Table 1.

Work environment barriers and enablers to CD, based on by Burke and Hutchins’ evaluation model [26] with subthemes shown in italics and example quotes

Themes	Subthemes
	Barriers	Enablers
Transfer climate ‘The overall workplace conditions that either encourage or inhibit the application of CD’	Culture
	“There's not necessarily a culture of debriefing; it's not something that we talk about at huddles” (P4)	“…the more people that are doing it, I think culture grows culture” (P8)
	Protected time and space
	“The main barrier is probably time and also an appropriate location” (P2)	“...there's nowhere that doesn't have a doctor's room or some sort of space” (P8)
	Debriefing tools
	“I find them difficult because I feel like I don't have a structure” (P1)	“Definitely having a tool is really helpful because it doesn't make it this ambiguous, scary thing” (P2)
Supervisor & peer support ‘The support registrars receive to use their new skills and knowledge’	Role-modelling
	“I've never really had a lot of experience of people debriefing with me when I was junior” (P9)	“I think the resus officers are quite helpful…because they're another team lead, they're quite supportive” (P5)
	Meta-debriefing
	“How do we debrief the med regs themselves? Because I think if we've been debriefing everybody else, it's sometimes really difficult to know who we can speak to about events that have been quite tricky” (P8)	“If you think of a debriefing as like a real team event, then I guess you are debriefing yourself” (P11)
Accountability ‘The degree to which the organisation expects registrars to use trained knowledge on the job and holds them responsible for doing so’	Debriefing training
	“Not everyone gets education and training about debriefing and how to do it or facilitate it and then they don’t know the importance of debriefing” (P3)	“I now have had some teaching in it, and I kind of know roughly what I'm doing with it and can put it into practice” (P11)
	Personal responsibility
	[when reflecting on missed debriefing opportunities] “People said to me, this must be the only job that you go and see an emergency or see someone die and then just get back to work. And I remember being like, ‘yeah, it is.’” (P10)	“You don't want to be the person not doing the thing that everybody else is doing. So yeah, I guess there is a personal responsibility as well” (P11)
Opportunity to perform ‘Whether registrars are provided with opportunities to use new learning in their work setting’	Debriefing purpose
	“Most of debriefings I’ve been in are because things have gone badly and it has been to check how everyone is feeling afterwards” (P5)	“Having to think about the purpose of debriefing has made me feel a bit more confident about doing it” (P11)
	Immediate vs delayed
	“I think events are fresh in your mind and the right people are there. Whenever you try and do something later on, inevitably people can't make it.” (P11)	“A cold [delayed] debrief allows you to take some of that emotion out of it and analyse it and go through it in much more of a structured way” (P12)
	Prompted vs routine
	“Normally, if it was a bad situation - if something went really well, normally that wouldn't trigger thinking about debriefing” (P4)	“But I guess if it is commonplace, and people know that this is not that specific case, and everyone's doing it in a very objective way, then that might actually make things better” (P9)
	Ad hoc vs stable team
	“You have different nurses almost every night, and you have people that are covering random clinical areas that you never see again. I think it [debriefing] is a challenge the less often you see a team” (P8)	“[when you work in an ad hoc team] you feel more comfortable sharing opinions in a more sort of anonymised setting” (P14)
Strategic link ‘The organisation’s goals and strategies’	Curricular alignment
	“We don’t really talk about it in specialty teaching” (P5)	“I think if it's something you had to get signed off, or some kind of education about for your portfolio, that would be quite helpful for everyone” (P13)
	Organisational standards
	“I think we can easily slip into service mode, being more of a service provision and just task oriented” (P3)	“Adding it to an arrest trolley or one of the forms for arrests, might help to encourage people to do it” (P12)