November 4, 2021

Creating Psychological Safety in Learning Environments

by Emily Keveryn, PharmD, PGY1 Pharmacy Practice Resident, Baptist Memorial Hospital - North Mississippi

Student engagement is often something teachers and educators strive to achieve for lots of reasons — to have students actively thinking about the material and responding to questions, to validate that what is being taught is being understood, and to promote positive attitudes toward the material. But why is there a lack of engagement so common in many learning environments? As a teacher, it may be easy to forget how stressful or daunting the feeling of speaking up in front of a group of peers or instructors is.  For students, this is one of the most common barriers to active engagement in group learning settings. Having an environment where students feel comfortable enough to interact without concerns of sounding silly or being embarrassed is challenging to achieve, especially in very large groups and, conversely, in very small groups too. 

Amy Edmondson, an American scholar of leadership, teaming, and organizational learning, coined the term "psychological safety” to describe “the feeling that one is comfortable expressing and being themselves, and sharing concerns and mistakes without fear of embarrassment, ridicule, shame, or retribution.”1,2 While Edmondson’s research focuses on psychological safety in teams in business and healthcare settings, many of the ideas and behaviors she observed are relevant to the classroom and other learning environments. It is human nature to want to be accepted, heard, and understood.  And, perhaps more importantly, to avoid rejection, embarrassment, or punishment.  Therefore, fostering a psychologically safe learning environment is critically important and it creates a climate where the material and learning process is engaging, exciting, and lively!

Whether it is in a large classroom, during medical rounds, interacting with an intern on a job site, or in any situation where an educator is teaching something, psychological safety must be present for many reasons.  It encourages learning by making the learner comfortable asking questions when they may not understand the material. It stimulates innovation by encouraging higher-level thinking and understanding.  And it provides a sense of belonging whereby learners feel they can express their thoughts on a subject without being ridiculed or feeling rejected. In one study that addressed psychological safety in a simulation with medical residents in a trauma scenario, researchers found that increased stress impaired knowledge recall and decreased clinical performance.  The medical resident’s performance was measured using a standardized assessment form and a global rating checklist.3 In another study, researchers found that feeling psychologically safe reduced anxiety in nursing students who were participated in simulation activities.  Anxiety was measured by pre- and post-surveys completed by the students.4 While these studies looked at psychological safety during simulation activities, the results strongly suggest that the environment, psychologically speaking, has a significant impact on learners' ability to perform activities, recall information, and feel confident.

Timothy Clark writes that there are four stages of psychological safety that individuals go through that reflect basic human needs: inclusion safety, learner safety, contributor safety, and challenger safety.5 Inclusion safety is the feeling of belonging and being accepted. One way to provide this type of safety is to learn and use students' names, welcome them to the classroom, and include the learner, and listen to their input. This can be challenging when educating multiple learners, balancing the time between each. Learner safety, which may arguably be the most important stage for educators, occurs when individuals feel comfortable asking questions, receiving feedback, asking for help, and even making mistakes. By actively listening and offering gentle, clear guidance, educators can increase learner safety. This stage is especially important when trying to encourage the learner to speak up and not fear retribution. Contributor safety satisfies the need to feel like we are contributing in a meaningful way and making a difference. When a learner feels included and safe to make mistakes, they feel more inclined to contribute and use the knowledge that they possess to make a difference. This builds off of learner safety, which bolsters confidence in asking questions, and encourages the learner to contribute ideas without fear. Lastly, challenger safety encourages individuals to use what they have learned and strive to make things better in the learning environment and beyond. Challenger safety occurs when students feel they can directly challenge the status quo, recommend an idea or a process, without feeling like the suggestion or comment may damage their reputation.

The Do’s and Don’ts of Psychological Safety:



Stay attentive to what is happening and if things seem to be feeling unsafe for some students, listen carefully to understand what may be causing others to feel this way, and ask questions to clarify how they feel.

Don't let uneasiness stop you from discussing what needs to be discussed - if you are feeling uncomfortable, it is likely they are too!

Offer encouragement and support to ensure that each learner knows they are heard and will not be subject to ridicule or embarrassment.

Don’t use sarcasm or emotive language, it can cause others to feel as though we may not be taking them seriously.

Reinforce a conversational culture by making it safe for anyone to talk about anything.

Don’t be defensive or apathetic; it will likely result in the situation continuing and the learner being afraid to speak up again

Psychological safety in learning environments is often something that educators struggle to achieve but is one of the best ways to increase student engagement, interaction, and learning. By role modeling an open and comfortable environment, we are also are fostering the skills within our learners as they learn how to interact with patients and colleagues … and students in the future! Educators need to understand the stages and the ways to create a psychologically safe learning environment to ensure learners get the greatest benefit from the learning process. 


  1. Edmondson A. Psychological Safety and Learning Behavior in Work Teams. Administrative Science Quarterly 1999; 44: 350–383.
  2. Edmondson A. The Fearless Organization: Creating Psychological Safety in the workplace for learning, Innovation and Growth. Hoboken, NJ: Wiley; 2018.
  3. Harve A, Bandiera G, Nathens AB, and LeBlanc VR. Impact of stress on resident performance in simulated trauma scenarios. Journal of Trauma and Acute Care Surgery 2012; 72: 497–503.
  4. Ignacio J, Dolmans D, Scherpbier A, et. al. Comparison of standardized patients with high-fidelity simulators for managing stress and improving performance in clinical deterioration: A mixed methods study. Nurse Education Today 2015; 35: 1161–1168.
  5. Clark TR. The 4 stages of psychological safety: Defining the path to inclusion and Innovation. Oakland, CA: Berrett-Koehler Publishers, Inc.; 2020.

November 3, 2021

Collaborative Teaching: One Way to Improve Teaching and Learning

by Giang Le, PharmD, PGY1 Pharmacy Practice Resident, Baptist Memorial Hospital-Golden Triangle

I came across this interesting article the other day entitled “Teacher collaboration in curriculum design teams: effects, mechanisms, and conditions.”1 This article got me thinking about my years in school. I recall only a few class sessions that had two or more teachers providing instruction together. For many courses, students are essentially learning from one teacher’s perspective — which is to say, one person’s perspective. Students might assume that what that teacher says is accurate and that piece of information must be the best answer.  I’m not sure that’s always true.  From the teacher’s perspective, I wonder if they get bored teaching the same materials every year? Do teachers ever get so used to their way of teaching that they become reluctant to change? Or unaware of the need to update their content or instructional methods? Maybe teachers need a partner. Maybe instruction is better when taught by a team. Indeed, there is evidence that collaborative teaching can help teachers update their knowledge, improve their practice, and enhance learners’ outcomes.1,2

What are collaborative teaching design teams? These teams involve educators working together to design all classroom activities, including developing a curriculum, selecting the most effective teaching methods, creating test questions, and developing tools to assess performance. An essential part of being an educator is to continue to learn – not only about the content but also ways of teaching. However, it can be hard to keep up with all the newly available information, especially when there are thousands and thousands of scientific articles published every day. In the process of balancing work life and personal life, teachers can find themselves in situations where they quickly skim an abstract or a summary. Teachers often rely on their existing knowledge and beliefs to develop learning materials. This is when collaborative teaching can be of benefit. Having people with different knowledge, skills, and perspectives on a team creates more opportunities to share knowledge.1 If a conflict arises (a conflict of ideas, not philosophies or personalities), teachers will have to provide evidence to support their reasoning and convince their peers. In this process of solving “constructive” conflicts, teachers begin to self-reflect on their existing knowledge and their ways of practice. Self-reflection is a critical and we should practice it every day, but it is always easier said than done. Collaborative design teams create the opportunities for constructive conflict and stimulate self-reflection.

One may agree that collaborative teaching can improve teachers’ knowledge, but the more important question is: Can it improve learner outcomes? That’s the ultimate goal that every educator should strive to achieve — improvements in students performance. This means that at the end of the course, we want our students to not only understand or recall but also be able to apply the materials in a variety of circumstances. Theoretically, all teachers should have a tool to assess the students’ performance to guide their teaching. With collaborative teaching design teams, teachers can work together to create these tools. Everyone can contribute based on their experience and what’s available in the educational literature. 

In a recent study, the investigators examined three specific forms of collaboration in teaching: (1) instruction-related, (2) project-related, and (3) organization, performance, and problems-related. Their study is a secondary analysis of the German Program for International Assessment (PISA) data. A sample of 869 schoolteachers was matched with a corresponding sample of 869 students. Students’ achievement in this study was measured by comparing their grades in the first half-year of the academic period. The relationship between the different forms of teacher collaboration and student achievement was estimated through a structural equation model. They found that the third form of collaboration—modified teaching based on students’ performance—positively influenced students’ achievement. However, an interesting aspect of this study was that the subject matter taught were primarily sciences (like maths, biology, physics, and chemistry). This might explain why the third form of collaboration focusing on practice problems would produce a positive outcome. In other subjects involving more discussions and debates, the knowledge-sharing and planning process might play a more important role.

Collaborative teaching design teams can theoretically improve other aspects of the learning process. For example, I remember when my class was divided into groups to do group assignments. From time to time, the professor would be occupied with one group and unavailable to others. This quickly led to frustration among students who had a hard time understanding the materials. Instructions that may seem easy to follow for the professor might not be interpreted the same way by the students. To finish the assignment within the class period, the students would turn in poorly done work and minimal learning occurred. Collaborative teaching would give students greater access to more instructors. This benefit also applies to practical labs where one professor cannot supervise the whole class to ensure everybody follows the instructions.

How do we implement effective collaboration? This process can be time-consuming since it requires team members to gather, discuss, and revise the course materials. A course may need to be developed a year in advance and regularly revised based on students’ feedback and performance. Another strategy for effective collaboration is to allow time to build relationships and foster a culture of trust, respect, and humility between the teachers on the team.3 It is best if each team member is willing and able to contribute in meaningful ways to the work of the group. Here is my favorite quote about teaching collaboration: “As a successful co-teacher, you need to (a) know yourself, (b) know your partner(s), (c) know your students, and (d) know your ‘stuff’.”4  Teachers will vary in their ability to effectively collaborate. Some may find it hard to work with partners who have different beliefs and teaching styles.  Others may find it hard to assess how well the students understand the materials. If teachers know their strengths and weaknesses, they can complement each other and support one another. While team teaching can be great, forcing collaboration when teachers are not on the same page will create more classroom confusion and negatively affect learners’ outcomes.

Collaborative teaching is an ongoing process with evidence that it can improve teachers’ and learners’ outcomes. Teachers may find the collaboration not only a beneficial way to enhance their knowledge but also an opportunity to update what and how they teach.  Like any form of collaboration, the process will take time, effort, and commitment to achieve success.


  1. Voogt JM, Pieters JM, Handelzalts A. Teacher collaboration in curriculum design teams: effects, mechanisms, and conditions. Educational Research and Evaluation. 2016; 22: 121-140.
  2. Mora-Ruano JG, Heine JH, Gebhardt M. Does teacher collaboration improve student achievement? Analysis of the German PISA 2012 sample. Frontiers in Education. 2019; 13: Article 3389. (Accessed 2021 Oct 12).
  3. Lauren D. Teacher collaboration: how to approach it in 2020. Schoology Exchange. 2020. (Accessed 2021 Oct 12).
  4. Keefe EB, Moore V, Duff F. The four “knows” of collaborative teaching. Teaching Exceptional Children. 2004; 36 (5): 36-42.