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A key portion of medical simulation is self-reflection and instruction during a debriefing session; however, there have been surprisingly few direct comparisons of various approaches. The objective of this study was to compare two styles of managing a simulation session: postsimulation debriefing versus in-simulation debriefing.One hundred sixty-one students were randomly assigned to receive either postsimulation debriefing or in-simulation debriefing. Retrospective pre-post assessment was made through survey using Likert-scale questions assessing students' self-reported confidence and knowledge level as it relates to medical resuscitation and statements related to the simulation itself.There were statistically significant differences in the reliable self-reported results between the two groups for effectiveness of the debriefing style, debriefing leading to effective learning, and the debriefing helping them to understand the correct and incorrect actions, with the group that received postsimulation debriefing ranking all these measures higher. Both groups showed significantly higher posttest scores compared with their pretest scores for individual and overall measures.Students felt that a simulation experience followed by a debriefing session helped them learn more effectively, better understand the correct and incorrect actions, and was overall more effective compared with debriefing that occurred in-simulation. Students did not feel that interruptions during a simulation significantly altered the realism of the simulation.