The Leaky Educational Container

By Eve Purdy (@purdy_eve)

Creating and maintaining psychological safety [1] has been a focus for simulation educators but seems to be less of an area of attention in other educational settings. The threats to psychological safety may be more obvious in simulation but the ability to take interpersonal risks is important in other learning environments too: think of the learner weighing up contributing during a case-based group session or the participant considering challenging a facilitator about the answer to a multiple-choice question. In each of these situations, individuals need to take a risk to fully participate in the learning. The good news is there are specific ways for educators to foster psychological safety to maximize learning. However, education events do not exist in a vacuum, and we know that psychological safety leaks both into and out of these spaces (Figure 1 – adapted from [2]). This reality presents both risk and reward to educators of all kinds. The leaks in to and out of educational events are particularly relevant for those involved in post-graduate medical education where the boundaries between work and learning are blurred. In this post we will consider how principles related to psychological safety from simulation can apply to other group learning sessions.

Creating a Safe Container

The seminal article “Establishing a Safe Container for Learning in Simulation” is a must-read for any educator, not only those involved in delivering simulation. Jenny Rudolph highlights key principles to creating an environment in which participants can take interpersonal risks and as such maximize learning for themselves and the group. A focused pre-briefing, often overlooked outside of simulation settings, is an efficient way to set-up psychological safety for the rest of the session. It can easily be applied to any other group learning setting and might look like:

• Introductions: a quick around the room where people have the chance to learn names. I usually ask a simple question that is related to the session content (i.e., “what do we do well in caring for patients with arrythmias”). This is an important step because we know once participants have spoken once, the threshold to do so again is much lower. It also signals inclusiveness from you as the leader. It also demonstrates the facilitator’s genuine interest in the participants’ experiences and supplies valuable insight into the experience and orientation of the group. This is also a time to clearly convey commitment and respect to learners and their perspective.
• Clarifying expectations: After introductions the facilitator can briefly introduce the purpose and structure of the session. It is an opportunity to address whether the session has evaluative components or not. It is an important time to let participants know what is expected in terms of participation. The advantage is that when expectations are clear they can also be high!
• Attending to logistic details: People feel much safer when they understand what is coming.  Make the structure of the session clear, when breaks will be, and when it will end. Seemingly simple but important.

Usually, this pre-briefing takes about 10 minutes which may feel like a long time…but even for an hour-long session I find that it is critical to ensuring the best experience for all in attendance and makes my job as the facilitator much easier!

Minding the Leaks In

Since learning events rarely occur in isolation, participants’ prior experiences in education and work impact how psychologically safe they feel (or don’t!) during a given session. This highlights the importance of considering, and mitigating or capitalizing on, those realities. Educators can ask a couple of simple questions:

• How do the participants relate with each other?Power gradients and prior experiences/team dynamics within a group will have direct impact on how the session unfolds. For the specific learning objectives do you have the right makeup of people attending? 
• How do I relate to the participants?As a facilitator your prior experiences with participants will impact their psychological safety. Are you the right person to be running a particular session? The importance of the pre-existing relationship places additional pressure on educators to be congruent in their affect across educational and workplace settings.
• Are there any important organizational culture considerations?We cannot expect participants who work in non-psychologically safe environments to enter an educational session and magically feel empowered. Extra effort by facilitators may mitigate some of these pre-existing realities but we also need to be honest about how educational events fit into the greater ethos of a department. This contextual knowledge should shape your approach.

Shaping the Leaks Out

Psychological safety also leaks out of educational spaces. This means that education can be an important vehicle for shaping workplace culture. Since education events are moments of cultural compression (a time when the values of a group weigh down with intensity), the degree of psychological safety fostered or compromised within a session has implications well beyond that space. This “leak out” puts additional pressure on facilitators. It is a source of significant risk but also offers potential reward. It means that our ability to foster psychological safety impacts how participants feel about themselves, their work, and their colleagues once they leave. Awareness of this leak out should result in a strong sense of urgency to be deliberate in efforts to foster psychological safety in educational events of all kinds – big or small! Some of the ways educators can try to shape the leak out include:

• Making familiarity an objective: One of the most significant contributors to workplace psychological safety is familiarity within the team. We should be deliberately designing educational events to foster familiarity between team members.
• Sign-posting the approach to fostering psychological safety: Giving people tools to foster psychological safety in their own workplaces can be helpful. For example, during the introductions part of the pre-briefing you might say “one of the reasons we do introductions is because we don’t always know everyone we are working with on the floor but we do know familiarity with our team members is one of the most important things we can do to better care for patients.”
• Signaling that the learning should leave the room and be ongoing: At the end of the session, facilitators can mirror the around the room from the pre-briefing and ask participants to share one thing they will take back to work. This is a reminder that the facilitator respects the participation and a signal that the learning can go beyond these walls.

So…how leaky is your educational container?

References:

1. Edmondson A. Psychological safety and learning behavior in work teams. Adm Sci Q. 1999;44(2):350–83.

2. Purdy, E., Borchert, L., El-Bitar, A. et al. Taking simulation out of its “safe container”—exploring the bidirectional impacts of psychological safety and simulation in an emergency department. Adv Simul. 2022. 5;7(1):5.

3. Rudolph JW, Raemer DB, Simon R. Establishing a safe container for learning in simulation: the role of the presimulation briefing. Simul Healthc. 2014;9(6):339–49.

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