Debriefing processes and practices in simulation-based training: A qualitative study

Background Simulation-based training (SBT) is widely used to enhance clinical performance, and debriefing is central to learning. Yet, little is known about facilitator–participant interaction dynamics during video-assisted debriefings. Drawing on Schön's reflective practice, this study examines how facilitator-guided postsimulation debriefings are structured, with a focus on interaction patterns. Method This qualitative, exploratory study analyzed 26 video‑recorded debriefings from high‑fidelity SBT sessions at two Swedish hospital simulation centers. Participants were multidisciplinary neonatal teams and simulation facilitators. Data were examined using reflexive thematic analysis and time‑based measurements of facilitator versus participant speaking time. Results The analysis resulted in six themes: (a) guiding versus steering; (b) explaining versus reflecting; (c) technical challenges; (d) the role of instructors, relational and contextual factors; (e) collective versus individual reflection; and (f) losing sight of the debriefing objective. Time-based analysis revealed facilitators' dominant role. Conclusions Debriefings frequently diverged from reflective, learner‑centered practice, limiting participant engagement. Strengthening facilitators' pedagogical skills, clarifying objectives, and improving technical support may enhance SBT effectiveness.