From leadership research to district action: Exploring effects of resilience-focused debriefing on reflection and teamwork in interprofessional simulation-based education – a mixed method study

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Background Interprofessional simulation-based education (IPSE) holds the potential to prepare healthcare students to handle the complexity of healthcare. However, complexity and resilience are traditionally not addressed deliberately in IPSE. The aim of this study was to explore the effect of resilience-focused debriefing (RFD) that addresses complexity and resilience, on reflection and teamwork in IPSE for pre-graduate healthcare students. Methods In a convergent mixed methods intervention study, 149 nursing and medical students in their last semester participated in a full-day IPSE course with five progressively challenging scenarios. Fifteen facilitators were instructed to use RFD. Qualitative date, comprised of transcripts from nine debriefings, were analysed using topic analysis. An intervention check was performed to assess the use of RFD. Quantitative data comprised pre-post ratings of team performance in videorecorded scenarios (1 and 5) from 18 groups using the Team Emergency Assessment Measure (TEAM). Additionally, a study-specific rating scale was employed to assess the extent of participants’ perceived challenges during scenarios. Results RFD helped facilitators to guide the students’ attention to the complexity of teamwork and how to manage such complex situations successfully by adapting crisis resource management principles and performing resilient actions (e.g., attunement, adaptive leadership), both as individuals and as teams. Applying RFD brought the students’ attention to how they were able to succeed despite the difficulties they encountered. Although the assessed team performance was on an acceptable level, students initially had difficulties in recognizing and learning from actions that led to successful outcomes. The significant decrease in the degree of challenges experienced suggests that students developed a greater tolerance for complexity. Nevertheless, the quantitative data showed that there was no pre-post difference in team performance as assessed by TEAM. Conclusions RFD can be used to increase healthcare students’ attention to the complexity of interprofessional teamwork in acute dynamic situations and help them recognize and learn from both successful actions and overcoming challenging situations. Although we did not find a significant gain in team performance, the integrated results suggest that RFD may potentially improve interprofessional teamwork. Further research is warranted to develop instruments measuring team performance that are sensitive to various aspects of resilience, as well as to deepen the understanding of RFD in the simulation-based education. Supplementary Information The online version contains supplementary material available at 10.1186/s41077-025-00398-4.

Study methods

A convergent mixed-method intervention design was used for this study [20]. We applied a pragmatic worldview [21] and drew on theories of complexity and resilience described above. To get a comprehensive understanding of the impact of RFD in IPSE we used a mixed methods study to explore both how the use of RFD affected the topics discussed in debriefings and its effects on team performance [22]. The quantitative and the qualitative data were analysed separately before the data were compared, contrasted, and synthesized to reveal collective insights. The study design is depicted in Fig. 1.

Limitations

This study meets calls for theory-driven research in SBE [60] and research on practical applications of resilient healthcare theories [8, 61]. We took guidance from the six core quality criteria of mixed methods research by Hirose et al. in order to ensure the methodological quality [22]. To ensure trustworthiness and dependability in the qualitative research process, strategies were employed in accordance with the criteria established by Lincoln and Guba [62]. The data analysis was first performed independently by each of the authors, TNA, HR, LO, and PA, and then in collaboration to identify and conduct a closer analysis of representative examples. The authors comprised researchers within nursing, medicine, and the learning sciences with various professional backgrounds. The participating facilitators were diverse in gender, professions, and specialties. The qualitative data analysis was performed on a subset of debriefings (scenario 3), which was considered to yield sufficient information power to answer the research questions [63, 64]. We collected data prospectively during two semesters in 2023 with 149 students in 18 groups. No power calculation was performed in this mixed-method study, but the sample size is comparable with other studies using TEAM for assessing team performance [31, 50].

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Pilot a structured team debrief in one voluntary staff team. Invite dissent, record a specific improvement action and assign responsibility without collecting identifiable criticism. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Compare participation distribution, action completion, near-miss reporting and a consistent voluntary team-climate measure. Increased reporting may reflect greater openness rather than more errors. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Torben Nordahl Amorøe; Hans Rystedt; Lena Oxelmark; Peter Dieckmann; Karin Jonsson; Cecilia Escher; Johan Creutzfeldt; Paulin Andréll. Exploring effects of resilience-focused debriefing on reflection and teamwork in interprofessional simulation-based education – a mixed method study. Advances in Simulation (2025-12-19). https://doi.org/10.1186/s41077-025-00398-4

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.