BackgroundClinical debriefing (CD) positively impacts individuals, teams and systems and has been shown to improve patient outcomes and staff wellbeing. Although there is a growing evidence base supporting CD, it has not been routinely adopted by many healthcare organisations. Despite the work environment being an important component of transfer of learning, there has been minimal focus on how it influences implementation and maintenance of CD in practice. The overall aim of this study was to explore the work environment barriers and enablers influencing the transfer of clinical debriefing skills from simulation to clinical practice.MethodsFollowing ethical approval, medical registrars who had participated in a simulation course involving a within-scenario CD were invited to participate in semi-structured interviews. These utilised Burke and Hutchins’ evaluation model as the initial conceptual framework and took place at least two months post-course. Interviews explored participants’ experiences of transferring learning related to CD from simulation to the clinical workplace, and were transcribed verbatim and dual coded using template analysis.ResultsFifteen medical registrars participated in interviews between January and May 2025. The work environment influences from Burke and Hutchins’ evaluation model resonated as important factors affecting adoption of CD. With the addition of subthemes generated inductively from the data, the model provided a framework for identification and articulation of the barriers and enablers to CD in the workplace. The most striking finding was participants’ sense of personal responsibility to engage with CD. In addition, participants identified the requirement for cultural change to enable CD.ConclusionsWork environment influences represent both barriers and enablers of CD in relation to the transfer of learning from simulation to clinical practice. Personal responsibility and workplace culture are important drivers of CD, and attention should be paid to the influence of both constructs in this context. Recommendations for practice, based on our findings, are designed to enable educators and organisations to promote the adoption of CD in their own settings. This will help to bridge the gap and make CD the norm, not the exception.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41077-025-00405-8.

Globally, in excess of one billion children experience violence and abuse every year, leading to upwards of 40,000 deaths. Child safeguarding education typically occurs in professional silos across healthcare, often focusing on specific undergraduate competencies. In practice, however, child safeguarding requires a multi-professional approach, necessitating effective communication in emotionally charged contexts. To address these needs, we designed an interprofessional course using simulation-based education for experienced healthcare professionals working in the emergency department. On three occasions, we delivered an in-person, two-day course with 32 healthcare professionals from medicine, nursing, and social work. We collected data using multiple methods including participant demographics and child safeguarding experience (n = 32), observational field notes, individual semi-structured interviews (n = 14) and focus groups (n = 4). We analyzed the data using landscapes of practice theory as a sensitizing concept. Using landscapes of practice theory, we deductively generated three key themes from our data: (1) collaborative learning, (2) the medium of language, and (3) creating a safe space. These themes encapsulate our participants' experiences in navigating interprofessional learning within newly established teams, during simulated child safety scenarios in the emergency department. Findings also detail participants' knowledge gains and confidence in reporting child safeguarding concerns. This co-designed interprofessional simulation-based child safeguarding course created space for learners to renegotiate safeguarding as a shared, interdependent responsibility. Authentic, emotionally charged scenarios in a psychologically safe environment helped participants tolerate uncertainty, rehearse reporting decisions, and develop a shared safeguarding lexicon. The resulting design principles may assist educators seeking to foreground psychological safety, authentic collaboration and the child's voice in interprofessional safeguarding education.

IntroductionInterprofessional education (IPE) improves outcomes for staff and patients, yet most pre-licensure training remains siloed. Simulation-based education (SBE) enhances clinical and communication skills, with particular benefit during transitions in training. While immersive simulation is costly, could integrating IPE and SBE at key transition points optimize its educational impact?This study explores how interprofessional simulation can support transitions to practice, and what unique value it can contribute to the learning experience.MethodsThis phenomenological study explored medical students’ experience of an interprofessional SBE programme. Adopting a sequential, mixed-methods design, students were asked about their experiences of participating in interprofessional simulations using various data collection methods over their transition from pre-licensure to professional practice. Methods included surveys (n = 229), one-on-one interviews (n = 29), focus groups (13 participants) and 1-year follow up interviews (n = 7). The qualitative data from interviews and focus groups are reported here. Codes and meaning units were developed and then scrutinized to develop a nuanced understanding of how the elements of the interprofessional simulation experience intertwined and the impact this had on the students.ResultsThree overarching themes were identified from the analysis and were explored in greater detail: realism, gaining confidence and learning to observe (noticing). Interprofessional SBE provides the realistic environment for a unique educational experience in which students develop skills of observing interprofessional clinical practice, and can gain confidence for the transition into that practice. The implications are that the time and effort invested in overcoming the obstacles to offering interprofessional SBE lead to learning outcomes that may not otherwise be achieved. The results are further discussed through three theoretical lenses: Meyer and Land's threshold concepts, Richards' interdependent agentic capabilities and Lave and Wenger's legitimate peripheral participation.ConclusionInterprofessional simulation offers students immersive, emotionally resonant experiences that enhance confidence, professional identity, and integration into clinical teams. These simulations prompt reflection on future roles and foster deeper understanding of interprofessional dynamics. The study identifies specific attributes of simulation that meaningfully contribute to learning, extending current SBE literature. By using a qualitative lens, this research highlights the unique value of interprofessional SBE in preparing students for collaborative practice and the complexities of modern healthcare.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41077-025-00392-w.

BackgroundInterprofessional 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.MethodsIn 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.ResultsRFD 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.ConclusionsRFD 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 InformationThe online version contains supplementary material available at 10.1186/s41077-025-00398-4.

BackgroundIn situ simulation can identify latent safety threats in healthcare, yet there has been limited focus on how these threats are subsequently addressed. Adopting a systematic approach to identifying, reporting, and resolving threats found during in situ simulations could enhance clinical safety and system resilience. This study investigated the resolution of safety threats detected through in situ simulation courses in Aotearoa New Zealand hospitals, aiming to quantify resolution rates and examine factors influencing successful resolution.MethodsThis multicentre study used an exploratory sequential mixed-methods design. We collected data on latent safety threats identified after in situ simulations using a structured reporting tool and assessed their resolution three months post-course. Associations between resolution and threat classification, risk assessment score, course type, and hospital size were analysed. Qualitative interviews with hospital simulation convenors explored contextual and experiential factors affecting resolution.ResultsAcross 20 courses in 15 hospitals, 278 safety threats were identified at the three-month follow-up, with 28% resolved. Threats involving equipment, environmental layout, and tasks were more often resolved than those related to teamwork or organisational factors. Smaller hospitals showed higher resolution rates; multilevel regression confirmed hospital size and threat classification as significant predictors of resolution. Qualitative thematic analysis of 15 interviews identified five key themes: influence of threat type; motivation to resolve the threat; identifying and communicating the threat; clinician agency within their organisation; and hospital structures and processes to support resolution of identified safety threat. Tangible threats within clinicians’ control were addressed more readily, often through straightforward interventions; conversely, threats requiring cross-departmental collaboration or structural change remained unresolved due to limited authority, time, and institutional support.ConclusionWhile in situ simulation effectively identifies latent safety threats, threat resolution remains limited. Our findings highlight the need to align institutional processes with frontline clinicians’ insights. Effective threat mitigation depends on both threat characteristics and organisational context. To fully realise the opportunity presented by in situ simulation to improve patient safety, healthcare systems must move beyond threat identification to actively support resolution—by empowering clinicians, enabling multidisciplinary collaboration, and embedding clear processes for follow-up and accountability.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41077-025-00401-y.

BackgroundAs more people age, healthcare professionals require skills in using tools for interprofessional, holistic health needs assessments to support aging in place. While simulation training is recognized to build professional skills, its application in training interprofessional teams by using tools to holistically assess and plan care for older adults at home remains limited.AimTo explore healthcare professionals’ perceptions of interprofessional simulation training in assessing the holistic health needs of older adults living at home (i.e., physical, cognitive, mental, sensory, behavioral, and social) and their views on appropriate measures.MethodA qualitative, exploratory study with five simulation training sessions focused on assessing health needs in older adults living at home. The simulation included 11 participants (nurses, physical therapists, and occupational therapists). The simulation sessions comprised introduction, briefing, scenario with role play, and debriefing, and were conducted in a home-like laboratory. The introduction prepared participants through e-modules. The briefing covered information about the scenario, participant roles, and tools to assess physical, cognitive, mental, sensory, behavioral, and social health needs. Participants chose either an active or an observer role in a scenario involving a health needs assessment in an older adult’s home. This was followed by debriefing during which participants shared their experiences. The debriefing transcripts served as the study data and were analyzed using thematic analysis.ResultsParticipants reported that the tools to assess health needs provided systematic and holistic insight on the health of a simulated older adult. They perceived that interprofessional collaboration supported both the assessment process and engagement with the older adult. Participants perceived that assessment scores informed decisions about necessary measures and could enhance older adults’ awareness of their functional abilities, potentially stimulating health-promoting actions. Participants perceived the simulation training as useful and realistic, and both the active and observer roles gave valuable experiences.ConclusionInterprofessional simulation training enabled healthcare professionals to practice holistic assessment and identify the health needs of older adult. They perceived that such assessments could inform appropriate measures and promote health. The participants reported the simulation training to be authentic and meaningful.

BackgroundThere is limited evidence and humanistic thinking about the thoughts and reactions of peer observers during nursing simulation. An increased understanding may provide new insights and opportunities to advance therapeutic relationships and holistic care. This study explored peer observer and active participant thoughts during simulation to better understand how shared learning experiences transform and improve nursing practice.MethodsA qualitive descriptive design generated data via peer observers and active participants’ self-reported experiences from pre-registration second-year, nursing students. Responses were synthesized and analyzed using reflexive thematic analysis.ResultsFrom 175 peer-observer accounts, four codes were generated and synthesized into three themes: Observer self-critique and critique of others; observer empathy and affect; and observers’ outsider perspective. Six codes were generated from the analysis of 234 active participant accounts analysis and synthesized into three themes: participant affect; participant cognition and participant confidence.ConclusionsThe peer observer role can experience simulation as an immersive and emotive encounter that may indicate active and deep learning is occurring. Simulation learning design should prioritize the identification of empathy experienced by observers for the participants and explicitly include it in cognitive processing undertaken during simulation debrief. Linking the experience of empathy with nursing theory in simulation is a powerful learning tool.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41077-025-00395-7.

BackgroundSimulation-based education offers a risk-free platform to prepare future health professionals for interprofessional collaboration during high-stakes emergencies. This study involved the design, implementation, and evaluation of a disaster-focused simulation to enhance interprofessional competencies among health professions students.MethodsAn interprofessional education (IPE) simulation covering the four disaster preparedness and management phases (mitigation, preparedness, response, recovery) was conducted for undergraduate health professions students. Students, assessors, and standardized patients (SPs) participated in the evaluation. Data on interprofessional competencies were collected from students using the Team’s Perception of Collaborative Care Questionnaire, from assessors using the Modified McMaster-Ottawa Scale, and from SPs using the Standardized Patient Team Evaluation Instrument. Descriptive statistics were used to summarize study variables. Paired sample t-tests were conducted to compare score differences between assessors. Learning curve across cases were tested using one-way repeated measures ANOVA, and associations between global scores and demographic variables were analyzed using t-test or ANOVA, as appropriate.ResultsThirty-three students, 13 assessors, and 8 SPs participated in the evaluation. response rates were 33.3% (students), 92.9% (assessors), and 100% (SPs). Students self-reported positive perceptions of teamwork in the activity, with over 90% agreement across all domains. Assessors’ ratings for the response phase corroborated these findings, with over 80% of students scoring at or above expectations in all domains. SPs’ evaluations were also high, with 70% agreeing that students demonstrated positive interprofessional practice behaviors. For the diabetic ketoacidosis case, teams’ global performance scores were calculated as the mean of the two assessors’ ratings. Students with prior IPE experience (M = 2.42, 95% CI: 2.24–2.60) and those who had completed a prior practice placement (M = 2.48, 95% CI: 2.30–2.65) performed significantly better than students without IPE experience (M = 2.06, 95% CI: 1.80–2.33) or a prior practice placement (M = 2.12, 95% CI: 1.86–2.37). While not statistically significant, a trend towards improved performance across cases in the response phase suggested a learning curve effect.ConclusionsSimulation-based IPE can strengthen interprofessional competencies for disaster preparedness and management, with greatest benefit when preceded by other IPE activities and clinical placements.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41077-025-00391-x.