Safe Risk: Psychological Safety in Clinical Simulation. A Narrative Review.
DOI:
https://doi.org/10.22201/fm.30617243e.2026.6.119Keywords:
psychological safety, clinical simulation, experiential learning, debriefing, simulation-based educationAbstract
Psychological safety has emerged as a critical factor in clinical simulation, where students participate in realistic scenarios while managing vulnerability and performance anxiety. Despite its recognized importance, understanding of how it operates specifically in clinical simulation remains fragmented. Objective: To provide an integrated understanding of the current state of knowledge about psychological safety in clinical simulation through narrative review. Methodology: Narrative review with structured searches in six databases (PubMed/MEDLINE, Google Scholar, LILACS, SciELO, DOAJ and ERIC) during 2015-2025. Research articles, review articles, and commentaries on psychological safety in clinical simulation were included. The synthesis followed a thematic approach at four levels: descriptive, conceptual, practical and critical. Results: Twenty-nine studies were included showing significant increase during 2023-2025 (55.17%). Geographic distribution showed concentration in the United States (23.07%) and Canada (17.94%). Edmondson's (1999) definition was adopted by 22 studies. Strategies were organized into three phases: prebriefing, simulation and debriefing. The main barrier was fear during evaluations (68.97%). Sixty-two percent identified significant correlations between psychological safety and learning satisfaction. Conclusions: Psychological safety constitutes a fundamental component of the educational ecosystem in clinical simulation. Research builds on Edmondson's framework, adapting it to health sciences education. Three-phase strategies provide a practical framework for implementation. Future directions include cross-cultural research, longitudinal studies and exploration of transfer to real clinical practice.
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