Designing PULSE: A Realtime Annotation Tool to Support Simulation Debriefing
This study addresses the challenges of high instructor workload and low observer engagement in simulation-based education, which often compromise debriefing effectiveness. In collaboration with nursing educators, the authors developed PULSE, a real-time annotation tool that introduces a novel student-led annotation mechanism. PULSE enables observing students to actively document their observations and reflections during simulations, thereby enhancing the structure, depth, and interactivity of debriefings. Grounded in human-centered co-design and informed by the DASH (Debriefing Assessment for Simulation in Healthcare) framework alongside qualitative interviews, the study systematically developed and validated an interactive debriefing support mechanism. Preliminary results demonstrate that PULSE significantly improves DASH scores (p = 0.027, Cohen’s d = 2.05), enhances classroom discussion quality, and shifts debriefing practices from instructor-centered toward greater student participation.