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:

DO	DON’T
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. 

References:

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.