Debriefing in Paramedicine

A Students Perspective

· Professional,education

Words By Chloe Deetlefs and Nick Abussi


Healthcare students and paramedics are familiar with simulation-based learning. This learning presents an opportunity to put your skills to the test, the last stop on the proverbial bus journey to real patient care. Some people love simulations, some loathe them. The cause of the latter may come down to the little conversation known as the debrief.

Many who have participated in simulations are familiar with the debrief, which usually begins immediately after the simulation is over. So, what is debriefing and where did it originate? Debriefing is a process which involves the analysis of an individual’s performance in a task through exploring their thoughts, assigning meaning to their actions, identifying knowledge gaps, and consolidating skills (Raphael & Wilson, 2000). The aim of debriefing is to enhance future experiences and encourage personal development. This practice dates back to World War II, where soldiers were encouraged to reflect on their personal feelings, decisions, and outcomes in combat to promote positive psychological effects (Nolen, 2020).

Today, debriefing is a key component of simulation-based learning. A facilitator guides a group discussion that reviews the clinical simulation, challenges the participants’ methodologies, and explores alternate strategies collaboratively. This approach stimulates creative thinking, self-reflection, and team reflexivity, which impacts the quality of future clinical practice (Diaz-Navarro et al., 2021). So, this raises the question: if debriefing is so positive, then why do students have such negative experiences?

What does the literature say?

According to the literature, students commonly harbor feelings of anxiety towards clinical simulations due to the fear of retribution or embarrassment (Baker-Rush et al., 2021). However, these feelings can be explored and mitigated during effective post-simulation debriefing to improve students’ willingness to participate and decrease anxiety towards future simulations (Code & Burkard, 2016). In many cases, however, the opposite occurs, with students feeling increasing levels of anxiety after each simulation and debrief. This contradictory outcome suggests that debriefing has been neglected or poorly conducted in these scenarios.

The term ‘debriefing’ is often inappropriately interchanged with the term ‘feedback’. Whilst debriefing involves collaborative discussion, the exploration of ideas, and self-reflection, feedback involves a unidirectional exchange between the facilitator and participants, wherein knowledge gaps are identified and critiques are provided by the facilitator (Voyer & Hatala, 2015). The inappropriate interchange of these terms is likely to contribute to incidents of ‘poor debriefing’ and anxiety-inducing experiences among students.

Feedback can be further subclassified as judgmental or non-judgmental. Non-judgmental feedback is delivered in a more neutral tone and is essential for facilitating rapport and empowerment between the mentor and participant. Alternatively, judgemental feedback is underpinned by personal biases and opinions, and is often centred on the participants’ shortcomings. This method is more likely to elicit an emotional response by the participant and lead to feelings of inadequacy. Consequently, feedback perceived as judgemental or negative can create resistance and resentment towards simulations, thus hindering the learning process (Burgess et al., 2020). This highlights the importance of differentiating debriefing from feedback, and being able to promote positive outcomes by applying debriefing techniques. Various simulation debriefing tools have already been developed, including ‘SHARP’ by Imperial College of London, and ‘Bubble Briefs’ by Hall and Turner (Nolen, 2020). The exploration and application of these techniques must be furthered within clinical education settings.

A student’s perspective

It’s just another day at uni. You’re drowning in assessments, slightly sleep deprived, facing the typical stressors of life, and you’ve just spent the past few hours filling your already-full brain with lecture content – more specifically, an in-depth anatomical analysis of the heart and the abundance of ways in which it can malfunction.

You catch your breath as you make it to class with less than a minute to spare… scenario time! It’s your turn to be the primary officer in a case-based paramedic simulation. The fate of the patient is in your hands as you draw upon the information you learned only a few hours prior to the class. You can feel your heartbeat pounding in your chest and your hands sweating beneath your gloves as you work your way through the 20-minute simulation, with every thought and every move being closely examined by your peers and experienced professionals.

Times up! You return to your seat and take a sigh of relief, glad that it’s finally over. It wasn’t so bad after all? But this is no time to relax as you proceed to the next phase: the debrief.

So, what happens next?

Scenario 1: You look at the ground as you anxiously await feedback from your peers and mentor, but instead, you are delightfully surprised! The room lights up with curiosity, stimulating conversation, and an eagerness to learn. Ideas bounce from left to right as the class navigates through the 20-minute simulation together, even sharing a laugh or two along the way. You aren’t made to feel ashamed of your actions, but rather inspired to further challenge yourself and think of new, creative ways to approach problems. You feel enlightened, knowing that you’ll carry these lessons with you. It was a highly rewarding and constructive debrief; the sort which leaves you feeling hungry for the next simulation, ready to conquer new challenges, and motivated to pursue greatness as a clinician. You walk away with a skip in your step, ready to take on the world.

Unfortunately, this isn’t always the case. Debriefing is a multifaceted construct which can have a profound effect on individuals – both positive and negative. So, let’s take a few steps back and explore the not-so-constructive debrief.

Scenario 2: You look at the ground as you anxiously await feedback from your peers and mentor. All eyes turn to you as though you’re in a court trial, and your every thought and move from the 20-minute simulation is dissected, questioned, and scrutinised. You find yourself sinking back into your seat as you receive one criticism after the other. In fact, you can’t even muster up the words to defend your actions or explain your thought process. It feels more like a massacre than a collaborative discussion! You ask yourself if you even did anything right at all? You want to enhance your skill set and become the best clinician possible, but your full attention is focused on surviving the debrief. You leave the room with a crippled confidence, fearful of the next simulation and all the future simulations to come. Moreover, you wonder if you’re even cut out for a career in paramedicine? Your heart sinks as your dream slips further and further away. 

Sadly, this scenario is not so far-fetched. Many students have reported feeling anxious, insecure, and incompetent after poorly conducted post-simulation debriefs. This largely shapes students’ willingness to participate in simulations and engage in honest, open dialogue due to fear of criticism or humiliation. The art of the debrief frequently gets tangled in what may be judgmental feedback from the facilitator or other students.

Fortunately, many students have also reported positive experiences with post-simulation debriefs. These positive debrief experiences typically occur when students have a sense of camaraderie with their peers and a good relationship with their mentor. This creates a low stress environment where students can reflect on their performance honestly and feel as though they can share their thoughts free of judgment. This is further reinforced when the group encourages the student with positive feedback, rather than solely dwelling on errors or debating management strategies. Students also benefit greatly from collaborative discussions that shape their thought patterns, rather than being told what’s right and wrong. This is most effective for personal growth and clinical development as it enhances students’ problem-solving capabilities.

So maybe debriefing is important after all…

Debriefing is a powerful tool that, when used effectively in the classroom setting, will enrich the next generation of paramedics. Through a collaborative, non-destructive approach, students can engage in open and honest discussion with their peers and mentor to share ideas, explore concepts, and solve their own problems. Positive debrief experiences promote further engagement and instill confidence in students as they navigate new challenges in the clinical simulation environment. These capabilities extend beyond the borders of the classroom and into the real world of paramedicine, which is a dynamic, complex, and ever-changing scene.

Therefore, it is imperative that we do not neglect ‘the debrief’. After all, “words can inspire, and words can destroy – choose yours well” (Robin Sharma).

Want to learn more about debriefing in healthcare simulation? Check out the Debriefing Diamond and the work of Jaye (2015).



Baker-Rush, M., Pabst, A., Aitchison, R., Anzur, T., & Paschal, N. (2021). Fear in interprofessional simulation: The role of psychology and behaviourism in student participation and learning. Journal of Interprofessional Education and Practice, 24.

Burgess, A., Diggele, C., Roberts, C., & Mellis, C. (2020). Feedback in the clinical setting. BMC Medical Education, 20(460).

Code, M., Burkard, J., & Bhatnagar, M. (2016). Too Anxious to learn? Should the ongoing debriefing technique be amongst the best practices in simulation? Journal of Anesthesia and Critical Care: Open Access, 4(1). doi: 10.1097/01.SIH.0000441572.58577.03

Diaz-Navarro, C., Leon-Castelao, E., Hadfield, A., Pierce, S., & Szyld, D. (2021). Clinical debriefing: TALK to learn and improve together in healthcare environments. Trends in Anaesthesia and Critical Care, 40.

Jaye, P. (2015) “The Diamond”: a structure for simulation debrief. The Clinical Teacher

Nolen, L. (2020). Simulation Debriefing. HealthySim.

Raphael, B., & Wilson, J. (2000). Psychological debriefing: Theory, practice and evidence. Cambridge University Press. doi:10.1017/CBO9780511570148

Voyer, S., & Hatala, R. (2015). Debriefing and feedback: Two sides of the same coin? Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 10(2), 67-68. doi: 10.1097/SIH.0000000000000075