Managing psychological safety in debriefings: a dynamic balancing act

Abstract

Debriefings should promote reflection and help learners make sense of events. Threats to psychological safety can undermine reflective learning conversations and may inhibit transfer of key lessons from simulated cases to the general patient care context. Therefore, effective debriefings require high degrees of psychological safety—the perception that it is safe to take interpersonal risks and that one will not be embarrassed, rejected or otherwise punished for speaking their mind, not knowing or asking questions. The role of introductions, learning contracts and prebriefing in establishing psychological safety is well described in the literature. How to maintain psychological safety, while also being able to identify and restore psychological safety during debriefings, is less well understood. This review has several aims. First, we provide a detailed definition of psychological safety and justify its importance for debriefings. Second, we recommend specific strategies debriefers can use throughout the debriefing to build and maintain psychological safety. We base these recommendations on a literature review and on our own experiences as simulation educators. Third, we examine how debriefers might actively address perceived breaches to restore psychological safety. Re-establishing psychological safety after temporary threats or breaches can seem particularly daunting. To demystify this process, we invoke the metaphor of a ‘safe container’ for learning; a space where learners can feel secure enough to work at the edge of expertise without threat of humiliation. We conclude with a discussion of limitations and implications, particularly with respect to faculty development.

Psychological safety in feedback: What does it look like and how can educators work with learners to foster it?

“…Our findings overall reinforce previous research across the fields of higher education, health professions education and communication, which have reported that learning behaviours are fostered by trust, respect, empathy, seeking to understand the learners’ perspective and an attitude that accepts mistakes as inevitable during learning 29,32,50 . In simulation‐based education, a set of ‘promising practices’ have been proposed for creating a safe context for learning, derived from a literature review and the team's expertise 39,40 . These included clarifying expectations; attending to logistical details; showing respect and curiosity regarding participants’ perspectives; understanding that mistakes occur in challenging learning environments, focusing on assisting learners to enhance their skills and maintaining positive regard for them.…”

“…This is important for learning outcomes as excessive anxiety distracts attention, interferes with complex thinking and impairs memory 7‐34,59 . This theme aligns closely with guidelines for simulation‐based education and doctor‐patient communication skills, which outline the importance of setting the tone for a collaborative partnership from the start 35‐58 …”

“…We then looked for corresponding educator behaviours that seemed to promote this form of engagement. We also looked for educator behaviours previously proposed to promote psychological safety in clinical and simulation‐based conversations 34,39,40,50 …”

“…The effect of psychological safety on learning and performance has been demonstrated in other areas of health care 35‐38 . In simulation‐based education, the importance of psychological safety is particularly emphasised; it is explicitly labelled as a goal at the outset and both educators and learners commit to ground rules that ‘realise it’ in practice 39‐41 . In the area of doctor‐patient communication, psychological safety promotes greater patient involvement and free flow of information between doctor and patient, which results in more accurate assessments, shared decision making, resolution of uncertainties, implementation of plans and improved clinical outcomes 42…”

Talking the talk in junior interprofessional education: Is healthcare terminology a barrier or facilitator?

“…Elective simulation opportunities were recognized as unique spaces where students can learn terminology with more opportunity than workplace settings to clarify ambiguous or novel terms, and with less perceived identity and social risk. Other studies have also commented on the ability of simulation to provide a psychologically safe learning environment [26][27][28][29].…”