Culturally adapted meta-debriefing: a mixed-methods study of reflective practice in Spanish-speaking simulation...

Simulation-based education has expanded across Latin America, creating demand for contextually relevant faculty development. Meta-debriefing, defined as a facilitated conversation following a debriefing, can strengthen debriefer performance. However, its implementation and effectiveness in Spanish-speaking settings remain underexplored. The CORE model (context, observation, reflection, and enhanced practice) provides structural guidance, but its adaptation to regional cultures has not been studied.

We conducted a concurrent mixed-methods study of one experienced meta-debriefer interacting and facilitating 15 remote meta-debriefing sessions with interprofessional novice debriefers. Quantitative data were derived from audio-recorded sessions using DASH, SET-M, a CORE-aligned checklist, and a meta-debriefing pillars tool. Qualitative data consisted of written observer reports, analyzed using inductive content analysis, and triangulated across sources.

Quantitative analysis revealed high adherence to the CORE model and consistent demonstration of the four meta-debriefing pillars. Peer-assessed DASH scores ranged from 6.8 to 7.0, while SET-M items were consistently marked as achieved. Qualitatively, the meta-debriefer demonstrated behaviors aligned with psychologically safe, context-dependent, theoretically grounded, and formative facilitation. The meta-debriefer used cultural metaphors (e.g., "boli," "cazuelas," and a prisoner's song) to clarify structure and normalize reflection. Five reflection strategies emerged as central to generating debriefer insight: (1) Structured reorientation, (2) constructivist linkage to clinical identity, (3) metaphorical framing, (4) strategic questioning (e.g., advocacy & inquiry, circular inquiry), and (5) emotional normalization.

This study demonstrates how meta-debriefing, when implemented through culturally sensitive and structured approaches like CORE, supports transformative learning among simulation debriefers. Meta-debriefer's relational style, use of shared narratives, and context-sensitive scaffolding activated learner-centered reflection. As meta-debriefing models gain traction in Latin America and beyond, this study highlights the value of culturally responsive faculty development strategies that integrate local language, values, and pedagogical traditions into simulation-based education.