Designing PULSE: A Realtime Annotation Tool to Support Simulation Debriefing

2026-08-10

AI Summary

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.

Abstract

Debriefing is central to effective simulation-based education. However, effective debriefing is challenged by high instructor workloads and limited engagement of observing students. A real-time annotation tool to support debriefing, called PULSE, was co-designed with nursing educators. A field study comparing three standard simulation debriefings with three debriefings using PULSE was conducted as a preliminary evaluation. Outcomes were assessed using the Debriefing Assessment for Simulation in Healthcare (DASH) student survey and a follow-up instructor interview. PULSE significantly improved overall DASH scores (t(4) = 4.03, p = 0.027, Cohen's d = 2.05). Survey findings suggested improvements in debriefing organization and depth of reflection. Interview data indicated that the student-generated annotations enhanced engagement and stimulated more interactive discussions. PULSE shows promise as a support tool for debriefing, particularly by facilitating reflection of observing students. However, larger and more diverse studies are needed to confirm effectiveness and refine the system for broader implementation.

Problem

• simulation debriefing
• instructor workload
• student engagement
• real-time annotation
• reflection

Innovation

• real-time annotation
• simulation debriefing
• student engagement
• reflective learning
• co-design