Navigating Equity, Diversity and Inclusion in Simulation-Based Education Debriefs: A Qualitative Study of Educators’ Lived Experience

Background: Equity, diversity and inclusion (EDI) themes arise in healthcare simulation, surfacing in debriefs regardless of design. National standards require simulation faculty to embed EDI principles into practice, yet how educators are prepared to facilitate it remains unclear. Although some faculty-facing resources exist, little is known about how educators experience facilitating these themes in the moment. To our knowledge, this is the first UK study exploring simulation educators’ experience of navigating spontaneous EDI-themed debriefs. This will inform how they might be better supported through faculty development. Methods: This study originated as a service evaluation at a large London NHS Trust, serving a diverse patient population and workforce. All eligible simulation educators trained in human factors skills and experienced in facilitating debriefs participated (n = 11). Semi-structured interviews explored their experiences of debriefing unplanned EDI themes, and the support required to enhance their practice. Data were analysed using Braun and Clarke’s reflexive thematic analysis with a constructionist framework and insider positionality. Coding and theme development were reviewed and reflexively challenged by an EDI subject-matter expert external to the simulation faculty. Results: Five themes were developed. Educators described fears around causing harm or losing credibility, which prompted a tendency to retreat from EDI themes. Facilitation drew heavily on their emotions and values, creating tension between their professional and personal selves. Their identities shaped their practice, offering confidence to some and doubt to others, though what mattered most was their examined awareness of their positionality. Participants perceived a theory-practice gap between how EDI was presented and enacted. They safeguarded learners’ psychological safety while giving little consideration to their own, and described an absence of support in developing this work. Conclusion: Facilitating EDI-themed debriefs asks more from educators than general debriefing. It occurs regardless of how experienced they are and reflects a gap that current faculty training does not address. As simulation faculty are expected to embed EDI principles into practice, understanding why intentional preparation matters is vital.