Taking simulation out of its “safe container”—exploring the bidirectional impacts of psychological safety and simulation in an emergency department

Abstract

Background Simulation facilitators strive to ensure the psychological safety of participants during simulation events; however, we have limited understanding of how antecedent levels of psychological safety impact the simulation experience or how the simulation experience impacts real-world psychological safety. Methods We explored the experience of participants in an embedded, interprofessional simulation program at a large tertiary emergency department (ED) in Australia. We engaged in theoretical thematic analysis of sequential narrative surveys and semi-structured interviews using a previously derived framework of enablers of psychological safety in healthcare. We sought to understand (1) how real-world psychological safety impacts the simulation experience and (2) how the simulation experience influences real-world psychological safety. Results We received 74 narrative responses and conducted 19 interviews. Simulation experience was both influenced by and impacted psychological safety experienced at the individual, team, and organizational levels of ED practice. Most strikingly, simulation seemed to be an incubator of team familiarity with direct impact on real-world practice. We present a model of the bidirectional impact of psychological safety and simulation within healthcare environments. Conclusion Our model represents both opportunity and risk for facilitators and organizations engaging in simulation. It should inform objectives, design, delivery, debriefing, and faculty development and firmly support the situation of simulation programs within the broader cultural ethos and goals of the departments and organizations.

PRE-scripted debriefing for Paediatric simulation Associated with Resuscitation EDucation (PREPARED): A multicentre, cluster randomised controlled trial

“…Given the increasing demand for these courses internationally, faculty are often inexperienced in debriefing with consequent risk of heterogeneity of learning outcomes or even psychological harm. 24. , 25.…”

“…The approach to debriefing should include establishing rapport and using a frank but non-threatening discussion of events, to ensure psychological safety of participants. 24 Psychological safety is the shared belief held by members of a team that the team is safe for interpersonal risk taking, which aims to empower individuals to perform during a simulation and engage in the debrief. 25 It is important for learners to be prompted to self-reflect on the simulation events, which should be conducted systematically.…”

Wearing hats and blending boundaries: harmonising professional identities for clinician simulation educators

“…This 'leak' of the clinician identity into the simulation space is not a new concept. Our research [64] team has previously demonstrated that participants' clinical roles and prior team interactions 'leak' into the simulation space, impacting the way that they engage with simulation. WD's reflection shows that this is also true for facilitators.…”

The many spaces of psychological safety in health professions education

“…Recent work has highlighted the porous nature of the 'safe container' in simulation and the bidirectional impact of PS (or lack thereof) between simulation and clinical settings. 9 Whereas simulation educators typically have the skills, motivation and time to manage PS, clinical workplaces usually focus far less on supporting PS. As an example, bullying, which includes belittling and harsh criticism, has been shown to impact nearly half of all post-graduate medical trainees in the United States.…”

“…Educators continue to debate what a ‘safe container’ means in challenging simulation activities and post‐simulation debriefings. Recent work has highlighted the porous nature of the ‘safe container’ in simulation and the bidirectional impact of PS (or lack thereof) between simulation and clinical settings 9 . Whereas simulation educators typically have the skills, motivation and time to manage PS, clinical workplaces usually focus far less on supporting PS.…”