The Psychological safety of the participants is vital for maximum engagement and learning in medical simulation. Although research is limited on the components that increase the likelihood that a participant feels safe, there is at least general agreement among simulation experts on practices that facilitators can employ to support the creation and maintenance of psychological safety. This article reviews the components and practices that contribute to psychological safety in medical simulation. One such critical element is confidentiality regarding the performance of individual learners outside of the simulation exercise. The practice of establishing a confidentiality agreement helps to build trust between participants and with the facilitator. This shared agreement among participants and the facilitator is one of the methods that help establish and maintain a psychologically safe environment for risk-taking. When the participant feels psychologically safe, they are more likely to adopt behaviors that enhance learning, such as willingness to practice at the edge of their abilities, sharing their thought process, and discussing and learning from mistakes. In this article, we are also going to discuss, how to identify the breaches in psychological safety and strategies to establish a safe environment during debriefing.
What is psychological safety, and why is it important?
Psychological safety is a shared belief held by members of a team that the team is safe for interpersonal risk-taking.[1][2] Medical simulation, particularly immersive simulation and debriefings, are risk-taking processes of learning.[2] It is common and often desirable for participants to practice at the edge of their abilities and to take risks to maximize learning. In these circumstances, mistakes can occur. Psychological safety is essential for participants to feel safe enough to practice at the edge of their abilities and to analyze mistakes to identify and mitigate learning gaps. Even when participants in medical simulation meet a high standard of performance, psychological safety is still relevant in their ability to discuss clinical reasoning in the face of uncertainty and within the hierarchy of medical training.[3] When learners feel psychologically safe and are not worried about being humiliated or shamed, they are more likely to adopt behaviors that enhance learning (learning behaviors), such as seeking feedback, talking about errors, and experimenting.[2]
The following are components and practices that have the potential to increase the likelihood of establishing and maintaining psychological safety in medical simulation:
Strategies to improve psychological safety: Rudolph et al proposed some explicit and implicit strategies to establish and improve psychological safety during debriefing
Identifying breaches in psychological safety
Facilitators in medical simulation who use practices such as confidentiality agreements, fiction contracts, understanding the learner's perspective, and being clear about objectives will be more likely to have safe learning environments and therefore improved learning. Improved learning and skills lead to improved patient care. It has also been shown that psychological safety in clinical teams increases the likelihood that members of the group speak up when they witness errors or quality issues. This willingness to speak up can avert errors before they cause harm to patients. The desire to speak up also improves safety reporting and can improve patient care through quality improvement.[10]
Psychological safety is essential in the function of interprofessional teams in medical simulation and the clinical setting. Interprofessional teams that are psychologically safe have improved communication.[11][12] Psychological safety also increases the chance members of a team speak up or report and issue when they see errors or quality improvement opportunities.[13] Both improved communication within health care teams and reporting quality issues within our healthcare systems are imperative in improving the quality of care we deliver to patients. Facilitators and leaders that foster psychological safety in medical simulation and clinical practice are involved with culture change that can improve patient care across an organization.
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