The Effect of Prebriefing Checklists in Clinical Simulation

Over the past few decades, simulation has emerged as an important learning and training methodology across various fields, which includes education in healthcare. Clinical simulation allows individuals to learn with, from, and about each other to enhance the clinical team’s mutual understanding to improve competence and confidence for the benefit of patients (Purdy et al,. 2022). The use of healthcare simulation in education is particularly effective to promote learning through realistic scenarios without the risks of real-world consequences. One crucial aspect that contributes to the effectiveness of simulation-based learning is prebriefing, which entails providing learners with pertinent information and guidance before initiating the simulation session. This article submitted by Esther-Louise Rogers, Clinical Skills, Education Lead at Ashford and St. Peter’s Hospital NHS Foundation Trust and Associate Clinical Teacher at Imperial College, aims to explore the impact of prebriefing on simulation-based learning experiences and examine its influence on learner engagement, performance, and the development of critical thinking and problem-solving skills. Additionally, the role of prebriefing in the preparation of learners for debriefing, the reflective process following the simulation activity, will be analysed.

The Importance of Prebriefing in Healthcare Simulation

Prebriefing is a fundamental component of effective medical simulation that is often poorly done or completely omitted by means of delivering ‘shock’ in-situ simulations or inconsistent faculty development which does not teach the importance of the prebrief. This lack of preparation and participant safety is a leading factor in learners’ disengagement and fear of simulation as it serves as the foundation for the learning experience. Prebriefing primarily involves briefing the learners on the learning objectives, expectations, and desired outcomes of the simulation, ensuring they are well-equipped to navigate the simulated environment. The prebriefing process often encompasses the provision of background information, clarification of roles and responsibilities, and discussion of the learning goals (Chamberlain, 2015).

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There is growing recognition that prebriefing promotes psychological or emotional preparation, vital in facilitating learners’ engagement and immersion in the simulation (Kolbe et al., 2019). An environment that is supportive and conducive to the learner promotes the learner to express their feelings and perspectives, and openly discuss their concerns. Prebriefing fosters a sense of psychological safety that allows the learners to approach the simulation with a positive mindset and heightened motivation (Cheng et al., 2016).

Effect of Prebriefing on Learner Engagement

Learner engagement is a critical factor that affects the educational outcomes of simulation-based learning experiences. By involving learners in the prebriefing process, they are more likely to actively participate in the simulation session and remain invested in the learning experience, enhancing their engrossment in the scenario (Rutherford-Hemming et al., 2019).

Moreover, prebriefing creates an environment that helps to develop a sense of autonomy among learners. The incorporation of self-directed strategies, such as goal-setting and reflection, prebriefing enables learners to identify their knowledge gaps, enhance their understanding, and promote responsibility for their learning (Jeffries, 2016). Consequently, the learners become more motivated to engage in the simulation process and acquire the necessary skills and competencies for professional practice.

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Impact of Prebriefing on Learner Performance

One of the primary goals of simulation-based learning is to help learners transfer the knowledge and skills acquired during the simulation to real-world settings effectively. Prebriefing is a crucial component in the achievement of this goal, as it directly impacts learners’ ability to perform during the simulation session (Rudolph et al., 2007).

Through the prebriefing process, learners understand what is expected of them, essential competencies and clinical practices, and the contextual factors that affect the simulation scenario. This knowledge enhances their ability to navigate the complex problems and situations presented during the simulation, which results in improved performance and decision-making. Consequently, the lessons learned during these sessions are more likely to remain embedded in learners’ professional practice in real-life situations (Rudolph et al., 2007).

Development of Critical Thinking and Problem-Solving Skills:

Prebriefing plays a significant role to promote learners’ critical thinking and problem-solving abilities, thereby contributing to the development of essential professional competencies. By providing learners with clear objectives that guide the simulation activity, prebriefing enables them to practice how to interpret and analyse complex problems, evaluate potential solutions, and apply evidence-based practices during the activity (Poore et al., 2014).

Additionally, prebriefing stimulates learners’ cognitive curiosity to encourage them to explore alternative approaches and ideas during the simulation session. This cognitive stimulation nurtures an investigative mindset, and bolsters the development of critical thinking and problem-solving techniques that remain applicable in real-world contexts (Fey & Jenkins, 2015).

Prebriefing and Debriefing: A Crucial Relationship

Debriefing is an essential aspect of the simulation learning experience, as it allows learners to reflect on their performance, discuss their observations, and identify areas for improvement (Dreifuerst, 2015). Prebriefing serves as the foundation for effective debriefing by creating a psychologically safe environment that encourages open communication and facilitates the process of feedback and reflection (Somerville et al., 2023).

In light of this, the authoring Trust developed a simple, easy-to-use Simulation Prebriefing Checklist based on Somerville et al. Twelve tips for the pre-brief to promote psychological safety in simulation-based education, which guides faculty in the core components of an effective prebrief. This checklist covers psychological safety, objectives, roles of both the learners and faculty, suspension of disbelief, and vital orientation to the learning environment (Image 1). The Simulation Prebriefing Checklist is now fully incorporated into our Trusts simulation faculty development program.

Simulation Prebrief Checklist from the NHS

PreBriefing Healthcare Simulation Team

The information provided during prebriefing establishes the expectations for the simulation activity, helps learners understand the goals of the session and their role within the scenario. This understanding fosters meaningful debriefing discussions, enables learners to pinpoint relevant issues, analyse their performance in light of these expectations, and develop actionable strategies for improvement (Issenberg et al., 2005).

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This article has explored the critical role of prebriefing in simulation-based learning experiences, and demonstrates its positive impact on learner engagement, performance, critical thinking, problem-solving, and debriefing. Undeniably, prebriefing is a crucial aspect of the simulation process, setting the stage for successful learning outcomes. By thoughtful planning and execution of prebriefing sessions, educators can contribute significantly to the quality and effectiveness of simulation-based learning experiences. Ultimately, such experiences can foster the development of essential competencies that prepare learners for real-world situations and contribute to the cultivation of agile, adaptive professionals equipped to succeed in their respective fields.

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