CEimpact Podcast

Creating a Psychologically Safe Learning Environment for Students and Residents

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In this episode of Precept2Practice, host Kathy Schott dives into the critical topic of psychological safety with guest Lisa Buss-Preszler, Pharmacy Education Supervisor at Mayo Clinic in Arizona. Together, they explore how fostering psychological safety in clinical learning environments empowers pharmacy students and professionals to thrive. Lisa provides practical strategies for preceptors to build trust, encourage open communication, and normalize failure, helping learners feel safe to ask questions and take risks. Tune in to learn how you can create a supportive environment that enhances both engagement and growth.

HOST
Kathy Schott, PhD
Vice President, Education & Operations
CEimpact

GUEST
Dr. Lisa Buss-Preszler, PharmD, BCACP
Pharmacy Education Supervisor and Program Director
PGY-1 Pharmacy Residency
Mayo Clinic Hospital - Arizona

Get CE: CLICK HERE TO CPE CREDIT FOR THE COURSE!

CPE Information
 
Learning Objectives
At the end of this course, preceptors will be able to:
1. Define psychological safety and distinguish it from related concepts such as physical safety and emotional intelligence.
2. Identify strategies to foster psychological safety in a clinical education setting to improve learner engagement and performance.

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-305-H99-P
Initial release date: 10/23/2024
Expiration date: 10/23/2025
Additional CPE details can be found here.

The speakers have no relevant financial relationships with ineligible companies to disclose.

This program has been:
Approved by the Minnesota Board of Pharmacy as education for Minnesota pharmacy preceptors.

Reviewed by the Texas Consortium on Experiential Programs and has been designated as preceptor education and training for Texas preceptors.


Want more information on this and related topics?

Fostering an Inclusive Environment: Creating a Safe Space for Learners


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Speaker 1:

Welcome back to Preceptive Practice, where we dive into the latest ideas shaping pharmacy precepting. I'm your host, Kathy Schott, and today we're diving into a topic that's not only essential for effective learning but also for creating safe, supportive environments where students and professionals can thrive Psychological safety. Joining us is someone who knows this subject inside and out. Lisa Buss-Pressler is the pharmacy education supervisor at Mayo Clinic in Arizona and an assistant professor of pharmacy in the Mayo Clinic College of Medicine and Science. She brings a wealth of knowledge on how to foster environments where learners feel safe, respected and empowered to take risks without fear of judgment.

Speaker 1:

We discussed what psychological safety truly means, how it impacts learning environments and, most importantly, actionable steps you can take to create and nurture this vital element in your own space. Let's listen in Well. Welcome, Lisa. I'm so glad to have you here today. I know that you and I have known each other for a very long time, from my days at Drake and beyond, but for our listeners, take a minute and introduce yourself, if you would, for me, and maybe share a couple of words about why this topic today is important to you.

Speaker 2:

Kathy, I am so excited that we finally got the opportunity to connect on the podcast For your listeners. My name is Lisa Buss-Pressler and I oversee education and training at Mayo Clinic in Arizona, where I've been the last five years, but I spent quite a bit of time on our Minnesota campus as well, and most of my career I have worked with pharmacy learners, whether that's pharmacy technician students, our clinical rotators or even our residency programs, and I think the reason that psychological safety became an interest of mine a few years ago was just really thinking back at some of the different experiences that learners come to us with, some of the experiences they've shared, and really wanting to make sure that our learning environment is as supportive and nurturing so that they can really learn and grow to the best of their potential.

Speaker 1:

Yeah, great, great, well, and I know that you developed a course for us, a full course on this topic for us. So we'll just be touching some of the higher points today, but I'll be sure to include that course link in the show notes. For folks who want to dive a little bit deeper, let's just start by taking a minute to define psychological safety. I think that's a word that we hear more and more, especially in the education and training space.

Speaker 2:

Yeah, I'd agree that I think it's probably something over the last, you know, three to five years has definitely come up more, whether that's education or work. And when I think about psychological safety, I think of it as it's, you know, my perception that I am safe in my environment, where, if I'm working with a team that I feel comfortable in sharing my ideas, giving opinions, even if those happen to be in disagreement with those that I'm in conversations with. And when I say safe, that I feel like if, when I speak up, that my ideas and thoughts are going to be accepted and I don't have to worry about being shamed or humiliated or judged based on what I have to say Great.

Speaker 1:

Great yeah. So it's really a pretty broad definition. Honestly, how would you say that differs from physical safety or emotional intelligence?

Speaker 2:

Physical safety I think is interesting because my perspective a little bit has evolved on this over the last couple of weeks, just with some literature I've read.

Speaker 2:

But the first thing I think that comes to mind when we hear physical safety, or at least to me, is your actual physical safety, If I'm thinking about in the workplace, that I don't have to fear about workplace violence happening, or maybe it's that I have PPE in its instances in which I need it or wherever I'm working has developed, you know, safety plans, whether that's I know how to evacuate in case of a fire or what to do in severe weather.

Speaker 2:

But a couple of weeks ago I happened to be reading a qualitative research paper on psychological safety and they included some definitions that learners gave, and one of the quotes that they had from a learner was that psychological safety was a physical safety, and they didn't go into that more.

Speaker 2:

But as I've thought about it and of course I can't speak for this individual, but right when, sometimes, when our learners say that they, you know, aren't perceiving a psychological safety, they talk about fear, they talk about shame, they talk about humiliation and anxiety and all of those things have a physical response, and so I think it can also be an instance, at least when you tie the terms together, that you're not feeling you know the physical effects of those negative emotions, that awareness and understanding of my emotions or the emotions of those that I'm interacting with and kind of tying it with psychological safety. I do think that if you have a low level of emotional intelligence, it may be more difficult to always create and promote a psychologically safe environment because you may not have that awareness of how your emotions are impacting those that you're working with, or maybe you're not able to understand or process the emotions of those that you're working with.

Speaker 1:

Okay, yeah, got it. Well, I think it's helpful. Some of that might seem common sense, but I think it's really helpful to kind of talk through it. So let's talk a little bit about why psychological safety is crucial in educational settings, particularly in clinical environments. What makes that, maybe, unique?

Speaker 2:

And, I think, taking a step back. So we have to remember, education is all about learning what we don't know or what we don't know how to apply yet. So this puts our learners in a really vulnerable situation where they have to learn and demonstrate that learning, or that acquisition of knowledge and that demonstrating of skills, you know, not only in front of faculty, but often we're asking our learners to do this in front of their peers as well as patients, especially, as they, you know, transition into that clinical environment. And the other thing that happens when we move to the clinical environment is this new reality that our patients are really complex beings and usually they are more complex than the way we were taught disease states or medication management in the classroom. We were taught disease states or medication management in the classroom, and so these gaps start appearing or maybe, you know, conflicting pieces of knowledge, and that leads to questions, and our learners need to be safe in asking those questions and helping connect the dots.

Speaker 2:

The more I've thought about this, I've often kind of wondered just about the overall design of healthcare education in general. It's not just pharmacy, a lot of healthcare professions right, we have the didactic and then we move to the clinical. And what do those clinical learning situations or experiences look like? So, at least for pharmacy, you know typical like for appies, for example, they're anywhere from four to six weeks long. In most cases they're in difficult, different learning settings. So you know, one month you might be doing critical care, the next week month you might be doing ambulatory care. There are different institutions, there are different preceptors, and so we're asking our learners to navigate all of these differences, build trust and confidence, which is needed for psychological safety, and so sometimes I do think a little bit about that and kind of what that learning curve and growth needs to happen in order for them to feel safe.

Speaker 1:

We always used to tell you know students when we were, you know, preparing in that P3 year before going on their APPEs, that it's kind of like starting a new job every four or five weeks. And you know, as I think starting a new job is one of the highest, most, you know, highest stressful experiences that anyone can experience, you know, up there, along with marriage and divorce, and you know moving.

Speaker 1:

Yes, moving, that's what I was looking for. So you know, here we're asking them to do that and, like you said, quickly build trust and, you know, demonstrate their abilities in just really short times. So it does make sense. You know, probably, that learners would be more at risk, you know, for feeling so vulnerable in those situations. Vulnerable in those situations. Let's talk about the positives first. You know, talk to me about what a really good learning environment looks like when learners do feel safe.

Speaker 2:

I think that there has been a lot of research that's come out in the last few years that's helped us focus on some of the positive outcomes in terms of you know what learners experience in these environments. Downside, a lot of that literature isn't in pharmacy students. Most of it is in medical and nursing learners, but again, the way the training is set up is a lot of similarities. So I think, for in our learners, some of the positive outcomes that they report is one about they have an increased level of an engagement. So when they feel safe and comfortable in their surroundings, they tend to be less self-conscious and they don't self-monitor their responses, which ultimately leads to that increased level of engagement. And I think for that same or similar reasons, our learners we tend to see them have a greater growth in their learning, their knowledge, the ability to repeat, as well as their overall performance.

Speaker 2:

There's also some data around feedback which I think feedback with preceptors could be any multiple podcasts in and of itself, but one of the interesting things coming out of the research there is that if learners feel safe, there is a correlation that they are reporting or what we're finding is that they are more willing to accept and implement the feedback, which probably means that that growth right again is going to be accelerated. And then I think the last like positive outcome overall is this increased sense of purpose. Right, we all want to have a purpose, we all want to know that we're contributing. And when you do feel safe, right, you are able to. Whether it's make recommendations on round or give recommendations to a patient about you know an OTC medication or whatever, or maybe it's working on a project at the department or even institutional level, that sense of purpose and belonging is extremely powerful for our learners.

Speaker 1:

Yeah. Do you have any examples or maybe you know an anecdote or something that would illustrate? You know like what went well, despite, the story is going to start with a massive failure.

Speaker 2:

So, as a background in pharmacy school, I worked at an independent community pharmacy and my first rotation was my hospital or institutional rotation. And my first rotation was my hospital or institutional rotation. Very first day, very first morning, very first rotation of the year, the department had a meeting and I don't know why they didn't just take me along to the meeting but instead they left me behind, gave me a stack of labels for iv orders for the day, pointed the iv bags and the, the vials of antibiotics, showed me how to, you know, put them together and said you know what, take care of these. And, um, we'll be back in about an hour. Yeah, there's a lot that can go wrong, trust me. Perfect. Yeah, there's a lot that can go wrong, trust me. So I can still see these labels, and it has been a couple of decades. But in the middle of this white label in all capital letters, surrounded by aster, worked in a hospital. Knows exactly what I did? But in my community pharmacy trained mind dispensing meant leave the pharmacy, and so I proceeded to activate every single IV bag for the next 24 hours, which ultimately meant we threw away a lot of medication bags that day.

Speaker 2:

I have no idea how much money I wasted, but, um, yeah, anyway, uh, everyone comes back and my preceptor looks at my work and you know there are lots of ways you could respond as a preceptor and you know the question I got was you know, tell me about. You know, tell me about what you did. You know the question I got was you know, tell me about. You know, tell me about what you did. You know in an inquisitive way. And we had some conversations. You know I got to learn about stability and how to look that up, but overall at the end it was a positive conversation and we even, you know, like brainstormed ideas to keep a future student from doing the same thing I had done. Yeah, and the positivity in this is right. Like I had four more weeks at this hospital and pharmacy small people talk but it never came up again. I continue to be given projects to work on independently.

Speaker 2:

They left me alone. I was sent out to do tasks and you know I even had a final evaluation and that never came up even there and I just remember how. You know that was a massive mistake, I can admit that, but just how supporting and it wasn't a big deal and I think that was just a great growth opportunity for me as an individual, as a student.

Speaker 1:

Yeah, yeah, that is a great story and, you know, says a lot about the preceptor and probably the rest of the staff there too. No, because that probably wasn't a secret.

Speaker 2:

I have to admit every once in a while I still am in this, I still have the opportunity to visit this particular institution, and I do cringe every time I do walk through the door, but they continue to let me in. So no hard feelings, that's great.

Speaker 1:

That is great. That's a great story, oh my gosh. Okay. Well, on that note, let's maybe shift gears, and maybe it's obvious, but let's talk about what some of the negative consequences can be when psychological safety is lacking. Had your preceptor taken a completely different approach?

Speaker 2:

Again, literature gives a lot of examples, and I think you know, if you think about what I talked about for the positives, you know you're going to see some of the exact opposites.

Speaker 2:

One of the things that our learners talk about and report is just that feeling of self-consciousness, and this tends to happen more so at the beginning of learning experience as well, as well as the overall clinical experience. Right, because there's this just lack of experience and overall knowledge, and then our learners often they're fearful of appearing incompetent, right? People in generally want to do good and impress you, so I think that comes out. So I think that comes out. The other thing that I think is really important for preceptors to consider is that our learners can have difficulty in performance, and so this is something that now, like having this realization, always comes into the back of my mind. If I have someone who is really struggling to perform at the level I'm expecting of them and to kind of dig into this, I think we have to think about the amygdala, so our fight or flight response, to give a little explanation. So when we don't, feel safe.

Speaker 2:

The amygdala is activated and when that happens, we tend to stop thinking rationally, our reactions may not be appropriate for the situation and really, when we're not thinking clearly, we're just not going to perform at the level we want to, whether that's the ability to answer a question or even perform a skill or a task A couple of other things that come into mind. You know that you're going to lose confidence if that is happening. That come in into mind. You know that you're going to lose confidence if that is happening, as well as you're likely to disengage, because if we're not feeling safe, we're going to do whatever we can to not bring attention to ourselves, right, right, yeah, yeah, yeah.

Speaker 1:

And so you know definitely that decreased engagement, opposite of what you talked about earlier. You know people just kind of want to fade into the woodwork and, you know, not stand out in any way. Yeah, so let's talk about some practical strategies. You know what can preceptors do, whether they're working with students or residents, to really foster? What are some intentional things that we can do to foster that safety?

Speaker 2:

Yeah, I think you know there are so many different strategies that I have to work hard to keep my answer focused, but I think the most important thing you can think about are some of the foundational pieces on which everything else is going to build upon, and our foundation is how we orient someone and we welcome them.

Speaker 2:

So, before we can even orient them, people are probably going to cringe when I say this, but syllabus having a syllabi or a learning experience description that's well thought out is really important, and putting time into that document so that you can really clearly talk about expectations and progression and really give the learner some guardrails so they know what the path is moving forward. Now you know you can't just create the document, you have to go over it, and I know for many preceptors, finding time, especially on a Monday, can be really challenging, no matter what your practice setting is. And so if you find yourself, you know, in that challenge to find protected time, maybe it's something that you can share with the learner beforehand, clearly state the expectation that they need to review it because you'll discuss, and then maybe you know it's in the morning or afternoon of that first day, you know asking some questions. You know sharing a little information and then asking questions. You know to gauge and understanding and comprehension versus, you know, having that full time blocked. I also think a really simple thing people can do is think about how you welcome a learner. Do you know their preferred name, do you know how to pronounce their name correctly, so that, along with a warm smile and you know we are so excited to have you with us and learn can really make or break our learners' first impressions of us as preceptors.

Speaker 2:

Another strategy, I think, is think about how you communicate accessibility whether or when you're not going to be accessible. You know, is it okay if learners text you? If they text you are there hours you are not going to respond to them. You know, recently I talked to a preceptor. You know the learner reached out while they were on vacation. And if you're going to be on vacation, you know I want you to go on vacation. Are we giving our learners go-to people in our absence so they can get those questions answered?

Speaker 2:

And I also think we have to think about, you know, our approachability. It is hard to be perfect, smiley, happy, excited people 24 hours a day, but certainly if our learners are coming to us at moments where we're sighing or, you know, not having the best of day, that can also make you know, make them wonder have they done something? Contribute that and maybe withdraw. And then just the third strategy I would offer is be open to the feelings and experiences of our learners.

Speaker 2:

It can be scary, as we talked about, to go to new places and sometimes our learners have expectations that their performance in an area they've never learned in equals those of pharmacists with multiple years of experience. Resetting expectations, and then also you know if it's above and beyond what you can address. Know our resources. You know that's referring them back to resources at a pharmacy school if it's their residents. You know knowing what resources you have for support. You know we don't need to be able to solve all those problems, but we just need to know where to send them to get the help, to address whatever concerns they may be having.

Speaker 1:

Right, yeah, that's a great call out. You've you've kind of talked about this a little bit in some of in in some of the strategies discussion here. But are there other things that you know leaders and mentors and preceptors can do to model behavior?

Speaker 2:

you know that is taking time to learn with the learners, again, kind of going back to that pressure and expectations our learners have of themselves, like I'm supposed to know everything when I get to you. But even the most seasoned you know leader, mentor, preceptor, has new situations that come up with them. Healthcare is consistently changing and so if you have those things that come up and you have a learner with them, you know, grab them and have you have them go through that process with you so that they can see, and you know, at that point you're also willing to be vulnerable, you know with them, right, you're? You're admitting, you know you've got to look and dig in there.

Speaker 2:

I mentioned this a little bit too, but I think that personal connection is so important in order for someone new to be open and trust you. Now, I'm not saying we have to be best friends, but maybe it's something as simple as is there a commonality of where you've done your training or your clinical interests, your training or your clinical interests, and gauging you know connections from there. I think, as long as we keep it on the professional level, I think that's another great thing that people can do.

Speaker 1:

Yeah, great suggestion Do you have? And I'm sure you do have any specific examples of, you know successful initiatives or programs. You know that you were a part of that efficient, you know effectively really promoted psychological safety.

Speaker 2:

like you know intentional, some intentional initiatives, yeah, I think one of the things that comes to mind that you see done in a lot of institutions and this is probably more employee based, necessarily, than learners but a lot of institutions have good catch programs where they're really highlighting, you know, patient safety stories, medication events or near misses, and of course the process in all of this isn't to highlight the error but it's really to celebrate the individual, the behaviors that they engaged in, to catch and prevent those errors from happening, as well as suggestions, you know, to change to make sure that these types of situations don't happen in the future.

Speaker 2:

So I think that's one example of something that I think is pretty successful in a lot of institutions. If you look at the overall number of events that are being reported, you know studies have shown that the institutions or departments with the highest level of errors it's not because that they don't know how to do their jobs, but it's because their employees feel safe enough to share and really learn and focus on that as a learning opportunity. One idea that I've seen in some of the literature with learners is a take on Feedback Friday, but instead called Failure Friday. I don't know as a society we're there with our love of failure.

Speaker 2:

But before you tune me out, so this is celebrating the fact that failure is not failure, but when we make a mistake, it's when we identify a gap in our knowledge and we're able to then identify what we need to learn or what skill we need to do to move forward, and so the focus is really on what did I learn new this week that will propel me into the future versus, like whoa is me? I made a mistake, and so I think that you know. Reframing failure is a great opportunity that we need to more capitalize on preceptors.

Speaker 1:

Yeah, I love that. When you first said it I was like what? That doesn't make sense. But to hear you talk about it, I think that strategy would probably help take some of the fear out of operating in a new environment, as we were talking earlier, the scar out of you know. Out of you know, operating in a new environment. You know, as we were talking earlier, the scariness of that. So, yeah, that's, that is super creative. I've never heard of that before. What are some things you know, besides sort of reflecting? You know this may be something many listeners haven't really thought about before you know in the, in the context of the learning environment, that they, that they provide you know what am I doing or not doing that is contributing or detracting from the psychological safety. So what are some steps that teams could take to assess, you know where they are in that and, and you know, hopefully then enhance it. Yeah, so I think you know, hopefully then enhance it.

Speaker 2:

Yeah, so I think you know if you're looking at like whether it's a precepting team, or even you know if you're a leader within a department or an organization, really thinking about how information flows. So is this unidirectional? And typically, if it is, it's from leadership to employees or preceptor to learner. And what can you do differently to make it more bidirectional or even better yet, led by employees or the learners? So one of the things like with learners I always think about in a topic discussion if I'm talking to, you know who's talking more.

Speaker 2:

It should be the learner right, because that's an opportunity for them to actively, you know, demonstrate. If I'm talking to them, you know they're probably going to tune out at some point out of boredom listening to me chat, I think you know, as you think about that, especially if you're looking at it like employee leadership, but still with students, like you know, make sure if, especially if it's like related to feedback, that you acknowledge that information is being heard and received. I think that that's another key piece of that. And then, if we're thinking about like individual, you know preceptors or preceptors as a team. One thing that I've touched on, but I can't emphasize enough, is really setting clear expectations of learners, and that's probably going to take some work If you think about all of the things that you might have learners do.

Speaker 2:

I mean, I've had students who've been on their first. You know they're told go work up a patient. Well, if you've never worked up a patient, what does that mean? And what does working up a patient in a hospital environment look like compared to an ambulatory care environment? So, and then taking all the tools to document that, whether that's in your syllabus, conversations, you know regular check-in points.

Speaker 1:

Yeah, that all makes really good sense. Lisa, could you do you think it's possible to outline just a simple action plan for listeners who want to start making small changes today?

Speaker 2:

I think really the action plan is to sit down and do an honest self-assessment with yourself. Everyone is going to be at a different place in the journey and there may be things that we've talked about, that you're doing and other things that you're like oh, I've never really thought about that. So I would just encourage you to sit down and be honest. And then the other action plan that I would suggest is just to take time and recognize the hierarchy that exists in our educational system, which can be extremely intimidating for learners. Right, and in pharmacy and in medicine as well, we often use layered learning. So preceptor, pgy2, pgy1, appe, ippe, intern even, and often in that hierarchy there's an understanding of you go to that level up and you don't skip. And so, again, a lot of challenges and taking the opportunity to flatten that wherever possible, make learning a we experience, I think can also help.

Speaker 1:

Yeah, that's a great suggestion. That's a great suggestion. This has been really helpful. I think you've given a really good picture of you know what that, what the concept of psychological safety is, the the positive benefits to the learner, the you know the risks to the learner if we don't foster that kind of environment, and I really appreciated your personal story, so thanks for sharing that.

Speaker 2:

Yes, glad.

Speaker 1:

Thanks for letting me share my widely embarrassing story of failure with all of your listeners. If you were going to leave one thing with listeners today, what's the one thing they could do to make a positive difference right away?

Speaker 2:

I have to pick two, but I'll make them short and sweet. Always invite questions and normalize failure. Love it. Those would be my two.

Speaker 1:

Perfect, that's perfect. Well, thank you so much, lisa, for having this conversation with me today and also for creating the full course, which I'll link in the show notes. I think we have a couple of great resources here for folks to really start making a difference in the learning environments that they're providing. So thank you.

Speaker 2:

You're welcome. Thanks for having me. It was a great time to get to chat with you and hopefully educate your listeners a little bit more on psychological safety.

Speaker 1:

I hope you found some great takeaways from my conversation with Lisa. If you'd like more education on this or related topics, check out the show notes for a link to the full course. Remember to check out the full library of preceptor by design courses available for preceptors on the CE impact website and be sure to ask your experiential program director or residency program director If you are a member, so that you can access it all for free. If you are a member, don't forget to claim your CE for today's episode. Thanks again for listening and I'll see you next time on precept to Practice.