High-Fidelity Simulation for Medical Students: Does Psychological Safety Increase During the Prebriefing Phase?

The purpose of this quantitative, experimental pretest-posttest control group design was to examine whether the level of psychological safety a medical student brings to a high-fidelity simulation predicts their psychological safety and stress levels after a simulation event. Because recent research has found inconsistencies in the effectiveness of the prebriefing phase of a simulation learning event, this raises the question of whether a facilitator can adequately establish psychological safety during the prebriefing. This study sampled 114 students from a medical school in the mid-Atlantic region of the United States to examine if pre-existing psychological safety can predict postsimulation stress and psychological safety when using an intervention of psychological safety elements in the prebriefing and controlling for team cohesion. The pretest was taken one week prior to the simulation event, and the posttest was given immediately after the simulation activity and before the debriefing. To measure these items, this study used the Psychological Safety in High-Fidelity Simulation (PSHFS) scale, the Group Cohesion Scale (GCS), and the Perceived Stress Scale (PSS) through a combination of pretest and posttest electronic surveys. The data were analyzed using multiple regression and showed that pre-existing psychological safety scores were a significant predictor for both postsimulation psychological safety and stress scores. However, team cohesion and the treatment intervention were not significant predictors. This research suggested that the level of psychological safety a learner brings to a simulation may have a greater influence than previously thought. Future research should explore whether elements of providing psychological safety in the prebriefing are exchangeable based on a learner's pre-existing psychological safety.