1 Safe Spaces for Learning: Taking Psych Safety Beyond the Sim Lab

By: Dr. Eve Purdy

During my simulation fellowship I learned to pay particular attention to the development of psychological safety during simulation activities. The concept gets lot of airtime and effort in the sim community but, as an anthropologist interested in fostering positive learning and work cultures, I venture it can and should be a focus for educators at our institution more broadly. Let’s take psychological safety beyond the sim lab!

As Amy Edmonson describes it, psychological safety is “a shared belief that’s its ok to take interpersonal risk” in a group/ workplace/ learning environment, and is a strong influence on the performance of work teams. Ideally, it can accelerate learning – allowing us to push boundaries, fail, and extend ourselves. But psych safety is not just ‘being nice’, offering appreciation, or ignoring poor performance. Courtesy and candour can co-exist.

Creating a ‘safe container’ for learning has received a lot of attention in healthcare simulation due to the evaluation apprehension that many simulation participants feel, as well as memories of experiences that were negative in some way. Psychological safety, however, is not uniquely important in the simulation learning environment – it is relevant in the clinical environment, the classroom, and perhaps most urgently our new online learning world.

So, what does psychological safety look like? It looks like a student not thinking twice about putting their hand up to contribute or ask a question, an active chatter on a zoom lecture with students bouncing ideas off each other, a nurse questioning a consultant’s decision on rounds, or a senior resident asking for feedback and a staff being direct about what could have gone better. It looks like trust. Trust that everyone is on the same team, trust that we all want to improve, and trust that we can do that together.

Psychological safety is created slowly, consistently and by actions as much as words. So what are some tips for creating psychological safety across learning environments (your online class, your facilitated small group, your ward team, your high-performing group)….

• Set crystal clear expectations (they can be high!) for what the learning session or day is going to look like (preparation, timing, expected contributions) then stick to those expectations
• Get everyone talking – consider asking simple, but relevant, questions to get your team chatting. For example, when starting ward rounds if you notice that a new patient is admitted with heart failure before you start for the day you could ask your team, “I noticed one of our new patients has heart failure, before we get cracking I’m curious – what do you think we do really well in caring for patients with heart failure?”
• Learn names, and use them. This may mean frequently introducing and learning about new members of your group or team since we are often working in fairly transient learning environments.
• Practice deliberate positive regard by identifying specific actions that are done well and the positive impact of those actions on you then expressing both to your learners or colleagues.
• Remember “Safe, Not Soft” is the sweet spot we are aiming for. This isn’t about being nice, it is about setting up a space where we can all take risks and learn from taking those risks.
• Normalize performance conversations – commit to considering two simple questions frequently and ideally together (i.e. after reviewing a patient, after rounds, at the end of a day, at the end of a small group session)…1. What are we proud of/what went well AND 2. What could have gone just 1% better.

These ideas are simple but they do require deliberate effort to operationalize, because our environments and culture aren’t always set up to make them easy. A commitment to considering psychological safety in every learning event and interaction will slowly but surely create a culture and commitment of learning to be better, together.

Photo by Benjamin Davies on Unsplash