8 - The Safe Container for Simulation

In this episode we discuss psychological safety in simulation. Harvard professor Jenny Rudolph, PhD joined us for the discussion, taking time out form her busy schedule as the Director of the Center for Medical Simulation in Boston.

We considered this all too familiar case study……

You’re facilitating a sim session in your ED. The junior docs and the nurses arrive, a few straggle in late. You do a nice RTR (Round the room) but everyone seems a bit anxious and they are shifting in their seats. You really want them to relax.

“You shouldn’t be anxious guys, this is what you do every day”.

They look more worried.

“I mean these will be sick patients, but this is the place to stuff up, rather than with a real patient”.

One of the docs looks like he might vomit.

“and remember what happens here, stays here, no you tube videos from what we are recording” - as you attempt to lighten the mood. “Its not like this is a test, we really just want to make sure you’re ok to be on nights on your own……”

“so relax….”

Two of the participants dash off for a toilet break before you start.

The podcast gave us a wonderful opportunity to delve deeper into the philosophy behind Jenny et al’s excellent article on Establishing a Safe Container for Learning in Simulation.

Most of our learners are pretty apprehensive about participating in sim. As Jenny explained to us – some people ‘come to life’ on stage with an audience, but most of us feel a sense of psychological threat if we are doing things in front of others and perceive this as evaluative i.e. a test of some sort. We may not know how an individual will be predisposed to respond, but as facilitators we can help everyone feel more psychologically safe.

We can do this through some practical steps - clarifying expectations, discussing confidentiality, and telling stories/ sharing our own fears and vulnerabilities. Establishing the fiction contract is important - as described in the ‘safe container’ paper, and building on work by Peter Dieckmann here. (beware - a deep dive into theory!)

The fundamental mindsets (of learner and facilitator behind these steps need to be understood.

Jenny described some key concepts in the area, starting with helping to shift our learners to a ‘growth mindset’ (see Carol Dweck’s TeD talk here) in response to the challenge of a simulation activity.

The idea of positive regard is crucial. We have to truly respect our learners and their efforts, and we need to demonstrate that. Well intentioned words suggesting this respect can be easily undone with ‘guess what I’m thinking’ questions that might make learners feel manipulated or unfairly judged.

So how do we know if we have achieved psychological safety for our sim participants?

Its complex.

Experts like Amy Edmonson (another TeD talk to watch) suggests that seeing supportive responses when one puts oneself on the line, such as by asking a question, seeking feedback, reporting a mistake, or proposing a new idea.

Sounds like our aspirations for our work teams….? Again, simulation practice parallels our real world healthcare practice.

Thanks again to Jenny Rudolph for an illuminating podcast.