INACSL Standards of Best Practice: Prebriefing | Preparation & Briefing

Prebriefing is an essential part of healthcare simulation and may enhance debriefing and reflection by providing learners with the information and knowledge they need to be fully prepared for clinical simulation education. Further, healthcare simulation prebriefing helps to establish the ground rules for each healthcare simulation-based experience. To help provide a standard for prebriefing best practices, the International Nursing Association for Clinical Simulation and Learning (INACSL) released the “Healthcare Simulation Standards of Best Practice Prebriefing: Preparation and Briefing.” This article discusses the organization’s standards of best practice as they relate to prebriefing and preparation.

Before the release of this standard of best practice, the preparation phase of prebriefing was part of the “INACSL Standards of Best Practice: Simulation Design.” Although prebriefing remains a crucial component of clinical simulation design, the practice is independently vital to each healthcare simulation-based experience. Research shows that high-quality simulation requires simulationists and educators who are knowledgeable in pedagogy, which includes the prebriefing phase.

According to the most current literature review by INACSL, prebriefing is referred to as both preparation activities and briefing activities. The organization further explains that, for the purposes of this prebriefing standard, prebriefing refers to the activities prior to the start of the clinical simulation including the preparation and briefing aspects of the simulation-based experience. INACLS further notes that the guidelines for this standard apply to both preparation and briefing, and then each of those components has their own guidelines to ensure they are met.

INACSL divides this standard and the term “prebriefing” into two distinct components (preparation and briefing) and refers to all activities that occur before the clinical simulation scenario. Prebriefing activities are intended to establish a psychologically safe learning environment by:

1) Situating the learners into a common mental model and preparing learners for the educational content of the healthcare simulation-based experience (preparation).
2) Conveying important ground rules for the simulation-based experience (briefing).

As this standard addresses all aspects of pre-simulation activities, the criteria have been separated into categories with required elements: general criteria necessary for all aspects of the standard, criteria to meet the preparation aspect, and criteria to meet the briefing aspect of the standard. Below are the general criteria needed to meet every aspect of this standard.

General Criteria

General Criterion 1: The simulationist should be knowledgeable about the scenario and competent in concepts related to prebriefing. Required elements include:

• Demonstrate competency in prebriefing through the incorporation of the HSSOBP.
• Maintain professional development through formal coursework, ongoing training, and education, or with targeted work in prebriefing.
• Conduct a planned prebriefing session that is tied to the clinical simulation objectives and serves to prepare learners for the healthcare simulation-based experience and the debriefing which follows.
• Follow the HSSOBPTM Professional Development.

General Criterion 2: Prebriefing should be developed according to the purpose and learning objectives of the simulation-based experience. Required elements for all clinical simulation-based experiences include:

• Plan prebriefing as a structured part of the healthcare simulation experience.
• Incorporate requirements for learner preparation and briefing during healthcare simulation design.
• Preparation and briefing requirements may vary, depending on the overall purpose and objectives of the clinical simulation-based experience.

General Criterion 3: The experience and knowledge level of the healthcare simulation learner should be considered when planning the prebriefing. Required elements include:

• The amount and type of prebriefing may be inversely proportional to the level of the clinical simulation learner. For example, novices to healthcare simulation-based learning and to the clinical setting may require more preparation, briefing, and orientation than experienced clinical simulation learners or clinical experts.
• The healthcare simulation designer and facilitator are responsible for ensuring that preparatory and briefing activities address the knowledge, skills, attitudes, and behaviors that will be expected of the learners during the simulation-based experience.

Preparation Criteria

Preparation: Criterion 4: Based on the needs assessment and purpose of the experience, preparation materials are developed to assure that learners are prepared for the experience and can meet the scenario objectives. Required elements include:

• Use adult learning theory principles to prepare prebriefing materials that are designed to decrease cognitive load and equip learners to practice “at the edge of their ability.”
• Use organizational or regulatory requirements to develop preparation materials for the clinical simulation-based experience.
• Decrease learner anxiety and increase psychologically safety. by providing preparation for scenario content. If prepared, learners are likely to feel comfortable carrying out scenario requirements and discussing scenario details during debriefing.

Preparation: Criterion 5: Preparation materials should be developed according to the purpose and learning objectives of the simulation-based experience. This criterion helps guide learners to perceive “the meaning of the scenario information” and supports learning based on learner level and scenario purpose. For example, a clinician may need limited information such as a patient report, but a novice learner may need assistance determining the salient aspects of the patient report. Required elements include:

• Use a variety of activities to ensure learner success in achieving the healthcare simulation learning outcomes.
• Develop preparation activities and resources to support understanding of the concepts and content related to the simulation-based experience. These activities may include (but are not limited to), items such as assigned readings or audiovisual materials, concept mapping or care planning exercises, review of patient health record/patient report, and more.

Preparation: Criterion 6: Plan the delivery of preparation materials both prior to and on the day of the clinical simulation-based experience. Required elements include:

• Augment learner’s previous knowledge and previous experience with the simulation modality.
• Allow for learners to complete preparation activities in advance of the simulation-based experience to reinforce previous learning and prepare learners for success.
• Consider implementing a “ticket” to enter the experience once preparation activities have been completed to ensure learner readiness for clinical simulation.
• Consider establishing consequences for the management of learners attending the simulation experience without having completed the preparation requirements.
• Consider additional preparatory activities on the day of the simulation-based experience such as a facilitated discussion or student planning session prior to beginning the simulation

Briefing Criteria

Briefing: Criterion 7: Prior to the simulation-based experience, the simulationist conveys important information to learners regarding expectations, the agenda, and the logistics for the experience. Required elements include:

• Set the expectations and tone for the upcoming scenario and debriefing and define expectations related to learners’ involvement and performance.
• Discuss logistical factors such as length of scenario(s), debriefing expectations, times for breaks, location of facilities, agenda, or overview for the day.
• Consider the use of a written or recorded prebriefing plan to standardize the process and content for each scenario/case. A written or recorded prebriefing plan should be required for clinical simulation-based experiences when used for high-stakes or summative evaluations.
• Identify expectations and roles for the learner(s) and the simulationist(s). This includes the establishment of ground rules and a fiction contract.
• Discuss the fiction contract with learners. As an example: “Despite the attempts to create a realistic environment, not all aspects of a simulated experience may be totally realistic.” In order to achieve the objectives and learn from the experience, learners need to immerse themselves in the experience and should be aware of what can and cannot be simulated during the experience.

Briefing: Criterion 8: Conduct a structured orientation to the healthcare simulation-based learning environment including the modality. Required elements include:

• Orient learners to roles and expectations.
• Provide information related to the use of recording equipment and observations by others (peers, faculty, facilitators, staff, health professionals, administrators).
• Review the evaluation methods being used for this experience and notify learners when they can expect to receive the measurement tools. (Follow the HSSOBPTM Evaluation of Learning and Performance)
• Orient learners to all factors of the experience to help them achieve the objectives: objectives, scenario, equipment, manikins, or another technology-enhanced environment; embedded standardized personnel; scenario setting, and other environmental factors.
• Orient to all technology that will be used during the experience such as manikins, virtual learning environments, screen-based learning, or commercial learning products.
• Provide learners with resources and guidance if they require technical assistance during the experience.

Briefing: Criterion 9: Establish a psychologically safe learning environment during the prebriefing. Required elements include:

• Establish a psychologically safe environment to ensure the learners feel comfortable to express thoughts without feeling uncomfortable or fearing negative consequences.
• Incorporate activities that help establish an environment of integrity, trust, and respect.
• Discuss the procedure for confidentiality and professionalism.
• Respond to questions and seek input from learners. Simulationists create an atmosphere of trust by being accessible and approachable.
• Prevent defensive behavior and support risk-taking which supports learning and development of a professional identity.

More About INACSL

The INACSL is the global leader in transforming practice to improve patient safety through excellence in healthcare simulation. INACSL is a community of practice for healthcare simulation where members can network with clinical simulation leaders, educators, researchers, and industry partners. INACSL also provides the INACSL Standards of Best Practice: Simulation, an evidence-based framework to guide simulation design, implementation, debriefing, evaluation, and research.

Learn More About INACSL Standards of Best Practice

About the Author: Lance Baily

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Lance Baily, BA, EMT-B, is the Founder & CEO of HealthySimulation.com, which he started while serving as the Director of the Nevada System of Higher Education’s Clinical Simulation Center of Las Vegas back in 2010. Lance is also the Founder and acting Advisor to the Board of SimGHOSTS.org, the world’s only non-profit organization dedicated to supporting professionals operating healthcare simulation technologies. His co-edited Book: “Comprehensive Healthcare Simulation: Operations, Technology, and Innovative Practice” is cited as a key source for professional certification in the industry. Lance’s background also includes serving as a Simulation Technology Specialist for the LA Community College District, EMS fire fighting, Hollywood movie production, rescue diving, and global travel. He and his wife Abigail Baily, PhD live in Las Vegas, Nevada with their two amazing daughters.