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From Simulation to Clinical Practice: Building Psychological Safety

CLIME | Recorded October 8, 2026

In this Grand Rounds, Dr. Karen Mangold explored what psychological safety is, why it is hard to build in healthcare, and how strategies from simulation-based education can be brought into everyday clinical teaching. She emphasized that psychological safety is not about protecting learners from mistakes, but about creating an environment where it is safe to ask questions, share ideas, take risks, and learn from errors.

Drawing on her work as a simulationist and pediatric emergency medicine educator, she walked through the core elements of a strong pre-briefing and debriefing, including the “basic assumption” that everyone is intelligent, capable, cares about doing their best, and wants to improve. She then showed how clinical teachers can adapt these practices for the clinical setting, such as introductions at the start of a shift, setting goals for each shift, and agreeing on cues during procedures.

Key insights

  • Psychological safety is the belief that you won’t be punished or humiliated for speaking up with questions, ideas, concerns, or mistakes. It is not about coddling learners.
  • Learners move through different kinds of safety: feeling included, feeling safe to ask questions, contributing ideas, and challenging the status quo.
  • Healthcare has unique barriers to psychological safety, including strict hierarchies, fear of judgment tied to grades and evaluations, time pressure, real patient stakes, and strong cultural norms.
  • A brief, intentional pre-briefing (introductions, logistics, the basic assumption, clear goals, and ground rules) lays the foundation for a safe learning environment.
  • “Debriefing with good judgment” pairs an honest observation and concern with genuine curiosity about the learner’s perspective, avoiding both harsh judgment and vague, non-judgmental questioning.
  • When assessment is involved, being clear about how results will be used, who will see them, and focusing on formative feedback helps keep the environment safe.
  • In clinical teaching, simple habits like learning names, asking each learner for a goal for the shift (and sharing your own), speaking respectfully about colleagues, and agreeing on procedure cues help build trust.
  • Approaching learners’ mistakes with humble curiosity, assuming good intentions and asking how they got there, is the starting point for building a safer culture.

Karen Mangold, MD

Dr. Mangold is an Associate Professor of Pediatrics and Medical Education at Northwestern University Feinberg School of Medicine and a Pediatric Emergency Medicine physician at Ann & Robert H. Lurie Children’s Hospital of Chicago. She serves as Program Director for both the Pediatric Emergency Medicine Fellowship and Northwestern’s Master of Science in Health Professions Education program. Dr. Mangold earned her MD from the University of Rochester, completed her pediatric residency and chief residency at Yale-New Haven Hospital, and completed fellowship training in Pediatric Emergency Medicine at Northwestern University. Dr. Mangold’s scholarly and educational work focuses on medical education, simulation-based training, trainee development, mentoring, and assessment. She has led numerous educational initiatives across undergraduate and graduate medical education, including curriculum development for residents, fellows, and faculty.

WATCH THE RECORDING

Captions Available

Resources

 

  • Rudolph, Raemer, Simon, Establishing a Safe Container for Learning Simulation: The Role of the Presimulation Briefing. Simulation in Healthcare Available UW HSL
  • Kolbe, Eppich, Rudolph, et al. Managing psychological safety in debriefings: a dynamic balancing act. BMJ Simulation & Techonology Enhanced Learning 2020;6:164-171 Available UW HSL
  • Hardie, O’Donovan, Jarvis Redmond. Key tips to providing a psychologically safe learning environment in the clinical setting. BMC Medical Education. 2022; 22:816 Available UW HSL
  • Friedman, Mogilner, Paul. Nuts and Bolts: Establishing Psychological Safety. Academic Pediatrics 26(3) Apr 2026 : View Article