Table 1.

Key strategies to ensure a safe simulation environment for communication skills training

Have dedicated faculty champion(s) whose focus is to develop a rapport with the learners, set the tone for the simulation encounters, debrief with faculty and with learners after the simulation encounters.

Ensure buy-in from the program director and other clinical leaders in the training program.

Ensure that the learners have space and time for reflection both before and after the simulation encounter (e.g., we used a conference room where instructions and schedules were written out, we minimized clinical interruptions during the simulation encounters by ensuring our fellows were excused from their clinical rotations).

Provide learners with ground rules to help to set expectations.

Emphasize that the simulation is learner-centered (e.g., the simulations were introduced to our learners as an opportunity for them to practice their communication skills; they were encouraged to invent any clinical details about the case they believed were appropriate).

Explain the role of the faculty evaluator (e.g., the faculty evaluator will not tell you what to do; they will provide you feedback and debrief with you at the end of the simulation).

Provide learners with mechanisms to respond to intrasimulation crisis (e.g., we instituted a Time Out option that the learners were encouraged to use to stop the simulation for any reason, including such things as anxiety, feeling beyond their comfort zone, etc.).

Provide faculty evaluators with ground rules about feedback and debriefing.

Feedback is learner centered (e.g., we asked the learner to name one or two things they did well, then asked them to name one or two things they could have done better).

Feedback is specific (e.g., we used the observable communication tasks developed for each case to ground feedback).

Encourage faculty evaluators to listen actively and to invite reflections from learners.