HealthEd: Empathy, Psychological Safety, and Confidence in the Return to Classroom-Based Learning

Empathy, Psychological Safety, and Confidence in the Return to Classroom-Based Learning

Amin Azzam
Published on Sep 25, 2023. Updated on Oct 24, 2023.

In today's Osmosis by Elsevier blog, Dr. Amin Azzam addresses the challenges of returning to the classroom during the post-pandemic era, emphasizing the need for psychological safety, clear communication with learners, and the importance of empathy.

I'm writing this during the busy "back-to-school" season in both my personal and professional lives. While my kids are busy figuring out school supplies, class schedules, and which friends will be in their classes, I'm gearing up to return to the health professional classroom setting. Though we're not out of it just yet, this fall feels like the closest we've been to "post-pandemic." But what does it mean to return to classroom settings? As a health professions educator who just happens to be a psychiatrist, I'd like to share my perspectives on empathy, psychological safety, and what it means to be confident returning to classroom settings.

Let's start with psychological safety. I am a part-time simulation educator at Samuel Merritt University, an all-health-sciences multi-campus university in the San Francisco Bay Area. In simulations, we focus on ensuring both physical and emotional safety for everyone involved (action learners, observer learners, simulated patients, sim tech specialists, and simulation faculty). A keystone manuscript in the simulation literature defines minimum best practices to establish a safe container for simulation-based learning (Rudolph, Roemer & Simon 2014). One of those key elements is psychological safety, which includes:

  • Assuming students are intelligent, want to improve, and care about doing their best
  • Encouraging students to make a reciprocal assumption that the simulation team is about "We got ya'" rather than "Gotcha!"
  • Declaring that the inevitable mistakes are not crimes to be punished but rather puzzles to be solved

It strikes me that these key elements can easily be applied to classroom settings as well (large group lectures, small groups, and lab-based sessions). My key message is to make these implicit assumptions more explicit with your learners, both in your written communications (e.g., syllabi, class discussion board postings, etc.) and your oral communications (e.g., announcements at the beginning of class sessions).

I presented a version of this blog as a webinar in March 2023. At the time, we were beginning to see educational programs return to in-person classroom synchronous learning. Through the Osmosis by Elsevier Medical Education Fellowship (OMEF) and Osmosis by Elsevier Nursing Student Ambassador (ONSA) programs, I surveyed students around the globe to assess their sense of safety returning to classrooms. Of course, this is a non-representative convenience sample, but we did have student responses from across program type, years in training, and countries of study. Here are some key findings:

I shared these results with the mostly health professions educator audience during the webinar and then polled them for their sense of safety returning to classroom settings. Understanding individual variation, one would expect faculty members to generally be older and, by definition, more medically complex than their mostly younger and healthier student population. Here are the results:

While these results merely represent a snapshot in time in March 2023, they suggest that at least while the pandemic remains in our sights, there will remain wide variation in the sense of safety in classroom settings.

This leads to the third concept in the title: empathy. One definition I like is the ability to understand and share the feelings of another" (Oxford English Dictionary, 2023). As we increasingly return to synchronous onsite learning experiences, it behooves us to remember to bring our "empathy supplies" with us in our backpack of school materials. 

In my clinical work in an outpatient building at the UCSF Department of Psychiatry & Behavioral Sciences, we have visible signs around masking guidelines. They remind me daily that the mask requirement (no matter my personal feelings) is helping my patients, and it helps assure them they are in a safe space. 

Speaking of which, when I'm on the subway, I've noticed how many people wear masks these days. There is a surge happening in my area, but the presence of masks in public places makes me hopeful that they will one day become commonplace, especially if you're feeling sick but can't stay home. This is certainly true in other more collectivist countries. Similar to the ubiquitous use of gloves and hand gel in healthcare settings, one day, we might treat these infection control measures as acts of service and part of the routine empathy of being humans. That can be true as much outside of healthcare as it currently is within.

I've heard a framework for the pandemic that I find useful. We had the “Before Coronavirus” (BC) era, the “During Coronavirus” (DC), and now the “kinda-after-coronavirus” (KAC) era. While we patiently wait for COVID to become endemic, let's remember that there will always be disproportionate risk to some people. As we return to synchronous classroom settings, remember your empathy and psychological safety so we can all be confident in the sacred teaching and learning spaces we're privileged to be a part of.

Interested in how Osmosis by Elsevier can support clinical education in your program? Schedule a call today. 

About the Author

Dr. Amin Azzam, MD, MA, Health Sciences Clinical Professor at the UCSF School of Medicine, Director of Open Learning Initiatives, and Lead Faculty Advisor at Osmosis by Elsevier, shares his expertise on the importance of Wikipedia editing, how it can help fight medical misinformation, and how it can improve the public's trust in science when integrated into formal education programs.


Rudolph, Roemer & Simon (2014): Establishing a safe container for learning in simulation—the role of the pre-simulation briefing. Simulation in Healthcare 9 (6): 339 – 349]

Oxford English Dictionary (2023). Empathy. In Oxford English Dictionary (Online Edition). Oxford University Press.