Plus-Delta Debriefing
Plus-delta is a debriefing strategy in which the facilitator asks learners to assess their own performance with a paired question: what went well, and what would you do differently next time. The plus items are the aspects of performance the learner judges to have gone well, and the delta items are the changes the learner would make. Cheng, Eppich, and colleagues describe it as conceptually simple and easy to implement, which is why it travels well to busy clinical settings, and they argue it works best when learner self-assessment is informed by the facilitator's own observations rather than left to stand alone.
Source: Cheng, Eppich, Epps, Kolbe, Meguerdichian, and Grant, Advances in Simulation (2021)
The authors separate two ways of posing the question, and the choice matters more than it looks. Single-barreled questioning asks the plus question first, works through each point in reflective discussion, and only then poses the delta question. Double-barreled questioning asks both back to back, which lets learners choose what to emphasize and usually means they lead with what went wrong. Programs that always use the double-barreled form tend to produce debriefs that skip strengths entirely.
That drift is the known failure mode. Learners bring a negativity bias to self-assessment and gravitate toward what they got wrong, so facilitators lose the chance to analyze why the good performance was good, which is the part that generalizes. Self-assessment in the health professions is also unreliable, and a learner's account of their performance can diverge from what the facilitator watched happen. Plus-delta on its own is a prompt, not a verdict, and treating a learner's self-report as the assessment record is a misuse of it.
Plus-delta sits inside larger frameworks rather than competing with them. In PEARLS it is one of the self-assessment strategies available in the analysis phase, well suited to opening that phase when time is short or when learners were quiet during the reactions phase, because it surfaces quickly what the learners themselves think mattered. The authors describe plus-delta as usable either as the primary conversational strategy in a debrief, when coupled with feedback and teaching, or blended selectively with other strategies such as focused facilitation. Outside healthcare, the US Army uses a version of the same idea in the After Action Review.
For a program, the appeal is that plus-delta is teachable in an afternoon and survives a six-minute debrief between cases, which makes it the realistic default for faculty who facilitate occasionally. The trade is depth. A learner who says they would have asked about goals of care sooner has named a delta, and it takes a follow-up question about their reasoning to turn that into something they will actually do differently with the next family.
What this looks like in a program
- Ask the plus question first and stay with it long enough to name why the good moves worked, rather than letting the conversation jump straight to the deltas.
- Follow each delta with a question about the learner's reasoning in the moment, so the debrief closes a thinking gap instead of collecting good intentions.
- Bring your own observations into the conversation. The point of informed self-assessment is that the learner's account and the facilitator's account get reconciled.
Related terms
Last updated August 2026