PEARLS Debriefing
PEARLS stands for Promoting Excellence And Reflective Learning in Simulation, a blended debriefing framework published by Walter Eppich and Adam Cheng in 2015. It lays out four phases of a debrief, reactions, description, analysis, and summary, and its distinctive contribution is in the analysis phase, where the facilitator chooses among three educational strategies: learner self-assessment, focused facilitation to promote critical reflection, and providing information through directive feedback or teaching. The paper also supplies a scripted debriefing tool with suggested wording for each phase and strategy, which is what makes the framework usable by faculty who are new to facilitating.
Source: Eppich and Cheng, Simulation in Healthcare, 2015;10(2):106-115
The four phases each do a specific job. The reactions phase opens with a question such as how are you feeling, and the authors recommend a follow-up prompt plus silence so that quieter participants also get to vent rather than letting one or two voices stand for the group. The description phase invites someone to summarize the key events or the main medical problems, which confirms that faculty and learners are working from the same account of what happened, and a mismatch here is itself useful material for later. The analysis phase carries the substance. The summary phase consolidates lessons learned, either learner generated or educator guided.
The three strategies in the analysis phase are the reason PEARLS is called blended. Learner self-assessment uses prompts such as plus-delta, what went well and did not go well and why, or what was easy versus challenging. Focused facilitation uses methods including advocacy and inquiry, where the educator states a concrete observation, shares their judgment about it, and then asks the learner to explain their thinking, so that mental models become explicit and can be reframed. Providing information means clear directive feedback or focused teaching, delivered honestly without being threatening. The authors are explicit that blending strategies within a single objective is often appropriate.
PEARLS also gives faculty decision support rather than leaving the choice to instinct. Before the debrief, educators consider the participants' insight and experience along with their own facilitation experience, then screen each performance gap with three questions: is the rationale for the gap already clear, how much time is available, and does the performance sit in a cognitive, technical, or behavioral domain. Self-assessment strategies suit the opening of the analysis phase when time is short. A clear knowledge gap with limited time points toward directive feedback and teaching. Unclear reasoning about a behavioral issue points toward focused facilitation.
The framework assumes the groundwork has been done. The authors state that use of the script presumes learners have been adequately prepared for the encounter and that creating a sense of psychological safety is essential, so PEARLS is not a substitute for a real prebrief. A follow-up faculty development guide published in 2016 extended the framework for teaching purposes, which is
What this looks like in a program
- Print the script and keep it in the room. Faculty who facilitate a few times a year get more out of scripted wording than out of a half-remembered model.
- Use the three screening questions while you are still observing the encounter, so you walk into the debrief with a strategy chosen for each performance gap.
- Do not let the reactions phase absorb the whole debrief. One follow-up prompt and a pause is usually enough before moving to description.
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Last updated August 2026