The impact of single- and multiple-learner format on perceived level of comfort and psychological safety in healthcare simulation

Introduction Healthcare simulation and debriefing practices are optimal tools in health professions education and rely on a well-built psychologically safe construct for effectiveness and success. However, it is not well understood how differences working in solo or group scenarios impact learner preferences on learning outcomes and maintenance of psychological safety. This study aimed to uncover the sentiment of learners towards comfort with engaging in healthcare simulation through factors that confer psychological safety. These sentiments were examined in relation to satisfaction with achievement of learning objectives. The ability to leverage solo or group participants as an intentional design feature has implications for creators of simulation curricula. With intentionality, the determination of participant number for simulation-based education may prove to enhance individualized growth while supporting a psychologically safe environment that carries through to the debriefing phase. Methods This was a cross-sectional, observational study involving nurses and medical residents. Surveys were conducted using demographics, Likert-style questions and free-text responses. One hundred seventy-one learners participated. The primary outcome was perceived level of comfort by the participant. Secondary outcomes were participant preference, perceived psychological safety, self-confidence, conduciveness to learning, anxiety and realism to actual patient care. Results One hundred seventy-one participants were enrolled. Respondents who experienced both solo and group learner scenarios were compared to those who experienced group scenarios only. Those who experienced both scenarios reported a strong association with overall level of comfort, satisfaction with scenario outcome, ability to make educated guesses and take risks (gamma > 0.3). Increased comfort with both scenario structures was strongly associated with an increasing number of simulation experiences. Discussion Participants of healthcare simulation endorsed high levels of comfort and favourable components of psychological safety when past experiences included a combination of both modalities. Curriculum development with a purposeful design decision to incorporate both modalities may maximize learner outcome, target debriefing considerations and demonstrate the psychological safety link existing within the educational design.