mullan, P. C., O’Connell, K. J., Ryan, L. M., & Wratney, A. T. (2017) · Pediatric Emergency Care · doi:10.1097/pec.0000000000001111 · Cited by 41
“Despite the benefits of debriefing, there remains little consensus on the optimal debriefing model, framework, or application to the clinical environment.(7,8,12,18) Furthermore, results of a national needs assessment survey on debriefing practices showed that pediatric emergency medicine (PEM) fellows are expected to…”
BackgroundNursing Students Managing Deteriorating Patients: A Systematic Review and Meta-Analysis
Haddeland, K., Slettebø, Å., Carstens, P. K., & Fossum, M. (2018) · Clinical Simulation in Nursing · doi:10.1016/j.ecns.2018.05.001 · Cited by 41
Freytag, J., Stroben, F., Hautz, W. E., Schauber, S. K., & Kämmer, J. E. (2019) · Scandinavian Journal of Trauma Resuscitation and Emergency Medicine · doi:10.1186/s13049-019-0591-9 · Cited by 41
Voyer, S., & Hatala, R. A. (2015) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0000000000000075 · Cited by 40
Fostering Adaptive Expertise Through Simulation
Clarke, S., Ilgen, J. S., & Regehr, G. (2023) · Academic Medicine · doi:10.1097/acm.0000000000005257 · Cited by 41
Simulation in nursing education
Lavoie, P., & Clarke, S. P. (2017) · Nursing Management · doi:10.1097/01.numa.0000511924.21011.1b · Cited by 38
Effects of Video-Assisted Debriefing Compared with Standard Oral Debriefing
Rossignol, M. (2017) · Clinical Simulation in Nursing · doi:10.1016/j.ecns.2016.12.001 · Cited by 38
Chernikova, O., Sommerhoff, D., Stadler, M. J., Holzberger, D., Nickl, M., Seidel, T., Kasneci, E., Küchemann, S., Kühn, J., Fischer, F., et al. (2024) · Educational Research Review · doi:10.1016/j.edurev.2024.100662 · Cited by 54
“Moreover, another promising direction for research would be to dive deeper into different activities of simulation-based learning (e.g., debriefing phase, see Cheng et al., 2014 for review) and applications of adaptive and adaptable support for these activities.”
Lavoie, P., Pépin, J., & Cossette, S. (2016) · Nurse Education Today · doi:10.1016/j.nedt.2016.12.002 · Cited by 37
Kolbe, M., & Rudolph, J. W. (2018) · BMJ Simulation & Technology Enhanced Learning · doi:10.1136/bmjstel-2017-000247 · Cited by 37
Metadata
- Authors
- Cheng, A., Eppich, W., Grant, V., Sherbino, J., Zendejas, B., & Cook, D. A.
- Affiliations
- University of Calgary (CA)
- Northwestern University (US)
- McMaster University (CA)
- Mayo Clinic (US)
- Corresponding author
- Cheng, Adam
- Venue
- Medical Education
- Publisher
- Wiley
- Published
- 2014-06-09
- Volume
- 48
- Issue
- 7
- Pages
- 657-666
- ISSN
- 0308-0110 (ISSN-L)
- 1365-2923
- OpenAlex
- W1986133144
- Cited by
- 481
- References
- 48
- Citations by year
- 2026: 51 · 2025: 34 · 2024: 42 · 2023: 24 · 2022: 27 · 2021: 48 · 2020: 58 · 2019: 43 · 2018: 42 · 2017: 35 · 2016: 44 · 2015: 27 · 2014: 5
- FWCI
- 4.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medical Education (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Education › Simulation-Based Education in Healthcare
- Health Sciences › Medicine › Surgery › Surgical Simulation and Training
- Social Sciences › Education › Innovations in Medical Education
- Keywords
- debriefing, simulation-based medical education, video-assisted debriefing
- MeSH terms
- Computer Simulation, Education, Medical, Education, Professional, Health Personnel, Humans, Teaching, Time Factors, Video Recording, Databases, Bibliographic, Problem-Based Learning
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