Most of the learning in a simulation happens after the scenario ends. Students can run a flawless code or miss every cue, and either way, what they take home depends on the conversation that follows.
That's why the INACSL Healthcare Simulation Standards of Best Practice treat debriefing as its own standard. A debrief should be planned into the simulation, led by someone competent in debriefing and guided reflection, built on a theoretical framework or model, and run in a way that keeps the conversation psychologically safe and confidential.
The standards don't tell you which model to use. This guide compares the five that nursing faculty use most, so you can pick one on purpose instead of by habit.
The five models at a glance
| Model |
How it runs |
Best for |
| PEARLS |
Reactions, description, analysis, summary, with a choice of strategy in analysis |
Most scenarios; mixed time; newer debriefers |
| Debriefing for Meaningful Learning (DML) |
Engage, explore, explain, elaborate, evaluate, extend |
Building clinical reasoning in prelicensure students |
| Debriefing with Good Judgment |
Reactions, analysis through advocacy-inquiry, summary |
Experienced facilitators; communication and teamwork |
| GAS |
Gather, analyze, summarize |
Short debriefs; skills and resuscitation |
| Plus/Delta |
What went well, what to change |
Very short debriefs; adding learner self-assessment to another model |
PEARLS
PEARLS (Promoting Excellence And Reflective Learning in Simulation) was published by Walter Eppich and Adam Cheng in 2015. It runs in a set order: setting the scene, reactions, description, analysis and summary.
What makes PEARLS popular is the analysis phase. The facilitator picks one of three strategies based on time, the learners and the gap:
- Learner self-assessment. Students say what went well and what they'd change.
- Focused facilitation. The facilitator digs into the reasoning behind a decision, often with advocacy-inquiry.
- Directed feedback. The facilitator teaches directly to close a knowledge or skill gap, which is useful when time is short.
Sample questions: "How are you feeling after that?" "Can someone summarize what was going on with the client?" "What made you decide to call the provider when you did?"
Choose PEARLS when you want one structure that works for most scenarios and most facilitators, including faculty who are new to debriefing.
Debriefing for Meaningful Learning (DML)
DML was developed by nurse educator Kristina Dreifuerst for nursing education. It uses six phases: engage, explore, explain, elaborate, evaluate and extend. Socratic questions make the students' clinical reasoning visible, so they practice thinking like a nurse rather than retelling what they did.
Sample questions: "What were you thinking when you saw the blood pressure drop?" "What else could explain these findings?" "If this client were in your care tomorrow, what would you do differently, and why?"
Choose DML when your objectives are about clinical reasoning and judgment, especially with prelicensure students. It usually takes longer than other models, and facilitators do best with some training in the method.
Debriefing with Good Judgment (advocacy-inquiry)
Debriefing with Good Judgment comes from Jenny Rudolph and colleagues at the Center for Medical Simulation. Its core skill is advocacy-inquiry: the facilitator states an observation, shares a point of view, then asks a genuine question about the learner's thinking.
Example: "I saw the monitor alarm three times before anyone looked at it. I was worried the client was getting worse. What was going on for you at that moment?"
The aim is to uncover the learner's frame, the assumptions that drove their actions, without hiding the facilitator's honest view.
Choose Good Judgment when you have an experienced facilitator and objectives about communication, teamwork or decision-making, where understanding why matters more than what happened.
GAS
GAS stands for gather, analyze, summarize. It was developed by Paul Phrampus and John O'Donnell at the Peter M. Winter Institute for Simulation, Education and Research (WISER), and it's the structure used in many American Heart Association courses.
Sample questions: "Tell me what happened from your point of view." "What went well with the team's response?" "What are two things you'll take into your next clinical day?"
Choose GAS when time is tight, the scenario is short or skill-focused, or you want a simple structure that every facilitator in your program can use the same way.
Plus/Delta
Plus/Delta asks two questions: what went well (plus) and what would you change (delta). It's quick and puts students in charge of the first assessment.
On its own it can stay shallow, so many facilitators use it inside another model, for example as the learner self-assessment in PEARLS, and then add two or three take-home points.
Choose Plus/Delta when you have only a few minutes, or as an opener before a deeper discussion.
How to choose a debriefing model
Ask four questions:
- What are the objectives? Clinical reasoning points to DML or focused facilitation. Teamwork and communication point to advocacy-inquiry. Skills and algorithms point to GAS or directed feedback.
- How much time do you have? Plan the debrief before you plan the scenario's length. Many programs plan a debrief at least as long as the scenario.
- Who are the learners? Newer students need more structure and more teaching. Experienced nurses benefit from deeper reflection.
- Who is debriefing? A model only works if the facilitator is comfortable with it. Consistency across your faculty often matters more than finding the perfect model.
Whatever you choose, write the debrief questions before the scenario runs, and tie at least one question to every objective. If an objective has no debrief question, it probably won't get learned.
Make the debrief part of the scenario, not an afterthought
The debrief is easiest to run well when it's written into the scenario from the start: objectives, patient states and debrief questions that all point the same way.
MapMySim drafts complete nursing simulation scenarios with the debrief written in the model your school uses (PEARLS, Debriefing for Meaningful Learning, Debriefing with Good Judgment, GAS or Plus/Delta), with questions tied to each objective and to the steps of the NCSBN Clinical Judgment Model. Every scenario is a draft for faculty review, and you can edit any part. Your first scenario is free.
For more on building scenarios, see How long does it take to write a nursing simulation scenario?