Transfer of clinical debriefing from simulation to practice: exploring the barriers and enablers

TL;DR

This study explores why clinical debriefing skills learned in simulations are not always used in real healthcare settings, focusing on work environment factors.

Contribution

The study identifies work environment barriers and enablers to transferring clinical debriefing skills from simulation to practice.

Findings

Participants felt a strong sense of personal responsibility to use clinical debriefing in practice.

Workplace culture was identified as a key factor influencing the adoption of clinical debriefing.

Burke and Hutchins’ model helped identify barriers and enablers to implementing clinical debriefing.

Abstract

Clinical debriefing (CD) positively impacts individuals, teams and systems and has been shown to improve patient outcomes and staff wellbeing. Although there is a growing evidence base supporting CD, it has not been routinely adopted by many healthcare organisations. Despite the work environment being an important component of transfer of learning, there has been minimal focus on how it influences implementation and maintenance of CD in practice. The overall aim of this study was to explore the work environment barriers and enablers influencing the transfer of clinical debriefing skills from simulation to clinical practice.

Following ethical approval, medical registrars who had participated in a simulation course involving a within-scenario CD were invited to participate in semi-structured interviews. These utilised Burke and Hutchins’ evaluation model as the initial conceptual framework and took place at least two months post-course. Interviews explored participants’ experiences of transferring learning related to CD from simulation to the clinical workplace, and were transcribed verbatim and dual coded using template analysis.

Fifteen medical registrars participated in interviews between January and May 2025. The work environment influences from Burke and Hutchins’ evaluation model resonated as important factors affecting adoption of CD. With the addition of subthemes generated inductively from the data, the model provided a framework for identification and articulation of the barriers and enablers to CD in the workplace. The most striking finding was participants’ sense of personal responsibility to engage with CD. In addition, participants identified the requirement for cultural change to enable CD.

Work environment influences represent both barriers and enablers of CD in relation to the transfer of learning from simulation to clinical practice. Personal responsibility and workplace culture are important drivers of CD, and attention should be paid to the influence of both constructs in this context. Recommendations for practice, based on our findings, are designed to enable educators and organisations to promote the adoption of CD in their own settings. This will help to bridge the gap and make CD the norm, not the exception.

The online version contains supplementary material available at 10.1186/s41077-025-00405-8.

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