Managing psychological safety in debriefings: a dynamic balancing act.

Debriefings should promote reflection and help learners make sense of events. Threats to psychological safety can undermine reflective learning conversations and may inhibit transfer of key lessons from simulated cases to the general patient care context. Therefore, effective debriefings require high degrees of psychological safety-the perception that it is safe to take interpersonal risks and that one will not be embarrassed, rejected or otherwise punished for speaking their mind, not knowing or asking questions. The role of introductions, learning contracts and prebriefing in establishing psychological safety is well described in the literature. How to maintain psychological safety, while also being able to identify and restore psychological safety during debriefings, is less well understood. This review has several aims. First, we provide a detailed definition of psychological safety and justify its importance for debriefings. Second, we recommend specific strategies debriefers can use throughout the debriefing to build and maintain psychological safety. We base these recommendations on a literature review and on our own experiences as simulation educators. Third, we examine how debriefers might actively address perceived breaches to restore psychological safety. Re-establishing psychological safety after temporary threats or breaches can seem particularly daunting. To demystify this process, we invoke the metaphor of a 'safe container' for learning; a space where learners can feel secure enough to work at the edge of expertise without threat of humiliation. We conclude with a discussion of limitations and implications, particularly with respect to faculty development.
Competing Interests: Competing interests: MK, WE, MM, VG, AC, HC and AC are faculty for the Debriefing Academy, which runs debriefing courses for healthcare professionals. MK is faculty at the Simulation Center of the University Hospital Zurich, also providing debriefing faculty development training. JR is faculty at the Center for Medical Simulation, providing debriefing faculty development training. WE receives salary support from the Center for Medical Simulation to teach on simulation educator courses; he also receives per diem honorarium from PAEDSIM e.V. to teach on simulation educator courses in Germany.
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