Quick and Easy Guide to Creating a Safe Learning Environment

Learning environment (according to Wikipedia!) encompasses “an educational approach, cultural context, or physical setting in which teaching and learning occur... the context of educational philosophy or knowledge experienced by the student….how individuals interact, governing structures, and philosophy. … The culture and context of a place or organization includes such factors as a way of thinking, behaving, or working, also known as organizational culture. “

Learning Climate is more focused – this is the tone or atmosphere of the teaching setting and whether learners can comfortably identify and address their limitations. It is the backbone of any learning experience. Think about it, if you as a learner are focused on protecting yourself from criticism, feelings of shame or inadequacy, or even progression in your training, there is not much mental energy left over for actual learning. There are a lot of factors that go into a learning climate – physical space, clinical pace and volume, scheduling, and others things that may not be under your control as a teacher. Here’s the good news…the attitude, actions and behaviors of the supervisor/teacher are the largest contributor to a medical student or residents’ experience of a learning climate. And this is under your control.

Basic Truths about Learning Climate 

  • Learning is more effective in the absence of fear, shame or humiliation
  • Positive learning climate is associated with greater patient safety and learner/team well-being 
  • If given instructions by supervisor to do something in error, learners are less likely to speak up in the presence of 
    • Lack of explicit instruction to speak up or ask questions 
    • Supervisor impatience 
    • Steep power hierarchy 
      • And learners’ perception of the power/status differential between 
        themselves and attendings is much greater than supervisors

Cultural/Organizational Characteristics of a Safe Learning/Work Environment

  • Freedom to take risks (speak up)
    • Speaking can mean sharing an idea, being honest with formative feedback, 
      pointing out if someone is getting ready to cut off the wrong leg, speaking up if 
      someone is making discriminatory or unkind comments…
  • Respect for divergent opinions
  • Fair and Reasonable Standards 
  • Clarity about what to expect
  • Perceived accuracy of performance feedback and assessment 
  • Level of commitment to a common purpose 
  • Clarity people have about mission and values
  • Set clear and consistent expectations
  • Keep learners stimulated
    • Show enthusiasm
    • Show interest via body language
    • Use an animated voice
  • Keep learners involved
    • Look at them
    • Listen to them
    • Encourage them to set individual learning goals
    • Encourage them to participate
    • Avoid monopolizing the conversation
  • Show Respect
    • Make introductions, address learners by name
    • Actively encourage learners to speak up/take risks/ask questions
      • Reinforce positively when they do (this is key)
    • Show respect for divergent positions 
    • Avoid ridicule; don’t interrupt
    • Be aware of our implicit bias
  • Provide focused, behaviorally based feedback
  • Be consistent in your interactions and behaviors…even if you are having a bad day
    • Demonstrate Emotional Self-regulation
  • Be calm, kind and patient
    • Laugh
  • Let learners know it’s OK to not know something 
    • State explicitly and role model it!
    • Invite learners to discuss their own problems/limitations/errors

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Musselman, et al. Medical Education 2005;39:926-934
Bould, et al. Can J Anesth March 2015; 62. 
Van Vendeloo, et al. Bone Joint J 2014;96-B:1133-8. 
Vaughn and Baker Medical Education 2004;38:1053-1060 
Salazar et al. J Am Coll Surg 2014;219:1001-1009 
Goleman D. Harvard Business Review 2000 
Stanford faculty development Center 2012