# How facilitators use healthcare students’ mistakes to promote reflections and discussions during simulation debriefings

## TL;DR

This study examines how healthcare educators use students' mistakes during simulation debriefings to encourage reflection and discussion.

## Contribution

Identifies two new communication elements—suppressions and summaries—used by facilitators to promote reflection in debriefings.

## Key findings

- Facilitators who prompted the most reflection used five communication elements: inquiries, positive feedback, hints, suppressions, and summaries.
- Suppressions and summaries were newly identified elements not previously documented in debriefing literature.
- Few studies have analyzed facilitators' actions during debriefings using naturalistic observation.

## Abstract

Simulation-based training is increasingly used in healthcare education. It allows students to practice in realistic environments using high-fidelity patient simulators and to engage with complex or rare diagnoses without risking harm to real patients. During the debriefing phase, students and facilitators reflect on actions taken and discuss what went well and what could be improved in future simulation sessions. To engage in productive reflection, students must be aware of their mistakes and performance gaps. Although the literature emphasizes the importance of providing both positive and corrective feedback, many facilitators struggle to deliver negative feedback due to concerns about hurting students’ feelings or damaging their relationships. This study explores how facilitators use nursing students’ mistakes to prompt reflection and discussion during healthcare simulation debriefings.

This was a qualitative video-supported observational study. 17 facilitators and 89 students from three universities in Norway participated in mandatory simulation-based training in their second year of education. The framework of Heath, Hindmarsh, and Luff (2010) inspired video analysis. The units of data consisted of verbal utterances, bodily conduct, gaze, and facial expressions, as noted through observations of participants’ turns at talk. We complemented this by using thematic analysis inspired by Braun & Clarke of selected video transcripts to support and deepen the analysis.

The facilitators who elicited the most reflections and discussions among the students during debriefings consistently employed five communication elements: inquiries, positive feedback, hints and cues, suppressions, and summarizing.

The main findings provide new insights into facilitators’ actions when eliciting student reflections and discussions. Many structured debriefing frameworks today include inquiries, positive feedback, and hints and cues. This analysis identified additional communication elements not previously recognized in the debriefing literature, namely suppressions and the use of summaries. Few studies have examined the facilitators’ actions during debriefings to elicit student reflection and discussion, particularly through naturalistic observation of real-world practice. Further research is needed to expand our understanding of these interactional dynamics and the situated strategies employed by facilitators.

The online version contains supplementary material available at 10.1186/s41077-026-00412-3.