Duckworth on Education: How to Debrief for Real-World Learning

We all like to say that people learn from experience. But in EMS, we’ve all met those who pass through experience without learning much at all. What turns experience into real learning isn’t repetition or exposure—it’s reflection. And reflection doesn’t just happen; it has to be guided. That’s where your skill and an effective debriefing tool comes in.

I’ve used many debriefing tools over the years, but I’ve settled on a modified model that I now apply every day to help my clinicians learn from education scenarios and real-world calls alike. It began with the classic plus/delta model and evolved into something more practical and effective: Five steps—Fair, Plus, Delta, Takeaways, and Apply. It’s structured enough to focus learning, yet flexible enough to adapt to nearly any setting where performance and reflection meet.

(Editor’s note: For readers new to the Plus/Delta framework, see the author’s earlier EMS World article, “The Plus/Delta Feedback Tool.”)

Fair: Begin With Emotional Readiness

If a scenario or incident feels unfair or unwinnable, learning won’t happen. When learners or clinicians are angry, embarrassed, or frustrated, they’re focused on defending their performance, not reflecting on it. That’s why I always start with Fair.

In a student scenario, I might ask, “Did that feel fair?” Sometimes they say yes, and we move forward. Other times, the room bursts open with pent-up frustration. “The patient was impossible,” or “The evaluator tricked us.” That’s fine. Let them air it out. If something truly was unfair, I acknowledge it. If it just felt unfair, we talk about what made it feel that way. Either way, emotions settle, and the group becomes ready to learn.

After difficult real calls, this step matters even more. A crew that feels judged or blamed won’t reflect effectively. I might start with, “Before we talk about the case, how’s everyone feeling about it?” Sometimes that simple question defuses tension faster than any clinical summary could. Fair sets the stage for honesty, curiosity, and safety, the foundation of psychological readiness to learn.

Plus: Highlight What Should Be Repeated

Once they’re ready, I move to Plus—what went well enough that we want others to do it that way every time. This isn’t false praise; it’s targeted reinforcement. Learners often overlook their own good work and over-emphasize mistakes, either their own or others’. Drawing attention to what worked reinforces the behaviors we want repeated.

In a simulation, I might say, “Let’s start with what you’d want every crew to do if they faced the same situation.” Someone might mention clear team communication, or rapid rhythm recognition, or a calm leader who delegated tasks well. Naming these successes turns them from lucky moments into teachable habits.

In field debriefs, the same approach helps crews see their strengths under stress. “You recognized the peri-arrest rhythm change early,” I might point out. “That’s the kind of awareness that saves time and lives.” Focusing on Plus builds confidence—and confidence builds competence.

Delta: Identify What Must Change

The Delta step—named for the Greek symbol for change—is where improvement begins. It’s about identifying what needs to change going forward, not about blame or fault-finding. Many learners are conditioned to expect criticism during debriefs, so I frame this intentionally: “What do we need to change next time?” never “What went wrong?"

In one trauma scenario, a team failed to recognize a tension pneumothorax. Instead of asking, “Why did you miss that?” I might say, “What might help you recognize that earlier next time?” That phrasing shifts attention from self-defense to problem-solving.

In a real incident, perhaps a medication delay occurred because of unclear role assignments. During debrief, I’d guide the crew toward identifying that delta. “How can we make roles clearer next time?” This way, the focus stays on change, not blame. The Delta step turns mistakes into momentum.

Takeaways: Solidify the Learning

Even a good debrief can fade if learners don’t consciously capture key points. Takeaways help lock in lessons. I often ask, “What’s your biggest takeaway?” and let each person answer briefly. Some repeat the same points I emphasized; others surface insights I didn’t expect. Sometimes, I have to correct a focus on something incorrect. This is how you can polish the lesson, so it really shines. This step reveals what truly stuck.

In one airway scenario, a student said, “I learned that speaking up sooner might have changed the outcome.” That single reflection told me more about her growth than any checklist ever could.

Apply: Make It Real

Reflection is only valuable if it changes what happens next. That’s why the final step, Apply, brings learning back into the real world. If possible, I have students immediately re-run the scenario with their new insights or pivot to a different scenario where the same lessons may be applied. If not, I end with a practical challenge: “When will you get to apply this next? What will you do differently?”

For working EMS crews, I might end a debrief by saying, “How can you use that same communication tool with your next cardiac arrest?” Application closes the loop between theory and performance. It’s how learning becomes behavior and behavior becomes culture.

Why This Works

This modified model expands the familiar plus/delta by addressing the human side of learning. Fair and Take-aways acknowledge the emotional and cognitive processes that underlie real reflection. Apply ensures learning doesn’t stay theoretical. Together, these steps make debriefing a reliable structure for growth, whether you’re teaching in a classroom, precepting on an ambulance, or reviewing a complex field response.

I use this tool nearly every day—after simulations, field calls, even casual peer reviews. It works because it’s repeatable and human. It respects the people doing the work while still demanding improvement. Over time, consistent use builds a learning culture that’s both resilient and reflective.

Put It Into Practice

• Start every debrief with safety. Emotional readiness isn’t optional. Acknowledge fairness and feelings before diving into performance.
• Reinforce what should be repeated. “Plus” isn’t about praise—it’s about identifying replicable excellence.
• Keep “Delta” forward-looking. Focus on change, not blame.
• End with intentional reflection. Have each learner name their biggest takeaway.
• Close the loop. Ensure learners know how and when they’ll apply what they’ve learned next.

When educators model this approach consistently, they do more than debrief—they cultivate the mindset of continuous improvement. And that, in EMS, is how we turn experience into real-world expertise that makes a difference for our patients.