Simulcast Journal Club is a monthly series that aims to encourage simulation educators to explore and learn from publications on Healthcare Simulation Education. Each month we publish a case and link a paper with associated questions for discussion. Inspired by the ALiEM MEdIC series, we moderate and summarise the discussion at the end of the month, including exploring the opinions of experts from the field.
The journal club relies heavily on your participation and comments and while it can be confronting to post your opinions on an article online, we hope we can generate a sense of “online psychological safety” enough to empower you to post! Your thoughts are highly valued and appreciated, however in depth or whatever your level of experience. We look forward to hearing from you.
Title : “Broken Trust”
The Case :
Nitin held Nimali’s gaze, silently searching for a hint of what emotion lay beneath. Suspicion, certainly… but there was something else he couldn’t quite grasp. In the dim light he slowly reached for her hand but withdrew at her involuntarily shudder. His heart broke quietly in that moment. “It’s a uniquely awful experience.” He ventured. “To lose the trust of the person who first taught you the Basic Assumption.”.
Nimali’s eyes flickered.
“I’ve lied to you.” He acknowledged. “I’ve lied to everyone here since my arrival. I’ve had to spin half truths and falsehoods through every conversation we’ve had. But Nimali, I’ve never lied about loving you.”.
Nimali winced as if she’d been struck. “I’m afraid, Nitin, that our fiction contract has expired.”
“I’ve wanted to tell you.” He said honestly. “I’ve wanted to for the longest time. But I can’t. You’ve got to believe me Nimali, I’m trying to protect you. You and this centre. I need you to trust me, we’re all in very real danger.”.
“You want trust?” countered Nimali. “Trust is built longitudinally. On a foundation of shared vulnerability, of integrity, of mutual respect… and from role clarity.”. She advanced on him, fearless and stern.
“What role are you playing, Nitin?”.
Tachypnoea took hold as Nitin frantically weighed his options : lose his cover or lose the woman he loved. His voice shook as he went to speak, and in that moment he finally recognised what he’d seen in her eyes besides fear. Affection. A remnant maybe, threatened and weak, but present nonetheless, with just a hint of positive regard. A kernel of their past maintaining the tiniest of openings into her heart. It was going to take a leap of faith.
He took a deep breath.
“I’m a spy, Nimali. A foreign agent recruited by your Government, and if we don’t stop this murderer soon, it won’t be just psychological safety I’m worried about.”.
The Articles :
Kolbe, M., Eppich, W., Rudolph, J., Meguerdichian, M., Catena, H., Cripps, A., Grant, V. and Cheng, A. (2019). Managing psychological safety in debriefings: a dynamic balancing act. BMJ Simulation and Technology Enhanced Learning, pp.bmjstel-2019-000470. [Currently open access thanks to BMJ STEL]
This month we’re looking at different papers that reflect upon psychological safety. The first, by Michaela Kolbe et al provides an update on thoughts regarding the Safe Container and in particular a focus on nuance and advanced moves at repairing a perceived psych safety breach.
In the second paper, Ng et al look at psychological safety with a different lens. Asking if perhaps medical culture remains so hierarchical that espousing the goals of psychological safety may not be enough to create a truly safe space for higher learning.
A questions for this month to start the conversation :
- How do you think these papers change your approach to maintaining or repairing a sense of psychological safety in your teams?
Kolbe, M., Eppich, W., Rudolph, J., Meguerdichian, M., Catena, H., Cripps, A., Grant, V. and Cheng, A. (2019). Managing psychological safety in debriefings: a dynamic balancing act. BMJ Simulation and Technology Enhanced Learning, pp.bmjstel-2019-000470.