Psychological Safety in Simulation

The lineage matters because it explains what the term does and does not mean. Edmondson studied work teams in a manufacturing company and found that team psychological safety was associated with learning behavior, and that learning behavior mediated between psychological safety and team performance. The learning behaviors she described are recognizable to anyone who has run a debrief: reflecting on action, seeking feedback, speaking up about what you think, asking for help, and testing ideas that might turn out to be wrong. Simulation borrowed the construct because those are exactly the behaviors a debrief depends on.

Jenny Rudolph, Daniel Raemer, and Robert Simon carried it into healthcare simulation with the idea of a safe container, an environment where learners face professionally meaningful challenges and are held to high standards in a way that engages them without intimidating or humiliating them. Their point is that safety and rigor are not opposites. A debrief can be direct about a missed diagnosis and still be psychologically safe, and the reason to build the container is precisely so that faculty can be honest about performance without triggering the defensive behaviors that shut a conversation down.

They name four practices, and all four belong to the presimulation briefing rather than the debrief. Clarify expectations, covering objectives, environment, roles, and confidentiality. Establish a fiction contract, the mutual agreement that everyone will engage with an imperfect simulation as if it were real. Attend to logistic details, which sounds minor until a learner spends the scenario hunting for equipment. Declare and enact a commitment to respecting learners and to caring about their psychological safety, and the enacting half is the one that gets skipped, since learners read the gap between what faculty say and what faculty do.

The Healthcare Simulation Dictionary defines it for simulation as a feeling, explicit or implicit, that participants are comfortable participating, speaking up, sharing thoughts, and asking for help without concern for retribution or embarrassment. The INACSL debriefing standard requires that the process maintain psychological safety and confidentiality, which makes it an accreditation-relevant condition and not a soft preference. It is also fragile in the way hierarchy makes things fragile. A resident who suspects the debrief will surface in an evaluation letter will manage what they say, and no amount of stated commitment fixes that if the program actually does it.