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

Abstract

Context Feedback conversations play a central role in health professions workplace learning. However, learners face a dilemma: if they engage in productive learning behaviours (such as asking questions, raising difficulties, offering opinions or contesting ideas), they risk exposing their limitations or offending the educator. This highlights the importance of psychological safety in encouraging learners to candidly engage in interactive dialogue and the co‐construction of knowledge. Previous research has recommended that building safety, trust or an educational alliance is key to productive feedback encounters. Yet it is unclear how to translate this into practice. Hence our research question was: What does psychological safety look like in workplace feedback and how can educators work with learners to foster it? Methods We analysed 36 videos of routine formal feedback episodes in clinical practice involving diverse health professionals. A psychologically safe learning environment was inferred when learners progressively disclosed information and engaged in productive learning behaviours during the conversation. We used thematic analysis to identify associated educator strategies, which seemed to promote psychological safety. Results Four themes were identified: (a) setting the scene for dialogue and candour; (b) educator as ally; (c) a continuing improvement orientation, and (d) encouraging interactive dialogue. Educators approaches captured within these themes, seemed to foster a psychologically safe environment by conveying a focus on learning, and demonstrating respect and support to learners. Conclusions This study builds on claims regarding the importance of psychological safety in feedback by clarifying what psychological safety in workplace feedback conversations might look like and identifying associated educator approaches. The results may offer educators practical ways they could work with learners to encourage candid dialogue focused on improving performance.

Development of the Feedback Quality Instrument: a guide for health professional educators in fostering learner-centred discussions

“…Stage 2 - Quantitative and qualitative analyses of video data to refine the provisional instrument: Psychometric testing of the item ratings data was conducted using Multifaceted Rasch Model (MFRM) analysis and exploratory factor analysis (EFA). Qualitative analyses of the video transcripts, reported in detail elsewhere, investigated two important but under-researched aspects of feedback, evaluative judgement [ 36 ] and psychological safety [ 37 ]. In particular, additional items were created for one instrument domain, foster psychological safety , as it was considered to be inadequately characterised following EFA analysis and a review of the latest literature did not reveal the practical information required.…”

“…Qualitative analyses were conducted using thematic analysis of the video transcripts focusing on two particular aspects of feedback: psychological safety [ 37 ] and evaluative judgement, [ 36 ] described in previous publications. There is increasing interest concerning these important aspirations in quality feedback in the feedback literature but we found little practical guidance on how educators can collaborate with learners to promote them.…”

“…These traits could be summed up as 'having someone's best interests at heart' and are embodied by collaboration. Based on principles identified in the literature and our own qualitative research study [37], FQI items depict ways educators can work with learners to nurture psychological safety; key themes include collaboration, respect, support and reducing the power gap [37,47,51,52]. An educator can promote the partnership by creating sustained opportunities for a learner to share their thoughts regarding learning activities (e.g.…”

The problem with feedback

“…Such dilemmas again emphasise the need for notions of feedback which extend beyond transmission of factual information to acknowledge its social dimension (Nicol and Macfarlane-Dick, 2006). Although the role of both positive and negative emotions in changing practice, at individual and system level, has not yet been sufficiently explored (Carrieri et al, 2020), it has been noted that feelings of psychological safety are required for learners to be productively involved in learning from feedback (Johnson, Keating and Molloy, 2020).…”

“…Central to this relationship are learners' beliefs about their educators regarding: a mutual understanding of the purpose of the educational relationship, an agreement about how this purpose might be jointly achieved, and mutual feelings of 'liking, trusting and valuing' the other (Telio, Ajjawi and Regehr, 2015). Molloy and colleagues (Molloy, 2010;Boud and Molloy, 2013;Johnson, Keating and Molloy, 2020) have similarly emphasised the importance of positive social relationships to ensuring that feedback encounters are productive. Ideally, educators will be viewed as trusted 'allies', with the building of psychologically safe spaces to reduce potential 'threats' so that all parties might engage in open, multidirectional dialogue.…”