Effect of Simulation Case Complexity on Engagement During Distance Debriefing - A Randomized Controlled Trial

•The aim of this study was to explore whether the complexity of a simulation scenario affects teaching, social, and cognitive presence in distance debriefing engagement and if there is a correlation between teacher, social, and cognitive presence with the psychological safety of the learning environment and the mental demand on learners.•The role of the debriefer proved to be a major factor in the engagement of learners in the distance setting, with strong teaching presence reducing participants’ mental load, contributing to their increased engagement.•The study findings provide considerations that may aid the development of new standards specific to distance simulation to better serve learner engagement in distance debriefing. Learner engagement in distance debriefing introduces challenges for educators. The influence of complexity in a simulation scenario on debriefing engagement is unclear. This study aimed to investigate the connection between scenario complexity and educator, social, and cognitive presence during distance debriefing, and the relationships with psychological safety and mental workload. We investigated the influence of a more complex versus less complex simulation case on debriefing engagement of healthcare professionals using a latent regression Rasch model. There was no statistical significance found in debriefing engagement of the 30 participants in the intervention (M = 109.66, SD = 16.17) versus 30 participating in the control (M = 112.42, SD = 15.30). No statistically significant difference between the intervention and control groups in team psychological safety (M = 15.00; SD = 2.07 and M = 14.52 and SD = 1.73) or in mental workload (M = 72.28; SD = 19.52 and M= 73.13; SD = 19). Our findings indicate that having an experienced and skilled debriefer who can establish high levels of psychological safety can create an engaging debriefing conversation regardless of the simulation. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.