So, what is psychological safety?

Contemporary simulation-focused conferences, courses and published literature consistently refer to the construct that is ‘psychological safety’. We’d like to encourage readers to pause and think deeply about what they mean when they say psychological safety. Further, to reflect on the actions or strategies that they take to foster psychological safety in others and manage their own, to reflect on the words that they use, and on the considerations that they make for psychological safety of all those involved.

Psychological safety has been described in various bodies of professional literature. Descriptions usually centre on individuals within a group context. They focus on the individual’s confidence in that group to take ‘risks’ without the fear of consequences to their self-image, status, credibility or career [2,3]. Some descriptions refer to consequences such as the unproductive emotion of embarrassment [4]. Others include words such as shame, stigma, punishment or retaliation [5,6]. Contexts of descriptions also vary. For example, some emphasize organizational culture [6], engagement in work [2], teamwork [3], quality improvement [5], error reporting [5], patient safety [4], and inclusion and innovation [7]. These descriptions reflect different lenses through which psychological safety can be viewed. We value these variations and the complementarity of different perspectives to this important condition for learning in simulation.

Given the educational context of the experience we started the editorial with, we share Clark’s (2020) description of psychological safety as ‘a condition where individuals feel included, safe to learn, safe to contribute, and safe to challenge the status quo, all without fear of being embarrassed, marginalized, or punished in some way’ [7].

What commonly happens in simulation-based education?

In simulation-based education, we often place learners in situations that explore the boundaries of their competences. One might argue that being at the edge of your ability is needed for learning. For example, being at the edge of your ability aligns with Vygotsky’s Zone of Proximal Development, where learners engage with tasks that challenge them just beyond their current abilities, thereby fostering growth through social interaction and guidance from more knowledgeable others [8]. We construct simulated environments in which we invite learners to behave as if in a naturalistic environment, without real-world harm to patients. But of course, those within the simulation are at risk of harm, including psychological distress. Giving learners more responsibility than what they might be used to – can often evoke intense emotions [9]. We closely observe learners’ behaviours and then together discuss their thoughts and feelings about these observations. These are challenging demands for all those involved.

Metaphors and psychological safety

While metaphors have their limitations, they can be useful in critical reflection and sense-making. As an author team, we found the metaphor of a garden particularly resonant with how we conceptualized psychological safety and simulation-based education. This connection likely stems from our shared interest in using simulation to nurture learning and growth. The development of a learner in a simulation can sometimes be fragile, much like a delicate flower.

Given optimal soil conditions, buds of growth can emerge with flowers – and so it is with learners. In the ‘psychological soil’ of simulation, the right conditions must exist, to enable learners to establish foundational roots of learning and grow from this supportive state. As with flowers, no two learners are the same; different conditions are required to enable each to flourish. These conditions must be carefully maintained to sustain ongoing growth. Without this continued support, learners may falter and in the worst case, wither.

Like gardeners, educators must ‘tend’ the garden of learning to foster learner development and growth. They need to closely observe and attune themselves to signs of progress and the conditions, and ‘till’ the ‘psychological soil’ where possible to support sustained growth, enabling learners to fully blossom.

One limitation of the garden metaphor is the fundamental difference between plants and human beings. For many plants, we know the precise balance of nutrients, light, water and other conditions required for them to thrive. In contrast, understanding what fosters psychological safety for a person is highly complex and multi-layered. People vary greatly – what works for one individual may not work for another. Furthermore, the same person’s needs can change over time and across contexts. This complexity calls on simulation researchers to deepen our understanding not only of what psychological safety is, but also of what supports it: for whom, in which situations, at what time and for how long.

In returning to the workshop described earlier, we do not know how that situation is best managed. Rather than telling us what the soil was (‘This is a psychologically safe space’), it may have been more helpful for the facilitators to have acknowledged their goal was to foster a space in which learners could feel psychologically safe, to participate, to take risks. Or, with our metaphor that they would monitor the soil as part of tending to foundational requirements of our garden.

Thanks for joining the workshop today. Together, we want to create and maintain a space in which you will feel comfortable to participate, to ….

During our critical reflection, we have tentatively concluded that we can speak of our intention as facilitators to foster a psychologically safe space in simulation, realizing that we can’t ensure it on our own. It is a dynamic and fluid state [10], impacted by psychological, social and physical factors, that may need to be monitored before, during and after the simulation-based activity.

While there may never be definitive answers to the questions we have asked, we hope readers are prompted to critically reflect on their own practices relative to psychological safety in simulation-based education. That they tend their ‘gardens’, that they monitor their soil and factors influencing its quality at any given moment so that their plants thrive and blossom. In future work, we will explore some of the ideas raised here, and others that have barely surfaced such as theories that have relevance to psychological safety and the measurement of psychological safety.