Feedback and Debriefing in Mastery Learning

  • Nahzinine ShakeriEmail author
  • David H. Salzman
  • Mark Adler
  • Walter J. Eppich
Part of the Comprehensive Healthcare Simulation book series (CHS)


Feedback and debriefing are key features of the mastery learning education bundle. There is, however, little guidance about how to optimize mastery learning feedback and debriefing. Weak feedback and debriefing cripple instructional interventions required for powerful learning. This chapter provides a survey of healthcare feedback and debriefing, defines key terms, and outlines a rationale for the essential role of feedback and debriefing in mastery learning. Much of the work we discuss is in the context of simulation-based mastery learning (SBML). We also present specific approaches, techniques, and strategies for structuring feedback and debriefing sessions in SBML. The chapter presumes a basic familiarity with different approaches to facilitating post-simulation debriefing. We close by offering specific recommendations for debriefing various skills within a SBML curriculum, including procedural skills, communication skills, and algorithm team-based resuscitation.


Debriefing Feedback Mastery learning Medical simulation 


  1. 1.
    van de Ridder JMM, Stokking KM, McGaghie WC, ten Cate OTJ. What is feedback in clinical education? Med Educ. 2008;42(2):189–97.CrossRefGoogle Scholar
  2. 2.
    van de Ridder JMM, McGaghie WC, Stokking KM, ten Cate OTJ. Variables that affect the process and outcome of feedback, relevant for medical training: a meta-review. Med Educ. 2015;49(7):658–73.Google Scholar
  3. 3.
    Lefroy J, Watling C, Teunissen PW, Brand P. Guidelines: the do’s, don’ts and don’t knows of feedback for clinical education. Perspect Med Educ. 2015;4(6):284–99.Google Scholar
  4. 4.
    Hatala R, Cook DA, Zendejas B, et al. Feedback for simulation-based procedural skills training: a meta-analysis and critical narrative synthesis. Adv Health Sci Educ. 2014;19:251–72.CrossRefGoogle Scholar
  5. 5.
    Kirkbright S, Finn J, Tohira H, et al. Audiovisual feedback device use by health care professionals during CPR: a systematic review and meta-analysis of randomised and non-randomised trials. Resuscitation. 2014;85(4):460–71.CrossRefGoogle Scholar
  6. 6.
    Couper K, Kimani PK, Abella BS, et al. The system-wide effect of real-time audiovisual feedback and postevent debriefing for in-hospital cardiac arrest: the cardiopulmonary resuscitation quality improvement initiative. Crit Care Med. 2015;43(11):2321–31.CrossRefGoogle Scholar
  7. 7.
    Yeung J, Meeks R, Edelson D, et al. The use of CPR feedback/prompt devices during training and CPR performance: a systematic review. Resuscitation. 2009;80(7):743–51.CrossRefGoogle Scholar
  8. 8.
    Cheng A, Brown LL, Durr JP, et al. Improving cardiopulmonary resuscitation with a CPR feedback device and refresher simulations (CPR CARES Study): a randomized clinical trial. JAMA Pediatr. 2015;169(2):137–44.Google Scholar
  9. 9.
    Yeung J, Davies R, Gao F, Perkins GD. A randomized control trial of prompt and feedback devices and their impact on quality of chest compressions—a simulation study. Resuscitation. 2014;85(4):553–9.CrossRefGoogle Scholar
  10. 10.
    Cheng A, Eppich W, Grant V, et al. Debriefing for technology-enhanced simulation: a systematic review and meta-analysis. Med Educ. 2014;48(7):657–66.CrossRefGoogle Scholar
  11. 11.
    Raemer D, Anderson M, Cheng A, et al. Research regarding debriefing as part of the learning process. Simul Healthc. 2011;6(Suppl):S52–7.Google Scholar
  12. 12.
    Tannenbaum SI, Cerasoli CP. Do team and individual debriefs enhance performance? A meta-analysis. Hum Factors. 2013;55(1):231–45.CrossRefGoogle Scholar
  13. 13.
    Kluger AN, DeNisi A. The effects of feedback interventions on performance: a historical review, a meta-analysis, and a preliminary feedback intervention theory. Psychol Bull. 1996;119(2):254–84.CrossRefGoogle Scholar
  14. 14.
    Dine CJ, Gersh RE, Leary M, et al. Improving cardiopulmonary resuscitation quality and resuscitation training by combining audiovisual feedback and debriefing. Crit Care Med. 2008;36(10):2817–22.Google Scholar
  15. 15.
    Edelson DP, Litzinger B, Arora V, et al. Improving in-hospital cardiac arrest process and outcomes with performance debriefing. Arch Intern Med. 2008;168(10):1063–9.Google Scholar
  16. 16.
    Morgan PJ, Tarshis J, LeBlanc V, et al. Efficacy of high-fidelity simulation debriefing on the performance of practicing anaesthetists in simulated scenarios. Br J Anaesth. 2009;103(4):531–7.Google Scholar
  17. 17.
    Wolfe H, Zebuhr C, Topjian AA, et al. Interdisciplinary ICU cardiac arrest debriefing improves survival outcomes. Crit Care Med. 2014;42(7):1688–95.Google Scholar
  18. 18.
    Davis DA, Mazmanian PE, Fordis M, et al. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006;296(9):1094–102.CrossRefGoogle Scholar
  19. 19.
    Kruger J, Dunning D. Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Pers Soc Psychol. 1999;77(6):1121–34.CrossRefGoogle Scholar
  20. 20.
    Bowers C, Braun CC, Morgan BB. Team workload: its meaning and measurement. In: Brannick MT, Salas E, Prince C, editors. Team performance assessment and measurement: theory, methods, and applications. Mahwah: Erlbaum; 1997.Google Scholar
  21. 21.
    Sawyer T, Eppich W, Brett-Fleegler M, et al. More than one way to debrief: A critical review of healthcare simulation debriefing methods. Simul Healthc. 2016;11(3):209–17.Google Scholar
  22. 22.
    Ganley B, Linnard-Palmer L. Academic safety during nursing simulation: perceptions of nursing students and faculty. Clin Simul Nurs. 2012;8(2):49–57.CrossRefGoogle Scholar
  23. 23.
    Rudolph JW, Raemer DB, Simon R. Establishing a safe container for learning in simulation: the role of the presimulation briefing. Simul Healthc. 2014;9(6):339–49.CrossRefGoogle Scholar
  24. 24.
    Rosenbaum L. Cursed by knowledge—building a culture of psychological safety. N Engl J Med. 2019;380(8):786–90.CrossRefGoogle Scholar
  25. 25.
    Edmondson A. Psychological safety and learning behavior in work teams. Adm Sci Q. 1999;44(2):350–83.Google Scholar
  26. 26.
    Kolbe M, Grande B, Spahn DR. Briefing and debriefing during simulation-based training and beyond: content, structure, attitude and setting. Best Prac Res Clin Anaesthesiol. 2015;29(1):87–96.CrossRefGoogle Scholar
  27. 27.
    Rudolph JW, Simon R, Dufresne RL, Raemer DB. There’s no such thing as “nonjudgmental” debriefing: a theory and method for debriefing with good judgment. Simul Healthc. 2006;1(1):49–55.CrossRefGoogle Scholar
  28. 28.
    Der Sahakian G, Aliner G, Savoldelli G, et al. Setting conditions for productive debriefing. Simul Gaming. 2015;46(2):197–208.CrossRefGoogle Scholar
  29. 29.
    Sawyer TL, Deering S. Adaptation of the U.S. Army’s after-action review to simulation debriefing in healthcare. Simul Healthc. 2013;8(6):388–97.Google Scholar
  30. 30.
    Jaye P, Thomas L, Reedy G. “The diamond:” a structure for simulation debrief. Clin Teach. 2015;12(3):171–5.CrossRefGoogle Scholar
  31. 31.
    Eppich W, Cheng A. Promoting excellence and reflective learning in simulation (PEARLS): development and rationale for a blended approach to healthcare simulation debriefing. Simul Healthc. 2015;10(2):106–15.CrossRefGoogle Scholar
  32. 32.
    Kolbe M, Weiss M, Grote G, et al. TeamGAINS: a tool for structured debriefings for simulation-based team trainings. BMJ Qual Saf. 2013;22(7):541–53.CrossRefGoogle Scholar
  33. 33.
    Phrampus P, O’Donnell J. Debriefing using a structured and supported approach. In: Levine A, DeMaria S, Schwartz A, Sim A, editors. The comprehensive textbook of healthcare simulation. New York: Springer; 2013.Google Scholar
  34. 34.
    Zigmont JJ, Kappus LJ, Sudikoff SN. The 3D model of debriefing: defusing, discovering, and deepening. Semin Perinatol. 2011;35(2):52–8.CrossRefGoogle Scholar
  35. 35.
    Fanning RM, Gaba DM. The role of debriefing in simulation-based learning. Simul Healthc. 2007;2(2):115–25.CrossRefGoogle Scholar
  36. 36.
    Senge P. The fifth discipline fieldbook: strategies and tools for building a learning organization. New York: Crown Business; 1994.Google Scholar
  37. 37.
    Rudolph JW, Simon R, Raemer DB, et al. Debriefing as formative assessment: closing performance gaps in medical education. Acad Emerg Med. 2008;15(11):1010–6.CrossRefGoogle Scholar
  38. 38.
    Rudolph JW, Simon R, Rivard P, et al. Debriefing with good judgment: combining rigorous feedback with genuine inquiry. Anesthesiol Clin. 2007;25(2):361–76.CrossRefGoogle Scholar
  39. 39.
    Kriz WC. A systematic-constructivist approach to the facilitation and debriefing of simulation and games. Simul Gaming. 2010;41(5):663–80.Google Scholar
  40. 40.
    Flanagan B. Debriefing: theory and techniques. In: Riley RH, editor. A manual of simulation in healthcare. New York: Oxford University Press; 2008.Google Scholar
  41. 41.
    Smith-Jentsch KA, Cannon-Bowers JA, Tannenbaum SI, et al. Guided team self-correction: impacts on team mental models, processes, and effectiveness. Small Group Res. 2008;39(3):303–27.CrossRefGoogle Scholar
  42. 42.
    Ahmed M, Arora S, Russ S, et al. Operation debrief: a SHARP improvement in performance feedback in the operating room. Ann Surg. 2013;258(6):958–63.CrossRefGoogle Scholar
  43. 43.
    Eppich WJ, Hunt EA, Duval-Arnould JM, et al. Structuring feedback and debriefing to achieve mastery learning goals. Acad Med. 2015;90(11):1501–8.CrossRefGoogle Scholar
  44. 44.
    Van Heukelom JN, Begaz T, Treat R. Comparison of postsimulation debriefing versus in-simulation debriefing in medical simulation. Simul Healthc. 2010;5(2):91–7.Google Scholar
  45. 45.
    Hunt EA, Duval-Arnould JM, Nelson-McMillan KL, et al. Pediatric resident resuscitation skills improve after “rapid cycle deliberate practice” training. Resuscitation. 2014;85(7):945–51.Google Scholar
  46. 46.
    Cheng A, Palaganas J, Eppich W, et al. Co-debriefing for simulation-based education: a primer for facilitators. Simul Healthc. 2015;10:69–75.Google Scholar
  47. 47.
    Cheng A, Hunt EA, Donoghue A, et al. Examining pediatric resuscitation education using simulation and scripted debriefing: a multicenter randomized trial. JAMA Pediatr. 2013;167(6):528–36.Google Scholar
  48. 48.
    Savoldelli GL, Naik VN, Park J, et al. Value debriefing during simulated crisis management: oral versus video-assisted oral feedback. Anesthesiology. 2006;105(2):279–85.CrossRefGoogle Scholar
  49. 49.
    Sawyer T, Sierocka-Casteneda A, Chan D, et al. The effectiveness of video-assisted debriefing versus oral debriefing alone at improving neonatal resuscitation performance: a randomized trial. Simul Healthc. 2012;7(4):213–21.CrossRefGoogle Scholar
  50. 50.
    McGaghie WC, Issenberg SB, Barsuk JH, Wayne DB. A critical review of simulation-based mastery learning with translational outcomes. Med Educ. 2014;48(4):375–85.Google Scholar
  51. 51.
    Eppich WJ, O’Connor L, Adler MD. Providing effective simulation activities. In: Forrest K, McKimm J, Edgar S, editors. Essential simulation in clinical education. Chichester: Wiley-Blackwell; 2013.Google Scholar
  52. 52.
    Arora S, Ahmed M, Paige J, et al. Objective structured assessment of debriefing: bringing science to the art of debriefing in surgery. Ann Surg. 2012;256(6):982–8.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Nahzinine Shakeri
    • 1
    Email author
  • David H. Salzman
    • 2
  • Mark Adler
    • 3
  • Walter J. Eppich
    • 3
  1. 1.Northwestern University Feinberg School of Medicine, Department of Emergency MedicineChicagoUSA
  2. 2.Northwestern University Feinberg School of Medicine, Departments of Emergency Medicine and Medical EducationChicagoUSA
  3. 3.Northwestern University Feinberg School of Medicine, Departments of Pediatrics and Medical EducationChicagoUSA

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