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Today, more than ever, effective inter-professional team communication, collaboration, and coordination in the care of patients with increasingly more complex disorders in the fast-paced, dynamic, evolving healthcare environment is paramount.  Inter-professional teamwork is now a worldwide-recognized core inter-professional competency that all healthcare providers should acquire.  Simulation-based training (SBT) is an excellent format for fostering the knowledge, skills, and abilities (KSAs) needed for highly reliable team interaction by bringing together inter-professional learners in a nonthreatening environment in which they can practice addressing high risk, low-frequency situations without any risk to a patient.[1] By doing so, these inter-professional teams can internalize these KSAs to make them automatic in the actual clinical environment. Although the high technology simulators and complex scenarios of SBT tend to focus more attention on its technology, methodology, and curricular components, the ultimate utility of SBT as an educational format relies on the effectiveness of the debriefing rendered during a session.[2] Some authors consider it the most crucial element of SBT.[3] It is within the debriefing that SBT participants identify their learning gaps and develop strategies for improving them, usually under the guidance of the educator/facilitator leading the SBT session.  Such guidance can be particularly challenging in the setting of an inter-professional team in which, by definition, learners come from different backgrounds and perspectives. Debriefing has played an integral role in the medical simulation since its implementation, and its advantages are well-founded in educational theory. Debriefing strategies are based upon learner types, scenario objectives, and preference of the educator leading the debrief. Irrespective of technique, debriefing leads to meaningful learning opportunities via experiential reflection. Reflective practice outlines how it is not the experience alone but the deliberate reflection on experience that leads to active learning. When appropriately applied to clinical practice and educationally productive debriefing following medical simulation can inevitably improve patient safety.[4]

Debriefing has played an integral role in the medical simulation since its implementation, and its advantages are well-founded in educational theory. Debriefing strategies are based upon learner types, scenario objectives, and preference of the educator leading the debrief. Irrespective of technique, debriefing leads to meaningful learning opportunities via experiential reflection. Reflective practice outlines how it is not the experience alone but the deliberate reflection on experience that leads to active learning. When appropriately applied to clinical practice and educationally productive debriefing following medical simulation can inevitably improve patient safety.[4] Medical debriefing is based upon the military and aviation fields, which have team building, crisis management, and high-risk situations in common. Anesthesiology debriefing specifically has its origins within aviation crew resource management (CRM). Military debriefing was developed by Colonel S.L.A Marshall, the chief United States Army historian in World War II, Korea, and Vietnam.[2] He conducted debriefings of the entire military unit immediately following an event. Jeffrey Mitchell, a psychologist, developed the Critical Incident Stress Debriefing (CISD) for civilians, also commonly viewed as the framework for medical debriefing today.[5] CISD is contingent upon its seven phases, including introduction, information discovery, detection of individuals’ thought processes, reaction, symptom description, teaching, and reentry. After repeated plane accidents in the 1960s and 1970s, pilot interviews revealed a lack of adequate training in leadership, decision making, judgment, communication, and crew coordination.[6] When CRM training resulted in improved outcomes for the aviation industry, Gaba et al. developed anesthesia CRM to improve safety in the operating room.[7]

Medical debriefing is based upon the military and aviation fields, which have team building, crisis management, and high-risk situations in common. Anesthesiology debriefing specifically has its origins within aviation crew resource management (CRM). Military debriefing was developed by Colonel S.L.A Marshall, the chief United States Army historian in World War II, Korea, and Vietnam.[2] He conducted debriefings of the entire military unit immediately following an event. Jeffrey Mitchell, a psychologist, developed the Critical Incident Stress Debriefing (CISD) for civilians, also commonly viewed as the framework for medical debriefing today.[5] CISD is contingent upon its seven phases, including introduction, information discovery, detection of individuals’ thought processes, reaction, symptom description, teaching, and reentry. After repeated plane accidents in the 1960s and 1970s, pilot interviews revealed a lack of adequate training in leadership, decision making, judgment, communication, and crew coordination.[6] When CRM training resulted in improved outcomes for the aviation industry, Gaba et al. developed anesthesia CRM to improve safety in the operating room.[7] Debriefing can occur either after or during a simulation exercise. It can also be either facilitator-guided or self-guided by simulation learners. Two of the most important aspects of healthcare simulation include debriefing and feedback.[8] The difference between feedback and debriefing is worth clarifying. Feedback is a one-way delivery of performance information to simulation participants with the intent to modify behavior and improve future activity performance.[9] Debriefing, on the other hand, is a bidirectional, interactive, and reflective conversation between facilitator and participant.[10] Of note, the act of debriefing itself is more important than the specific technique utilized. There has been no data to suggest that there is a best or optimal way to debrief, but rather a large variety of techniques available from which simulation educators and experts can choose.

To optimize team outcomes related to debriefing inter-professional teams in SBT, the learning objectives, curriculum, and scenarios should focus on team-based competencies in lieu of task-based ones.  In this manner, the participants will avoid the burden of learning both technical and non-technical skills. Other essential strategies include involving the entire team in the debriefing and meeting their multiple needs, focusing on team-based concepts rather than individual-based topics, and employing reliable, valid assessment tools to measure the teamwork during the SBT to allow for objective use to guide the debriefing.  By focusing on team communication, cooperation, and coordination during the debriefing of inter-professional team SBT, the likelihood of their transfer to the actual clinical environment with concomitant improvement of patient care increases.[52] The most commonly used and studied method for simulation debriefing, facilitator-guided post-event debriefing, has been shown to improve individual and team performance in many contexts.[53] With effective debriefing, learners can improve upon technical skills, achieve mastery learning, and improve adherence to resuscitation guidelines.[22] There is some evidence to suggest that post-event debriefing is preferred to within-event debriefing by learners due to improved skill retention.[54] A debriefing session's success depends on the expertise of the facilitator and the group of learners relative to the simulation scenario and teaching objectives.[55] Novice learners require more directive feedback from facilitators than those with more experience. Facilitators can create a memorable debriefing experience by enumerating educational objectives before the simulation activity, matching simulation content to learner experience level, and using appropriate techniques such as GAS or the advocacy inquiry method.

The most commonly used and studied method for simulation debriefing, facilitator-guided post-event debriefing, has been shown to improve individual and team performance in many contexts.[53] With effective debriefing, learners can improve upon technical skills, achieve mastery learning, and improve adherence to resuscitation guidelines.[22] There is some evidence to suggest that post-event debriefing is preferred to within-event debriefing by learners due to improved skill retention.[54] A debriefing session's success depends on the expertise of the facilitator and the group of learners relative to the simulation scenario and teaching objectives.[55] Novice learners require more directive feedback from facilitators than those with more experience. Facilitators can create a memorable debriefing experience by enumerating educational objectives before the simulation activity, matching simulation content to learner experience level, and using appropriate techniques such as GAS or the advocacy inquiry method. There is a form of debriefing with several clinical experiences, including intraoperative arrest or patient death. These can range from discussing a medical error to a complex interdisciplinary trauma response in a formal or informal setting. Structured debriefings are most commonly found in the resuscitation literature.[56] Debriefing allows the formative evaluation of a resident or medical students’ clinical performance. In daily practice, the skills for simulation debriefing can be extrapolated to provide feedback to learners in the operating room or intensive care unit setting. Veloski et al. found that prolonged and persistent feedback from faculty had a profound impact on learners’ clinical performance.[57] In an environment where all medical personnel has the responsibility to teach throughout their careers, debriefing skills developed during simulation can have an essential impact in the clinical arena. Aiding healthcare practitioners in developing the habitual practice of eliciting and delivering feedback effectively can help in contributions to patient safety.

There is a form of debriefing with several clinical experiences, including intraoperative arrest or patient death. These can range from discussing a medical error to a complex interdisciplinary trauma response in a formal or informal setting. Structured debriefings are most commonly found in the resuscitation literature.[56] Debriefing allows the formative evaluation of a resident or medical students’ clinical performance. In daily practice, the skills for simulation debriefing can be extrapolated to provide feedback to learners in the operating room or intensive care unit setting. Veloski et al. found that prolonged and persistent feedback from faculty had a profound impact on learners’ clinical performance.[57] In an environment where all medical personnel has the responsibility to teach throughout their careers, debriefing skills developed during simulation can have an essential impact in the clinical arena. Aiding healthcare practitioners in developing the habitual practice of eliciting and delivering feedback effectively can help in contributions to patient safety. Because there is no formalized or structured curriculum for the development of debriefing techniques, simulation educators should rely on the principles of learning theory to guide their approach. Rudolph et al. stress the need to alter pre-existing cognitive frames to construct new understanding and practice regimens for learners.[57] Participants should be encouraged to increase their cognitive capacity for learning, and facilitators should provide ample opportunities for the practice of clinical skills while providing constructive feedback. The medical knowledge and clinical skills gained during simulation would seamlessly transfer to clinical practice and patient care. This is more likely if facilitators integrate learning into larger frameworks and if participants have a foundational understanding of the underlying principles being taught. Most importantly, the nuances of successful debriefing require the development of trust between the facilitator and learner, as the emotional and cognitive dimensions of learning are intimately intertwined. In this way, a successful learning environment is attuned to the learners’ emotional state and motivations.[58]