Psychological safety... P.S. it'll be OK! Understanding senior medical students' experiences of psychological safety (PS) in simulation

Abstract

Simulation is a teaching technique which mimics real-life situations to enable learners to experience the thoughts and emotions of treating patients, without patients present. The simulated clinical cases allow learners to practice managing situations when a delay in treatment or mismanagement may cause harm. By enabling the learning to happen away from real patients, it was commonly thought that learners feel more able to make mistakes. However, some learners fear being observed and worry they may expose a lack of knowledge or skills and lose credibility in front of their peers. Conversely, this anxiety may make learners unable to speak up or be fully engaged, and reduce their willingness to be stretched. Medical students are not yet doctors and lack knowledge and experience in clinical environments. Furthermore, they have rarely been taught using simulation before, which can exacerbate concerns about judgement or scrutiny of their performance. Psychological safety is an abstract concept researched in the context of simulation and embedded in guides on how to design and deliver this form of teaching (Motola et al., 2013). Promoting psychological safety can help learners feel free from judgement and view mistakes as learning opportunities without concern for how they are viewed by others (Kahn, 1990). The aim of this research was to understand: (i) how medical students experience simulation; (ii) how they describe psychological safety; (iii) what factors are weighed up by students when sensing the degree of psychological safety, and what teachers can do to help students feel more psychologically safe. I conducted 20 interviews with final-year medical students, which included learners from under-represented groups such as international students, mature students and those who identified as having a disability. I shared my early results from all the medical student interviews with simulation facilitators during focus groups. I asked the facilitators to reflect on psychological safety during simulation with medical students and asked them to comment on my initial findings. This study was approved by the Medical Education Research Ethics Committee at the University of Edinburgh as being ethical