Clinical Simulation in Nursing (2018) 25, 12-19

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Featured Article

Effects of Prebriefing on Psychological Safety and

Learning Outcomes
Young Sook Roh, PhD, RN, Professora,
Jung-Won Ahn, PhD, RN, Assistant Professora,*,
Eunyoung Kim, RN, Graduate Studentb, Jina Kim, RN, Graduate Studentb
a
Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
b
Graduate School of Nursing & Health Professions, Chung-Ang University, Seoul, Republic of Korea

KEYWORDS Abstract
cardiopulmonary Background: Prebriefing is an essential strategy recommended for simulation-based education for
resuscitation; learner’s psychological safety and learning outcomes.
nursing students; Method: The experimental group received prebriefing activities consisting of skills practice, sce-
patient simulation; nario review and concept mapping, orientation on simulation environment and equipment, and fic-
prebriefing; tion contract. Control group had the same prebriefing activities except concept mapping and fiction
psychological safety contract.
Results: Nursing students in the experimental group showed higher team psychological safety and
cardiopulmonary resuscitation performance. However, there were no differences in overall academic
safety or satisfaction with debriefing scores.
Conclusion: Prebriefing strategies that incorporate the fiction contract and concept mapping could
help nursing students to improve team psychological safety and performance.

Cite this article:

Roh, Y. S., Ahn, J.-W., Kim, E., & Kim, J. (2018, December). Effects of prebriefing on psychological
safety and learning outcomes. Clinical Simulation in Nursing, 25(C), 12-19. https://doi.org/10.1016/
j.ecns.2018.10.001.
Ó 2018 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier
Inc. All rights reserved.

With expansion of simulation-based education in under- learning experience is defined as anticipatory reflection
graduate education, strategy that can enhance psychological and planning which is facilitated by a qualified nursing
safety of learners has been emphasized (Bommer et al., simulation educator to support decision making, psycholog-
2018). Prebriefing as the first phase before simulation ical safety, and debriefing activities (Page-Cutrara, 2015).
Prebriefing encompasses both orientation tasks and learner
Funding: This research did not receive any specific grant from funding engagement activities before the simulation experience
agencies in the public, commercial, or not-for-profit sectors. (Chamberlain, 2015; Tyerman, Luctkar-Flude, Graham,
* Corresponding author. Jung-Won Ahn, PhD, RN, Assistant Professor,
Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro
Coffey, & Olsen-Lynch, 2016). Specific prebriefing activ-
Dongjak-gu, Seoul 06974, Republic of Korea: kylieahn@naver.com; ities include case studies, concept mapping activity, review
jwahn@cau.ac.kr (J. -W. Ahn). of simulated patient chart (McDermott, 2016), and fiction

1876-1399/$ - see front matter Ó 2018 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.ecns.2018.10.001
Prebriefing on simulation-based education 13

contract (Muckler, 2017; Rudolph, Raemer, & Simon, objectives, orientation to the learning environment, and
2014). Some studies have reported positive learning out- overview of learner roles and expectations (Meakim
comes of various prebriefing strategies for nursing students, et al., 2013; Page-Cutrara, 2014; Rudolph et al., 2014).
including group preplanning sessions (Elfrink, Nininger, To establish psychological safety of the learner, presimu-
Rohig, & Lee, 2009), expert nurse role-modeling video lation briefing includes the following practices: (1) clari-
(Coram, 2016), learning fying expectations, (2) establishing a ‘‘fiction contract’’
engagement and orientation with participants, (3) attending to logistic details, and
Key Points activities (Chamberlain, (4) declaring and enacting a commitment to respecting

Prebriefing is an 2017), concept map type learners and concern for their psychological safety
essential part in simu- prebriefing worksheet and (Rudolph et al., 2014). Prebriefing activities reported in
lation learning which facilitated reflection (Page- the nursing simulation literature include orientation to
involves orientation Cutrara & Turk, 2017), and the manikin and equipment for simulation, informing de-
and learning engage- orientation, experience of briefing, roles during the scenario (Chunta & Edwards,
ment activities. simulation environment, 2013), preparation assignments involving cognitive and/

There is limited evi- and skill practice (Kim, or psychomotor domains (Distelhorst & Wyss, 2013),
dence on the effects Noh, & Im, 2017). and attendance at additional laboratory practice sessions
of various prebriefing Fiction contract is a form designed to refine psychomotor skills (Gantt, 2013; Kim
strategies used in of collaborative agreement with et al., 2017). Another attribute includes behavioral expec-
simulation learning. participants, in which both in- tations such as suspension of disbelief scenario discussion

Prebriefing strategies structors and learners have and application of nursing process and creation of a safe
that incorporate the commitments (Dieckmann, and trusting learning environment (Chamberlain, 2015).
fiction contract and Gaba, & Rall, 2007). It can Other strategies for prescenario preparatory work include
concept mapping contribute to learner’s engage- creating cognitive aids such as cue cards or concept maps
could help nursing ment (Rudolph et al., 2014) to be used during simulation scenario as a quick reference
students to improve and ability to suspend disbe- (Sharoff, 2015).
team psychological lief during simulation-based
safety and learning (Muckler, 2017). Effects of Prebriefing on Perception and Learning
performance. Concept mapping activity is Outcomes
also one of the suggested
prebriefing activities Bommer et al. (2018) have reported that medical students in
(McDermott, 2016). It is a reflective learning activity that the presimulation orientation group have less anxiety with
can increase students’ knowledge integration (Bressington, greater confidence and higher performance scores following
Wong, Lam, & Chien, 2018) and critical thinking (Yue, all three simulations compared to students in the control
Zhang, Zhang, & Jin, 2017). group. Their presimulation orientation comprised a basic
Prebriefing is essential for successful debriefing, five-minute orientation to the simulation environment and
decreasing student anxiety, and affecting learner perfor- manikin with ground rules of the simulation.
mance (McDermott, 2016). It also allows learners to better Some studies have identified positive perceptions of
focus on cognitive and psychomotor skills (Bommer et al., prebriefing in nursing students. Elfrink et al. (2009) have
2018). However, relatively few studies have identified the found that nursing students report group preplanning ses-
effect of prebriefing strategies incorporating fiction contract sions as the most helpful component of the simulation
and concept mapping on nursing student’s psychological experience (34%) compared to debriefing (19%). After
safety and learning outcomes. a collaborative group preplanning session following pa-
tient hand-off and report, nursing students reported less
anxiety, reported greater group ownership of the plan
Background of care, and participated more during the simulation.
When prebriefing activities comprised reflection on
Prebriefing and Its Activities one’s first code, practice and review of cardiac assess-
ment, a worst-case scenario game, and a code video
Prebriefing is an information or orientation session that and discussion of the roles of code team members,
instructors provide to learners before simulation-based nursing students reported positive attitudes toward a
learning (Meakim et al., 2013; Tyerman et al., 2016). Pre- clear and explicit prebriefing and showed improved car-
briefing includes discussion of academic integrity, and fic- diopulmonary resuscitation performance (Brackney &
tion contract to provide the learner with an opportunity to Priode, 2015). Prebriefing preparatory material provides
identify expected outcomes (Chamberlain, 2015; Chmil, beneficial information for nursing students and instruc-
2016). Prebriefing activities include review of learning tors. It allows nursing students to fully engage during

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Prebriefing on simulation-based education 14

the simulation experience while decreasing anxiety psychological safety, academic safety, satisfaction with
(Sharoff, 2015). debriefing, and performance in nursing students.
One study has found that when expert nurse role-
modeling video is incorporated as a prebriefing strategy,
nursing students show higher clinical judgment compared Materials and Methods
to students in the control group with standard prebriefing
when they are rated by expert faculty reviewers (Coram, Design
2016). However, student self-assessed and peer-rated clin-
ical judgment scores did not differ significantly between This study used a nonequivalent control group posttest-only
experimental and control groups (Coram, 2016). design (Table 1).
Conversely, no significant differences in knowledge, self-
efficacy, or technical skills between videotaped role- Sample
modeling and lecture groups in crisis resource management
principles or clinical management of pediatric patients Regarding optimal sample size, 26 participants would be
among nurse practitioner students have been reported required in each group for an effect size of 0.5 with 80%
(Anderson, LeFlore, & Anderson, 2013). Nursing students’ power at a significance level of 0.05 on a t-test using
anxiety level or simulation performance score did not differ G*Power 3 calculation (Faul, Erdfelder, Lang, & Buchner,
between a supervised individual prebriefing group and a 2007). A total of 281 fourth year nursing students were
control group with usual preparation either (Gantt, 2013). enrolled in a simulation course. Nursing students in the
Page-Cutrara and Turk (2017) have reported that the experimental group (n ¼ 163) underwent prebriefing activ-
group with the use of a concept map type prebriefing work- ities consisting of skills practice, scenario review and
sheet and facilitated reflection has statistically significant concept mapping, orientation on simulation environment
higher scores for competency performance, clinical judg- and equipment, and fiction contract (prebriefing method 1);
ment, and prebriefing experience. The integration of those in the control group (n ¼ 118) underwent the same
concept mapping and cause-and-effect diagramming has prebriefing activities with the exclusion of the concept map-
induced comfort and positive perception on critical and ping and fiction contract (prebriefing method 2). A total of
reflective thinking for nursing students (Decker et al., 30 nursing students were invited from each group using a
2010). Conversely, there were no significant differences in convenience sampling to satisfy the minimum sample size
self-reported learning self-efficacy between a concept map- required. Data of the experimental group (n ¼ 27) and con-
ping group and a usual teaching method group (Bressington trol group (n ¼ 23) were used for the final analysis.
et al., 2018). The effect of concept mapping as a prebriefing
activity has not yet been studied; further studies are needed.
Measures
One study has compared outcomes among four groups
of nursing students including 1) no prebriefing, 2) prebrief-
General Characteristics
ing with learning engagement and orientation activities, 3)
General characteristics including age, gender, and overall
prebriefing with orientation activities, and 4) prebriefing
grade point average for the previous semester were
with learning engagement activities (Chamberlain, 2017).
collected.
Orientation activities comprised identification of learning
objectives, review of participant roles, and review of the
Team Psychological Safety
manikin and equipment. Results showed that perceptions
Korean version of the Edmondson (1999)’s Team Psycho-
of overall simulation effectiveness, learning, and self-
logical Safety scale was used to assess the extent to which
confidence were significantly higher for the prebriefing
respondents felt safe to speak up about issues or ideas
group (Chamberlain, 2017). Kim et al. (2017) have reported
regarding team performance (Kim, Kwon, & Choi, 2016).
that nursing students receiving all three prebriefing activ-
The scale had seven items. Each item was scored with a
ities (orientation, experience of simulation environment,
seven-Likert scale (1 ¼ strongly disagree, 7 ¼ strongly
and skill practice) showed significantly highest scores in
flow, clinical competency, satisfaction, and self-
confidence compared to those in the group of oral orienta-
tion only or oral orientation with experience of simulation Table 1 Research Design
environment. Group Intervention Posttest
Thus, many studies have reported positive effects of Experimental group (n ¼ 27) X1 O1
various prebriefing activities for nursing students. However, Control group (n ¼ 23) X2 O2
relatively few studies have evaluated effects of prebriefing
X1: prebriefing 1dorientation, skills practice, scenario peer review,
activities on psychological safety, satisfaction with debrief- concept mapping, and fiction contract. X2: prebriefing 2dorientation,
ing, and performance of nursing students. This study was skills practice, and scenario peer review. O1, O2: psychological safety,
conducted to identify the effects of prebriefing on team academic safety, satisfaction with debriefing, and team performance.

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Prebriefing on simulation-based education 15

agree). Higher score denotes a higher level of team psycho- For the experimental group, the format of simulation for a
logical safety. Cronbach’s alpha coefficient for the scale cardiac arrest patient scenario was given, including pre-
was reported to be 0.78 (Kim et al., 2016). It was 0.70 in briefing method 1, simulation session, and post-simulation
this study. instructor-led debriefing. In the control group, the whole
simulation process was the same as in the experimental
Academic Safety During Nursing Simulation group except that they received prebriefing method 2.
Academic safety was assessed using the academic safety Nursing students in both groups participated in the
measurement tool (Ganley & Linnard-Palmer, 2012). The instructor-led debriefing session using the Gather, Analyze,
instrument has two factors: 1) academic safety and comfort and Summarize debriefing model. The instructor was with
and 2) anxiety. The scale had ten items. Each item was students throughout the prebriefing activities, simulation,
scored with a five-Likert scale (1 ¼ strongly disagree, and debriefing.
5 ¼ strongly agree), with higher scores indicating higher The authors implemented a 100-minute prebriefing
academic safety level. Cronbach’s alpha coefficient for method 1 process based on the model case of prebriefing
the scale has been reported to be 0.84 (Ganley & (Chamberlain, 2015; Page-Cutrara, 2015). Nursing students
Linnard-Palmer, 2012). It was 0.88 in this study. practiced their clinical skills related to the cardiac arrest
simulation one week before the simulation (60 minutes).
Satisfaction with Debriefing On the day of simulation, nursing students reviewed the
Satisfaction with debriefing was assessed using the Korean simulation topic, learning objectives, and a synopsis of a
version of Debriefing Assessment for Simulation in scenario and created a concept map regarding the care for
Healthcare-Student Version (DASH-SV), an instrument the patient and rationale for their decisions (30 minutes).
using behaviorally anchored rating scale to identify the An instructor provided them a module that included a
extent to which students would perceive the debriefer. The copy of the scenario synopsis, learning objectives, a patient
instrument comprised six elements of effective debriefing chart and recent nursing report, and role descriptions. Once
following simulation experiences (Brett-Fleegler et al., learners reviewed this module together, the instructor asked
2012; Roh, Kelly, & Ha, 2016). Each element of the scale questions to identify nursing students’ feeling about their
was scored with a seven-point effectiveness rating from 1 preparation for the scenario and important issues. Nursing
(‘‘extremely ineffective’’) to 7 (‘‘extremely effective’’). students also discussed their assumed roles (charge nurse,
Cronbach’s alpha coefficient for the scale has been reported procedure/medication nurse, assessment nurse, and
to be 0.82 (Dreifuerst, 2012). It was 0.92 in this study. recorder) for simulation. Then, the instructor showed stu-
dents the simulation environment and equipment required
Team Performance of Cardiopulmonary Resuscitation in a simulation laboratory. They were encouraged to ask
Video-recorded group performance was rated using the questions as needed and to discuss feelings they had about
Korean version of Advanced Cardiovascular Life Support participating (10 minutes). The instructor brought the pre-
Skills Checklist (Roh & Kim, 2014; Wayne et al., 2008). It briefing activity to a close by reminding learners of time
was scored as 0 (not done), 1 (done incorrectly), or 2 (done frames and that the scenario would be followed by a de-
correctly). The checklist had 20 items. Two raters who were briefing. All participants in the experimental group signed
blinded to group assignment assessed team performance of the fiction contract form which described responsibilities
cardiopulmonary resuscitation based on the checklist. Intra- of instructors and students in simulation-based learning.
class correlation coefficient of the two raters was 0.97. These learners began the scenario with a plan, rationale,
or options for approaching care of patient.
Procedure For the control group, 100-minute prebriefing method 2
including scenario review (30 minutes), skills practice (60
A total of 281 fourth year nursing students participated in a minutes), and orientation on simulation environment and
core nursing simulation course. There were 12 student equipment (10 minutes) were given except fiction contract
teams with nine instructors. Each team was led by two and concept mapping.
instructors. Approximately 24 students were assigned to The whole class ended in the second week of December
each team conveniently according to student’s identification 2017. Web-based surveys were carried out from December
number. Each team of 24 students consisted of four groups 26, 2017 to January 12, 2018, after grades related to the
with six nursing students in each group. The authors subject were finalized. Of the 30 students in each group, 27
developed the instructor manual to maintain consistency (90% response rate) and 23 (76.7%) completed the survey.
among instructors. Instructor meetings were held to discuss
issues regarding prebriefing and simulation before the class. Data Analysis
Of these 12 student teams, nursing students in six teams
(n ¼ 163) received prebriefing method 1 while those in the Descriptive statistics and t-tests were calculated to sum-
other six teams (n ¼ 118) received prebriefing method 2. marize quantitative data using IBM SPSS Statistics for

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Prebriefing on simulation-based education 16

Table 2 Comparisons of Study Variables Between Experimental and Control Groups

Experimental Group (n ¼ 27) Control Group (n ¼ 23)
Variables Mean  SD t p
Team psychological safety 5.81  0.60 5.33  0.63 2.754 0.008
Academic safety 3.77  0.68 3.44  0.71 1.665 0.103
Academic safety and comfort 3.77  0.67 3.35  0.67 2.186 0.034
Anxiety 3.38  0.89 3.80  1.12 -0.094 0.926
Satisfaction with debriefing 36.74  3.93 34.70  7.31 1.202 0.238
Establishment of an engaging learning environment 6.11  0.80 5.83  1.27 0.932 0.358
Maintenance of an engaging learning environment 6.04  1.02 5.70  1.46 0.943 0.352
Structuring the debriefing in an organized way 5.96  1.06 5.61  1.53 0.964 0.340
Provoking engaging discussions 5.96  0.94 5.52  1.59 1.167 0.251
Identifying and exploring performance gaps 6.33  0.78 6.04  1.19 1.033 0.307
Helping simulation participants achieve or 6.33  0.68 6.00  1.13 1.239 0.224
sustain good practice
Team performance 33.89  2.74 26.28  4.37 7.488 <0.001

Windows (version 23.0; IBM Corp., Armonk, NY). Group psychological safety (t ¼ 2.754, p ¼ .008) and cardiopul-
differences at each testing interval were analyzed using monary resuscitation performance (t ¼ 7.488, p < .001)
independent samples t-tests. Statistical significance was than those in the control group who received prebriefing
considered at p < .05. method 2.
Overall academic safety score was not significantly
Ethical Considerations different between the two groups (t ¼ 1.67, p ¼ .103). In
comparison of subscale scores, the experimental group
Ethical approval was obtained from the institutional review showed higher academic safety and comfort subscale score
board (1041078-201708-HR-160-01). Nursing students (t ¼ 2.19, p ¼ .034). However, there was no significant dif-
were informed that answers to questionnaires would be ference in anxiety subscale score (t ¼ e 0.09, p ¼ .926) be-
treated anonymously and confidentially. Students were tween the two groups. The overall mean score for
informed that they could refuse to participate or withdraw satisfaction with debriefing was not significant different be-
from participation in the study at any time without penalty. tween the two groups (t ¼ 1.202, p ¼ .238).
Student self-report questionnaires and performance evalu-
ation results were not reflected in grades. Voluntary
Discussion
informed consent was obtained from each participant.
Our results revealed that nursing students who received
prebriefing method 1 showed higher team psychological
Results safety and cardiopulmonary resuscitation performance
compared to those in the control group who received
Homogeneity of General Characteristics Between prebriefing method 2. However, there were no significant
Experimental and Control Groups differences in overall academic safety or satisfaction with
debriefing between the two groups.
There were no statistically significant differences in general Regarding team psychological safety, one study has
characteristics such as age (24.0  0.98 years vs. found that learning orientation is positively and signifi-
24.1  1.08 years, t ¼ e0.171, p ¼ .865), Grade Point cantly related to psychological safety (Frazier, Fainshmidt,
Average (3.67  0.26 vs. 3.63  0.38, t ¼ 0.491, Klinger, Pezeshkan, & Vracheva, 2017). Multiple prebrief-
p ¼ .626), or percentage of women (96.3% vs. 91.3%, ing activities could be used to establish a psychologically
c2 ¼ 0.552, p ¼ .457) between experimental and control safe context in simulation-based learning (Rudolph et al.,
groups. 2014). In this study, nursing students might have a higher
score of team psychological safety due to obtaining suffi-
Comparisons of Study Variables Between Experi- cient information for simulation through additional pre-
mental and Control Groups briefing activities such as fiction contract and concept
mapping before simulation. Furthermore, during the pre-
Comparisons of study variables between experimental and briefing activities, the instructor’s explanation, support,
control groups are shown in Table 2. Nursing students who and feedback to the learner may affect psychological safety.
received prebriefing method 1 showed higher team Therefore, designing and implementing learning orientation

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Prebriefing on simulation-based education 17

through prebriefing activities can be a useful strategy to student anxiety during debriefing. Therefore, prebriefing
foster psychological safety. activities might be beneficial for nursing students to create
Overall academic safety score was higher in the safe simulation-based learning experience and facilitate
experimental group; however, the difference in the score learner engagement.
between the two groups was not statistically significant. In the present study, the experimental group showed
The experimental group had higher academic safety and better team performance of cardiopulmonary resuscitation
comfort subscale score. Some previous studies have than the control group. This result is consistent with a
reported that anxiety in the group with presimulation previous study showing that medical students in the
orientation is less in medical students compared to that in prebriefing group have higher performance scores
the control group (Bommer et al., 2018). After a collabora- (Bommer et al., 2018). In another study, nursing students
tive group preplanning session, nursing students report less have also showed high competency score using a concept
anxiety (Elfrink et al., 2009). Conversely, a preparatory su- map type prebriefing worksheet to facilitate reflection
pervised individual simulation experience did not affect (Page-Cutrara & Turk, 2017). Prebriefing activities such
nursing students’ state anxiety (Gantt, 2013). Our result as orientation, experience of simulation environment, and
that overall academic safety score was not significantly skill practice could also increase competency of nursing
different between the two groups was not surprising students (Kim et al., 2017). Conversely, prebriefing with a
because both groups had presimulation orientation, skills supervised individual simulation experience before the
practice, and scenario review that could induce academic evaluative simulation did not affect nursing students’ simu-
safety. Prebriefing activities including concept mapping lation performance (Gantt, 2013). Team psychological
and fiction contract in our study could boost higher self- safety has been emphasized as one of the important factors
confidence for performance and academic safety compared promoting team performance (Edmondson, 1999). One
with the control group. Concept mapping approach can meta-analysis has also found a positive relationship be-
encourage the integration of theoretical knowledge with tween psychological safety and task performance (Frazier
clinical knowledge (Bressington et al., 2018). Through et al., 2017). In our study, nursing students with prebriefing
concept mapping, nursing students could integrate theoret- method 1 contributed to team psychological safety climate
ical knowledge with clinical knowledge, thus positively through receiving information for upcoming simulation
affecting their self-confidence in subsequent simulation with improved critical and reflective thinking through
performance. Fiction contract is a collaborative and explicit team discussion for concept mapping. This could provide
agreement among instructors and learners (Rudolph et al., them opportunity to focus on cardiopulmonary resuscita-
2014). Nursing students could clarify the responsibility tion tasks better by minimizing mistakes, thus leading to
and commitment of the instructor and the learner well better team performance than those in the control group.
with respect to fidelity and realism by signing fiction This study has some limitations. First, this pilot study
contract. was slightly under-powered so caution is needed when
Our results showed no significant difference in satis- generalizing our study results. Therefore, caution is needed
faction with debriefing between the two groups. In this when generalizing our study results. Second, because of a
study, experimental and control groups received the nonequivalent control group posttest-only design, homoge-
debriefing session with the same instructor guidelines neity of pretest was not identified.
using the Gather, Analyze, and Summarize debriefing
model. Students experienced similar engagement during
debriefing session conducted by the same guidelines, Conclusions
although instructors and prebriefing activities were
different. Our results did not support the effect of Prebriefing is required to support learners by supplement-
prebriefing activities on satisfaction with debriefing. ing limited knowledge and experience before simulation
However, some studies have suggested that the orientation experience. Our results revealed that nursing students who
of components related to debriefing during the prebriefing received prebriefing method 1 had higher team psycho-
process can affect learner engagement (Chunta & logical safety and cardiopulmonary resuscitation perfor-
Edwards, 2013). Fiction contract has been found to be mance compared to those in the control group who
one good strategy for learners to actively engage in simu- received prebriefing method 2. However, there were no
lation plus debriefings (Rudolph et al., 2014). Nurse edu- significant differences in overall academic safety or
cators should make an academically safe learning satisfaction with debriefing between the two groups.
environment so that nursing students could learn without Thus, nurse educators should design and implement
fear of failure during simulation (Ganley & Linnard- learning orientation using prebriefing activities to foster
Palmer, 2012). However, nursing students have reported psychological safety and improve performance of nursing
anxiety during debriefing (Tosterud, Hall-Lord, Petz€all, students. Further study is needed to identify the effect of
& Hedelin, 2014), so it is necessary to include a strategy various types and amount of prebriefing strategies on
in the prebriefing to induce effective learning by reducing learning outcomes and perceptions with rigorous research

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Prebriefing on simulation-based education 18

design in simulation-based education. A repeated study Dreifuerst, K. T. (2012). Using debriefing for meaningful learning to foster
targeting different population involving qualified health- development of clinical reasoning in simulation. Journal of Nursing Edu-
cation, 51(6), 326-333. https://doi.org/10.3928/01484834-20120409-02.
care workers can be considered. Edmondson, A. (1999). Psychological safety and learning behavior in
work teams. Administrative Science Quarterly, 44(2), 350-383.
Elfrink, V. L., Nininger, J., Rohig, L., & Lee, J. (2009). The case for group
planning in human patient simulation. Nursing Education Perspectives,
Acknowledgments 30(2), 83-86.
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G* power 3: A
Authors’ contributions: Study design was carried out by flexible statistical power analysis program for the social, behavioral, and
Y.S.R., J.A., E.K., and J.K. Data collection and analysis biomedical sciences. Behavior Research Methods, 39(2), 175-191.
was performed by Y.S.R., J.A., E.K., and J.K. Manuscript Frazier, M. L., Fainshmidt, S., Klinger, R. L., Pezeshkan, A., &
Vracheva, V. (2017). Psychological safety: A meta-analytic review
writing was done by Y.S.R. and J.A. Final revision and and extension. Personnel Psychology, 70(1), 113-165. https:
approval were carried out by Y.S.R., J.A., E.K., and J.K. //doi.org/10.1111/peps.12183.
Ganley, B. J., & Linnard-Palmer, L. (2012). Academic safety during
nursing simulation: Perceptions of nursing students and faculty. Clinical
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