Ears: A Novel Debrief Model for in-Situ Paediatric Simulation

Background: In-site simulation, defined as simulation conducted within the clinical environment, using the authentic healthcare team and equipment, has become an increasingly valuable tool for improving paediatric emergency care. Its advantages include high realism, interprofessional collaboration, and immediate relevance to clinical practice. However, in-situ sessions are often opportunistic and time-limited, creating challenges for facilitators when conducting effective debriefs. Existing debriefing models such as the GAS, PEARLS, or Diamond model may be too time consuming, or insufficiently tailored to the unique emotional and team dynamics of paediatric care. Currently, there is no debrief framework specifically designed for paediatric in-situ simulation. This highlights the need for a model that is concise, structured, and places emphasis on listening to participants. Method: To inform the development of a novel debrief model, I conducted a survey of paediatric specialty registrars and consultants at Chelsea and Westminster Hospital who have experience facilitating paediatric in-situ simulations. Participants were asked about perceived challenges, useful strategies, and preferred structures for debrief in this setting. In parallel, I conducted a literature review of widely used debrief models in simulation based education, with attention to their adaptability to paediatric and in-situ contexts. Key findings from both sources were synthesised to create a pragmatic, focused model. Results: Survey respondents reported varied experience and training in debriefing, with only half routinely using a structured model. Most debriefs lasted 5 to 20 minutes (83%), yet half felt time pressures often reduced effectiveness, particularly outside protected teaching time. Limited time (60%), difficult group dynamics (60%), and lack of a clear structure (40%) were the most common barriers to effective debriefing reported by participants. When asked what would make a new model most useful, respondents emphasised that it should be concise, easy to use, easy to remember, and time efficient. Literature review confirmed that current models provide useful frameworks but are not specifically adapted to the unique demands of paediatric in-situ practice. Based on these findings, I developed the EARS Debrief Model. E Emotions: acknowledge and normalise participants’ emotional responses. A Actions: brief recap of clinical and team behaviours during the scenario. R Reflection: explore underlying reasoning, communication, teamwork, and both clinical and human factors. S Summary: consolidate key learning points and highlight actionable takeaways. The model is designed to be completable within 8 to 10 minutes, ensuring efficiency in pressured clinical environments. A visual diagram of EARS has been developed for distribution to facilitators, providing prompts and examples of open ended questions for each stage. Conclusion: The EARS model offers a novel, paediatric specific framework for debriefing in-situ simulations. By prioritising listening, emotional processing, and structured reflection, it addresses the unique challenges of paediatric emergencies while remaining concise enough for use in time limited settings. EARS provides a practical tool to support facilitators in delivering impactful debriefs that integrate clinical and human factors learning. Further evaluation across different centres will be valuable to assess its generalisability and effectiveness.