Debriefing or Feedback: Exploring the Impact of Two Post-Scenario Discussion Methods in the Acquisition and Retention of Non-Technical Skills


  • Carla Sá-Couto Biomedical Simulation Center. Faculty of Medicine. University of Porto. CINTESIS@RISE. Community Medicine, Information and Decision Sciences Department. Faculty of Medicine. University of Porto.
  • Diana Rodrigues Biomedical Simulation Center. Faculty of Medicine. University of Porto. Serviço de Anestesiologia. Centro Hospitalar e Universitário de São João. Porto.
  • Marcos Gouveia Biomedical Simulation Center. Faculty of Medicine. University of Porto. Department of Surgery and Physiology. Faculty of Medicine. University of Porto. CUF Porto Hospital. Porto.



Clinical Competence, Formative Feedback, Patient Care Team, Simulation Training, Students, Medical


Introduction: There is a paucity of quantitative studies objectively comparing debriefing and feedback as methods for post-scenario discussion and its impact on healthcare teams’ acquisition and retention of non-technical skills. The main purpose of this study is to provide some insight on this research question, using a sample of medical students. A secondary objective explores students’ opinion and preference on the post-scenario discussion.
Material and Methods: Forty-five medical students were distributed among 15 teams, and randomly allocated to two groups. Each team participated in three different simulated scenarios, with similar levels of difficulty and opportunities to apply specific non-technical skills: leadership, communication, and task management. To assess the acquisition and retention of skills, scenarios occurred on days one (baseline), two (acquisition) and 20 (retention). Team performance was objectively evaluated by an observer, using scenario recordings. Students individually assessed different aspects of debriefing and feedback.
Results: Both debriefing and feedback groups showed similar overall increase in objective scores, with significant increase between days one and two (acquisition), and a smaller increase between days two and 20 (retention). Students indicated debriefing as the preferred discussion method.
Conclusion: Debriefing and feedback are effective post-scenario discussion methods, promoting acquisition and retention of non-technical skills, by undergraduate students. Allying debriefing reflexive practice with feedback directive style, and shifting appropriately between facilitation and instruction, can be a good compromise to achieve a timely and educationally meaningful discussion.


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Kohn L, Corrigan J, Donaldson M. To err is human: building a safer health system. Committee on Quality in America. Washington: National Academy Press; 1999.

Institute of Medicine. Crossing the quality chasm: a new health care system for the 21st century. Washington: National Academy Press; 2001.

National Healthcare System, National Patient Safety Agency. Seven steps to patient safety: full reference guide. London: NHS; 2004.

Donaldson MS. An overview of to err is human: re-emphasizing the message of patient safety. In: Hughes RG editor. Patient safety and quality: an evidence-based handbook for nurses. Rockville: Agency for Healthcare Research and Quality; 2008.

Pham JC, Aswani MS, Rosen M, Lee H, Huddle M, Weeks K, et al. Reducing medical errors and adverse events. Annu Rev Med. 2012;63:447-63. DOI:

Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016;3:353-i2139. DOI:

Bagnasco A, Pagnucci N, Tolotti A, Rosa F, Torre G, Sasso L. The role of simulation in developing communication and gestural skills in medical students. BMC Med Educ. 2014;23:14-106. DOI:

Hamo I. The role of the skills laboratory in the integrated curriculum of the Faculty of Medicine and Health Science. Med Teach. 1994;16:167-78. DOI:

Gordon J, Wilkerson W, Shaffer D, Armstrong E. Practicing medicine without risk: students’ and educators’ responses to high-fidelity patient simulation. Acad Med. 2001;76:469-72. DOI:

Bradley P. The history of simulation in medical education and possible future directions. Med Educ. 2006;40:254-62. DOI:

Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative. Simul Healthc. 2006;1:252-6. DOI:

Gaba DM. The future vision of simulation in health care. Qual Saf Health Care. 2004;13:i2–10. DOI:

Motola I, Devine LA, Chung HS, Sullivan JE, Issenberg SB. Simulation in healthcare education: A best evidence practical guide. Med Teach. 2015;35:10,e1511-30. DOI:

Sa-Couto CD, Patrão L, Maio-Matos F, Pego JM. Biomedical simulation: evolution, concepts, challenges and future trends. Acta Med Port. 2016;30;29:860-8. DOI:

Gardner R. Introduction to debriefing. Semin Perinatol. 2013;37:166-74. DOI:

Rudolph J, Simon R, Dufresne R, Raemer D. There’s no such thing as “nonjudgmental” debriefing: a theory and method for debriefing with good judgment. Simul Healthc. 2006;1:49-55. DOI:

Fanning R, Gaba D. The role of debriefing in simulation-based learning. Simul Healthc. 2007;2:115-25. DOI:

Tavares W, Eppich W, Cheng A, Miller S, Teunissen PW, Watling CJ, et al. Learning conversations: an analysis of the theoretical roots and their manifestations of feedback and debriefing in medical education. Acad Med. 2020;95:1020-5. DOI:

Ramani S, Könings KD, Ginsburg S, van der Vleuten CP. Meaningful feedback through a sociocultural lens. Med Teach. 2019;41:1342-52. DOI:

Sawyer T, Eppich W, Brett-Fleegler M, Grant V, Cheng A. More than one way to debrief: a critical review of healthcare simulation debriefing methods. Simul Healthc. 2016;11:209-17. DOI:

Jug R, Jiang XS, Bean SM. Giving and receiving effective feedback: a review article and how-to guide. Arch Pathol Lab Med. 2019;143:244-50. DOI:

Pendleton D, Scofield T, Tate P, Havelock P. The consultation: an approach to learning and teaching. Oxford: Oxford University Press; 1984.

Chowdhury R, Kalu G. Learning to give feedback in medical education. Obst Gynaec. 2004;6:243-7. DOI:

Branch W, Paranjape A. Feedback and reflection: teaching methods for clinical settings. Acad Med. 2002;77:1185-8. DOI:

Abulebda K, Auerbach M, Limaiem F. Debriefing techniques utilized in medical simulation. [Updated 2020 Nov 21]. 2020. [cited 2020 Dec 16] Available from:

Dreifuerst KT. The essentials of debriefing in simulation learning: a concept analysis. Nurs Educ Perspect. 2009;30:109-14.

Pivec JR. Debriefing after simulation: guidelines for faculty and students. St. Paul: St. Catherine University; 2011.

Nicholas C. Teaching with simulation. In: Huggett KN, Jeffries WB, editors. An introduction to medical teaching. 2nd ed. Springer; 2014. p. 93-112. DOI:

Chen TY. Medical leadership: an important and required competency for medical students. Tzu Chi Med J. 2018;30:66–70. DOI:

Agha RA, Fowler AJ, Sevdalis N. The role of non-technical skills in surgery. Ann Med Surg. 2015;4:422-7. DOI:

Voyer S, Hatala R. Debriefing and feedback: two sides of the same coin? Simul Healthc. 2015;10:67-8. DOI:



How to Cite

Sá-Couto C, Rodrigues D, Gouveia M. Debriefing or Feedback: Exploring the Impact of Two Post-Scenario Discussion Methods in the Acquisition and Retention of Non-Technical Skills. Acta Med Port [Internet]. 2022 Jun. 27 [cited 2024 Jul. 25];36(1):34-41. Available from: