In-Simulation Versus Post-Simulation Debriefing in Medical Training: A Scoping Review and Theoretical Framework for Military Application.

Abstract

Introduction: Simulation-based medical training is important for readiness. Feedback and debriefing are important components of simulation that support learning. Debriefs for military training are traditionally conducted at the conclusion of training, but recent evidence in the civilian medical training literature suggests that in-simulation debriefing may provide benefits for skill acquisition. The purpose of this scoping review is to map the body of literature examining post-simulation and in-simulation debriefing, highlight trends in the literature, and identify research gaps.

Materials and methods: A scoping review of the literature was conducted using the Joanna Briggs Institute Scoping Review Methodology, searching PubMed, the Web of Science Core Collection, and gray literature. Studies were included if they evaluated simulation-based emergency medicine or critical care medical training with an in-simulation debriefing intervention compared to post-simulation debriefing, measured at least one learning or performance outcome, and included a randomization element. Studies were excluded if they lacked a comparison group, involved non-acute care, utilized solely device-generated feedback, or did not explicitly articulate in-simulation debriefing protocols.

Results: A total of 21 articles met inclusion criteria; none involved military populations. The majority of studies (90.5%) employed rapid cycle deliberate practice as the in-simulation debriefing method, and the most studied domain was cardiac arrest and resuscitation (57.1%). No studies reported performance or retention measures favoring post-simulation debriefing, and 77.8% of studies measuring time to intervention found significant improvements when in-simulation debriefing was utilized. Effect sizes were only reported in 14.3% of included studies.

Conclusions: The majority of reviewed studies reported outcomes favoring in-simulation debriefing; no studies favored post-simulation debriefing for performance measures. Effective implementation of in-simulation debriefing in a military training context would require deliberate instructor development and standardized methods for aligning debriefing methods with the experience level of the target audience. Future research should examine the effects of in-simulation debriefing on tactical medical skill performance and the time to intervention in a military training context.