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107 Psychological safety in emergency department in-situ simulation training
  1. A Clark,
  2. A Buckley,
  3. S Trippick
  1. University College London Hospitals NHS Foundation Trust, UK


Background Simulation-based medical education (SBME) can present a threat to the psychological safety of learners.1 Learners may fear embarrassment in front of their peers or supervisors. This can inhibit cognitive and behavioural flexibility in the learners, and therefore reduce learning.2 Facilitator practices have been proposed that may increase learners’ sense of psychological safety in SBME.3

Most research into the attitudes of learners toward SBME has been in the simulation centre setting; little work has been conducted with in-situ SMBE participants, where shorter timescales can make it more difficult for facilitators to establish a safe learning environment.

Methodology Multi-professional learners at all grades taking part in our emergency department in-situ simulation exercises at UCLH are required to complete confidential pre-simulation and post-debriefing questionnaires, which are presented in a five-point Likert scale format.

Our questionnaires include eight pre-sim and six post-sim questions around participants’ anxiety and the concept of psychological safety. In the pre-sim questionnaire, we also ask for “three words or short phrases that describe how you feel before or during in-situ simulation training”. Data is being collected between 1 April and 1 August 2016.

Early results Pre-simulation, 85% of participants described themselves as “anxious” or “nervous”. 89% of medical staff, but only 40% of nursing staff, agreed that the learning environment is safe for making mistakes.

Post-simulation, all professional groups were similarly (94%) likely to agree that the learning environment was safe for making mistakes.

Potential impact Our early results suggest that we cannot take learners’ psychological safety for granted during in-situ simulation exercises, and there may be differences between professional groups. It may be helpful for facilitators to adopt “in-situ specific” pre-simulation practices to enhance the safety of the learning environment. We plan to develop a simple toolkit to guide the in-situ pre-simulation briefing.


  1. Savoldelli GL, Naik VN, Hamstra SJ, Morgan PJ. Barriers to use of simulation-based education. Can J Anaesth 2005;52(9):944–950.

  2. Edmondson A. 1999 Psychological safety and learning behavior in work teams. Adm Sci Q 1999;44(2):350–383.

  3. Rudolph, J, Raemer DB, Simon R. Establishing a safe container for learning in simulation. Simul Healthc 2014;9(6):339–349.

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