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Eye-opening facilitator behaviours: an Interaction Analysis of facilitator behaviours that advance debriefings
  1. Klas Karlgren1,2,3,
  2. Fredrik Larsson1,4,
  3. Anders Dahlström3,4
  1. 1Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
  3. 3Department of Research, Education, Development, and Innovation, The Södersjukhuset Hospital, Stockholm, Sweden
  4. 4Department of Neonatology, Sachs' Children and Youth Hospital, Stockholm, Sweden
  1. Correspondence to Dr Klas Karlgren, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm 17177, Sweden; klas.karlgren{at}


Introduction Analyses of simulation performance taking place during postsimulation debriefings have been described as iterating through phases of unawareness of problems, identifying problems, explaining the problems and suggesting alternative strategies or solutions to manage the problems. However, little is known about the mechanisms that contribute to shifting from one such phase to the subsequent one. The aim was to study which kinds of facilitator interactions contribute to advancing the participants’ analyses during video-assisted postsimulation debriefing.

Methods Successful facilitator behaviours were analysed by performing an Interaction-Analytic case study, a method for video analysis with roots in ethnography. Video data were collected from simulation courses involving medical and midwifery students facilitated by highly experienced facilitators (6–18 years, two paediatricians and one midwife) and analysed using the Transana software. A total of 110 successful facilitator interventions were observed in four video-assisted debriefings and 94 of these were included in the analysis. As a starting point, the participants’ discussions were first analysed using the phases of a previously described framework, uPEA (unawareness (u), problem identification (P), explanation (E) and alternative strategies/solutions (A)). Facilitator interventions immediately preceding each shift from one phase to the next were thereafter scrutinised in detail.

Results Fifteen recurring facilitator behaviours preceding successful shifts to higher uPEA levels were identified. While there was some overlap, most of the identified facilitator interventions were observed during specific phases of the debriefings. The most salient facilitator interventions preceding shifts to subsequent uPEA levels were respectively: use of video recordings to draw attention to problems (P), questions about opinions and rationales to encourage explanations (E) and dramatising hypothetical scenarios to encourage alternative strategies (A).

Conclusions This study contributes to the understanding of how certain facilitator behaviours can contribute to the participants’ analyses of simulation performance during specific phases of video-assisted debriefing.

  • debriefing
  • Interaction Analysis
  • video-assisted feedback

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  • Contributors The manuscript has been read and approved by all named authors and there are no other persons who satisfied the criteria for authorship but who are not listed. All authors have contributed to the design, data collection, analysis, writing, revision and approval of the manuscript. We further confirm that the order of authors listed in the manuscript has been approved by all of us.

  • Funding This work was supported by the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet.

  • Competing interests None declared.

  • Ethics approval Approval was obtained from the regional ethical review board in Stockholm (2016/2102-31/5).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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