Participant trauma in healthcare simulation can occur when clinical simulation is not delivered in a psychologically safe foundation and structure. Sometimes, despite the best intentions and skills as clinical simulation faculty there is risk of harm to clinical simulation participants. Humans all arrive to clinical simulation based education with their own set of baggage and emotions often which has nothing to do with the healthcare simulation based education. This article by Erin Carn-Bennett, RN, MSN will explore the concept of participant trauma from healthcare simulation and how as healthcare simulation staff there can be mitigations in place to reduce risk of occurrence in clinical simulation based education.
Psychological Safety is Everything for Everyone in Healthcare Simulation
Psychological safety is a major priority for most healthcare simulation programs currently, but this hasn’t always been the case. Even in more recent years, a blame and shame culture existed in healthcare simulation programs. For the most part this was done unconsciously or without knowledge of the damage that was done to clinical simulation participants. However, as clinical simulation continues to innovate, improve and become more beneficial to the participants’ learning journey, psychological safety has become more at the forefront of everything done in healthcare simulation.
A lot of participants in clinical simulation have been traumatized in the past by psychologically unsafe clinical simulation. These experiences can be carried through into clinical simulation based education sometimes for the rest of participants careers. As clinical simulation faculty members, there are definitely many opportunities to rebuild trust and to explore previous clinical simulation trauma to assist with psychological safety and engagement in current time healthcare simulation. This also extends to clinical simulation staff who can also have had their own healthcare simulation trauma experiences as participants as well.
Healthcare Simulation is a Safe Place to Make Mistakes
For many healthcare simulation programs, there is a culture now of celebration of participants making mistakes in scenarios. This is to encourage clinical simulation participants to make mistakes and to learn from them in a safe environment which doesn’t compromise patient safety. This culture of psychological safety to make mistakes has not always existed in healthcare simulation programs though and this takes a significant amount of time and dedication to maintain consistently.
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As a healthcare simulation faculty member, if attention is paid to what participants share there is often commonly a lot of disclosures of previous clinical simulation trauma. Clinical simulation participants will often share that they don’t like clinical simulation before scenarios commence, in the introductions phase or after the clinical simulation scenario. This information is often normalized or disregarded by clinical simulation faculty as this information can be common to be heard by participants sharing.
As clinical simulation faculty truly listening to participants and what is shared is incredibly critical in order to be able to make them feel psychologically safe. If the environment and time is right to encourage further discussion then try to get the participant to expand on their experience and to share more details. After a scenario or course can be a great time to recheck in with a participant who has disclosed previous clinical simulation trauma as well. A genuine check in with a participant who has been brave enough to be vulnerable can be incredibly powerful and can help them to build trust with clinical simulation faculty.
There can be a lot of benefit to psychological safety for an explicit statement to be made that psychological safety is a priority at commencement and closing of clinical simulation courses. This statement needs to be genuine and not in a tokenistic fashion. This can be even further extended to acknowledge that some participants would have experienced trauma as participants in the past in clinical simulation and that faculty are always available to discuss this. To even just openly make this statement in a genuine fashion can help to build trust with clinical simulation participants and make them reflect on their experiences and if this applies to them.
To Display Fallibility as a Healthcare Simulation Facilitator Increases Trust
As clinical simulation faculty there can be merit to increase psychological safety by displays of fallibility. Fallibility to increase psychological safety can be done in ways such as highlighting when the clinical simulation faculty makes errors and taking ownership of these errors. Fallibility can also be explicitly stated alongside psychological safety as a priority. An example of this could be after introductions in a clinical simulation course which states: “Your psychological safety is paramount to us in this clinical simulation course. We will do our best to maintain psychological safety but also acknowledge that we are learning as well. If we make a mistake we will be accountable and take ownership to improve for next time.”
Once a participant has shared about previous clinical simulation trauma, often there can be a connection made between this faculty member and clinical simulation participant. In future clinical simulations, be sure to recheck in with this participant and ask if the clinical simulation attended recently has felt more psychologically safe. This feedback is incredibly useful to be able to improve psychological safety for clinical simulation participants.
A solid foundation and structure to clinical simulation which is delivered can also increase psychological safety and reduce the risk of trauma to participants. An established debrief modality or tool can provide a framework to keep clinical simulation participants psychologically safe. However, implied psychological safety is not always a success. As clinical simulation faculty there needs to be the ability to reflect on our own performance, our own baggage and how to improve for next time.
This article has explored trauma in healthcare simulation experienced by participants and the impact that this can have on learning and engagement. As clinical simulation faculty members, there is a lot of power and potential to do damage to those who attend clinical simulation. Psychological safety to reduce risk of harm to clinical simulation participants is hugely important at any healthcare simulation based education. Once harm has occurred, this can have an impact for a clinical simulation participant’s entire career. This alone should be enough for clinical simulation faculty to be able to consider what methods are in place to reduce this risk to participants as an iterative process.
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