Prebriefing: An Equal to Debriefing?

Contrary to what many people might believe, simulation in nursing has been the go to educational intervention to bridge the gap between theory and practice long before all the high-fidelity simulators [1]. An article published in the Journal of Nursing Education, dating back to 1972, discussed simulation as an opportunity to practice assessment skills [1]. The authors of the article developed a simulation out of booklets, slides, and films where students were first given a patient scenario and correlating sources of information such as the patient chart and list of healthcare team members to read through and reflect on. The students then had to plan and decide which action to take next. Each action option was a designated page in a booklet where the student peeled a label to reveal a patient cue that was assigned to that decision. If the step taken was harmful, the next assessment cue given was a poor outcome. If the step taken was helpful, the next assessment cue given was a positive outcome. The simulation experience ended with immediate feedback for the student on how well they performed followed by group discussions [1].


Introduction
Contrary to what many people might believe, simulation in nursing has been the go to educational intervention to bridge the gap between theory and practice long before all the high-fidelity simulators [1]. An article published in the Journal of Nursing Education, dating back to 1972, discussed simulation as an opportunity to practice assessment skills [1]. The authors of the article developed a simulation out of booklets, slides, and films where students were first given a patient scenario and correlating sources of information such as the patient chart and list of healthcare team members to read through and reflect on. The students then had to plan and decide which action to take next. Each action option was a designated page in a booklet where the student peeled a label to reveal a patient cue that was assigned to that decision. If the step taken was harmful, the next assessment cue given was a poor outcome. If the step taken was helpful, the next assessment cue given was a positive outcome. The simulation experience ended with immediate feedback for the student on how well they performed followed by group discussions [1].
Fast forward 40 years and the International Nursing Association for Clinical Simulation and Learning (INACSL) identifies these three simulation steps described above as prebriefing, simulated-based learning experience, and debriefing [2]. Instead of peel off labels to reveal patient cues, high-fidelity mannequins reveal patient cues in a realistic manner.
Prebriefing, is described by INACSL, as the information session prior to the start of the simulation-based learning experience in which preparatory information such as scenario objectives, roles to be carried out in the scenario, overview of available equipment, etc., is given to the learners [2]. Simulation-based learning experience, is described by INACSL, as the structured activity that allows participants to develop or enhance knowledge and skills by responding to realistic situations in the simulation lab [2]. Debriefing, is described by INACSL, as following the simulation-based learning experience where learners are engaged in discussions regarding reflections of their performance in hopes to transfer learning into future situations [2].
Despite the tremendous growth in simulation technology and in the literature there are still gaps in our understanding of its pedagogy. Performing a basic CINAHL search using the keywords simulation over 28,000 articles populate. Add the keyword nursing and 4,501 articles populate. Add the additional keyword debriefing, 183 articles populate. If the keyword prebriefing is replaced for debriefing, only 4 articles populate. Of course this is just a basic search; additional articles could be found with a more thorough search. Nevertheless, this basic CINAHL search points out that there is a gap in the literature when it comes to the simulation phase of prebriefing.
Why is the literature limited in prebriefing? Upon further investigation, it is evident that there is no consistent terminology regarding prebriefing or a clear process of what it entails [3][4][5][6][7]. Upon reading, one might assume that the learning experience does not occur until after prebriefing. In fact, the nursing literature identifies the last simulation phase, debriefing, as the most influential element to student learning due to its reflection activities [2,[8][9][10][11][12][13]. Reflection is stated to be triggered by the theory-practice gap by connecting knowledge and experiences [14] which is similar to how Curtis and Robert [1] described simulation over 40 years ago.
Is reflection only found in the debriefing phase of simulation? The only author that formally identifies reflection in the prebriefing phase of simulation is Onda [15]. She has identified prebriefing as, the reflection-before-action phase, or where learners reflect on how new information presented fits with one's prior knowledge. Onda's [15] description of prebriefing mirrors what Curtis and Robert [1] described as their first step in their simulation design over 40 years ago, in which learners gather the data and reflect on which step to take next. It seems that reflection has always been part of prebriefing, so why is the literature not identifying prebriefing as an important learning phase where time is allotted for reflection of new information in addition to customary preparatory activities?
Simulation has bridged the theory-practice gap for a long time.
Although not readily identified, reflection throughout all the simulation phases has also been present. What has not been present is the focus on prebriefing in the nursing literature. To fully understand the pedagogy of simulation, we need to turn our efforts towards understanding prebriefing and how to enhance the quality of as we have done for its counterpart debriefing. This could easily be done by allowing time for learners to reflect on new information presented and plan for what steps they may need to take in the upcoming simulationbased learning experience.