title: Debriefing for technology-enhanced simulation: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Debriefing is a common feature of technology-enhanced simulation (TES) education. However, evidence for its effectiveness remains unclear. We sought to characterise how debriefing is reported in the TES literature, identify debriefing features that are associated with improved outcomes, and evaluate the effectiveness of debriefing when combined with TES.
  
  
  METHODS
  We systematically searched databases, including MEDLINE, EMBASE and Scopus, and reviewed previous bibliographies for original comparative studies investigating the use of TES with debriefing in training health care providers. Reviewers, in duplicate, evaluated study quality and abstracted information on instructional design, debriefing and outcomes. Effect sizes (ES) were pooled using random-effects meta-analysis.
  
  
  RESULTS
  From 10 903 potentially eligible studies, we identified 177 studies (11 511 learners) that employed debriefing as part of TES. Key characteristics of debriefing (e.g. duration, educator presence and characteristics, content, structure/method, timing, use of video) were usually incompletely reported. A meta-analysis of four studies demonstrated that video-assisted debriefing has negligible and non-significant effects for time skills (ES = 0.10) compared with non-video-assisted debriefing. Meta-analysis demonstrated non-significant effects in favour of expert modelling with short debriefing in comparison with long debriefing (ES range = 0.21-0.74). Among studies comparing terminal with concurrent debriefing, results were variable depending on outcome measures and the context of training (e.g. medical resuscitation versus technical skills). Eight additional studies revealed insight into the roles of other debriefing-related factors (e.g. multimedia debriefing, learner-led debriefing, debriefing duration, content of debriefing). Among studies that compared simulation plus debriefing with no intervention, pooled ESs were favourable for all outcomes (ES range = 0.28-2.16).
  
  
  CONCLUSIONS
  Limited evidence suggests that video-assisted debriefing yields outcomes similar to those of non-video-assisted debriefing. Other debriefing design features show mixed or non-significant results. As debriefing characteristics are usually incompletely reported, future debriefing research should describe all the key debriefing characteristics along with their associated descriptors.
authors.affiliation: Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Cheng
authors.forename: Walter
authors.initials: W
authors.lastname: Eppich
authors.forename: Vincent
authors.initials: V
authors.lastname: Grant
authors.forename: Jonathan
authors.initials: J
authors.lastname: Sherbino
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zendejas
authors.forename: David A
authors.initials: DA
authors.lastname: Cook
mesh_terms: D003198:Computer Simulation; D016206:Databases, Bibliographic; D004501:Education, Medical / Q000379:methods; D004517:Education, Professional / Q000379:methods*; D006282:Health Personnel / Q000193:education*; D006801:Humans; D018794:Problem-Based Learning / Q000379:methods*; D013663:Teaching / Q000379:methods*; D013997:Time Factors; D014741:Video Recording / Q000706:statistics & numerical data