School of Education


Doctor of Philosophy in Education (PhD)


Janice Kooken


healthcare simulation, psychological safety, team cohesion, stress in simulation, medical education




The purpose of this quantitative, experimental pretest, posttest control group design was to examine if the level of psychological safety a student arrives with to a high-fidelity simulation is predictive of their stress and psychological safety levels after a simulation event. Because recent research has found inconsistencies in the goals of the prebriefing phase of a simulation learning event, there exists 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 preexisting 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. To measure these items, this study used the Psychological Safety in High-Fidelity Simulation (PSHFS) scale, the Group Cohesion Scale (GCS), and the PSS through a combination of pretest and posttest electronic surveys. The data were analyzed using multiple regression and showed that preexisting psychological safety scores were a significant predictor for both postsimulation stress and psychological safety scores. However, team cohesion and the treatment intervention were not significant predictors. This research suggested the level of psychological safety a learner arrives with to a simulation may have a more significant influence than originally thought in previous research. Future research should explore if elements of providing psychological safety in the prebriefing are exchangeable based on a learner’s preexisting psychological safety.

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