PEARLS for Systems Integration: A Modified PEARLS Framework for Debriefing Systems-Focused Simulations

Mirette M. Dubé*, Jennifer Reid, Alyshah Kaba, Adam Cheng, Walter Eppich, Vincent Grant, Kimberly Stone

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

38 Scopus citations


Summary Statement Modern healthcare organizations strive for continuous improvement in systems and processes to ensure safe, effective, and cost-conscious patient care. However, systems failures and inefficiencies lurk in every organization, often emerging only after patients have experienced harm or delays. Simulation and debriefing, focused on identifying systems gaps, can proactively lead to improvements in safety and quality. Systems-focused debriefing requires a different approach than traditional, learner-focused debriefing. We describe PEARLS for Systems Integration, a conceptual framework, debriefing structure and script that facilitators can use for systems-focused debriefing. The framework builds on Promoting Excellence And Reflective Learning in Simulation, using common debriefing strategies (plus/delta, focused facilitation, and directive feedback) in a modified format, with new debriefing scripts. Promoting Excellence And Reflective Learning in Simulation for System Integration offers a structured framework, adaptable for debriefing systems-focused simulations, to identify systems issues and maximize improvements in patient safety and quality.

Original languageEnglish (US)
Pages (from-to)333-342
Number of pages10
JournalSimulation in Healthcare
Issue number5
StatePublished - Oct 1 2019


  • Debriefing
  • patient safety
  • systems integration
  • systems-focused debriefing
  • systems-focused simulation

ASJC Scopus subject areas

  • Epidemiology
  • Medicine (miscellaneous)
  • Education
  • Modeling and Simulation


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