How video games saved me during the pandemic: A gamer's guide to psychological safety

If there are two things I've learned over the course of the pandemic, it's that, (1) working in a team, virtually, can be mentally taxing, and (2) everyone should play a video game at some point in their life. To understand what I mean, I encourage you to keep reading or skip ahead to A Final Note from the Developer, if you like spoilers. First things first, you can't play a game you know nothing about. Right? For most, psychological safety is a foreign term. In fact, if you had asked me for a definition a little less than a year ago, you would have been met with a puzzled look and nothing more. Lucky for you, I'm here to fill in the gaps so that you don't have to spend as many hours as I did flipping through the literature. The term itself was coined in 1999 by Amy Edmondson, a well-known figure in the world of management and the Novartis Professor of Leadership at Harvard Business School. She described psychological safety as “a shared belief held by members of a team that the team is safe for interpersonal risk taking” [[1]Edmondson A. Psychological safety and learning behavior in work teams.Adm Sci Q. 1999; 44: 350-383Crossref Scopus (5176) Google Scholar]. In a study of 496 employees in a manufacturing company, Edmondson proved that team performance could be predicted by learning behaviour, which is enabled by psychological safety [[1]Edmondson A. Psychological safety and learning behavior in work teams.Adm Sci Q. 1999; 44: 350-383Crossref Scopus (5176) Google Scholar]. Importantly, Edmondson ruled out the possibility of efficacy as the primary mediator between the antecedents of team leader coaching and the outcome of team learning behavior, thereby shifting the focus to psychological safety alone [[1]Edmondson A. Psychological safety and learning behavior in work teams.Adm Sci Q. 1999; 44: 350-383Crossref Scopus (5176) Google Scholar]. At this point, you may be wondering what makes psychological safety such a recommendable game. More likely than not, you've been in a situation where individuals have been labeled as “inadequate” on the sheer basis that they verbalize and contribute too little when placed in a collaborative setting. These situations can take a heavy toll on one's mental health and cause individuals to feel that they are innately flawed, further leading to withdrawal and isolation from the group [[2]Medaille A. Usinger J. Engaging quiet students in the college classroom.Coll Teach. 2019; 67: 130-137Crossref Scopus (11) Google Scholar]. Taking a step back however, a question can be raised regarding the root of this behaviour and why these individuals find it so challenging to share their thoughts with colleagues of the same caliber. More importantly, a conversation can be held regarding the strategies and tools needed to prevent these feelings from seeding and how mental health and well-being can be better supported. Largely, the answer to these concerns can be found in understanding psychological safety and the consequences that occur when there is a lack thereof. In the years following Edmondson's findings, research surrounding psychological safety sprang into effect and implications began to emerge for fields outside of business, such as healthcare and education. To expand further, one interesting and relatively novel method of conceptualizing psychological safety is through the 4 stages described by Timothy R Clarke, which are as follows:Inclusion safety: The sense of belongingness to one's team without a fear of being excluded. Members should feel comfortable, wanted, and appreciated [[3]Clarke T.R. The Four Stages of Psychological Safety. Berrett-Koehler Publishers, 2020Google Scholar].Learner safety: The ability to ask questions and experiment freely. Members should not be afraid to ask for help when needed [[2]Medaille A. Usinger J. Engaging quiet students in the college classroom.Coll Teach. 2019; 67: 130-137Crossref Scopus (11) Google Scholar].Contributor safety: The ability to offer one's own ideas without ridicule. Members should not feel embarrassed or vulnerable when expressing their ideas [[3]Clarke T.R. The Four Stages of Psychological Safety. Berrett-Koehler Publishers, 2020Google Scholar].Challenger safety: The ability to raise concerns and question viewpoints when appropriate. Members should be able to suggest changes to existing ideas or plans [[3]Clarke T.R. The Four Stages of Psychological Safety. Berrett-Koehler Publishers, 2020Google Scholar]. As you continue through from Patches 1.1 to 1.4, you will gain a better understanding of how psychological safety is fostered, what components are involved, and how these ideas are relevant to healthcare as it currently stands. In my personal experience, the average video game has had upwards of 175 unique items for players to use in their quest for victory. Unsurprisingly, one of the most overwhelming parts of playing a new game is learning all of the components involved in building an item. One important thing to remember is that there are different ways of getting you to the desired result and that none of the routes are necessarily superior when compared to the rest; everything is situational. Psychological safety is no different in that many variable approaches have been used by researchers and academics to define how the state is achieved. One of my personal favourites is the CENTRE tool, which stands for confidentiality (with standard limits), equal airtime, non-judgmental (respectful) listening, timeliness, the right to pass, and engagement [[4]Cave D. Pearson H. Whitehead P. Rahim-Jamal S. CENTRE: creating psychological safety in groups.Clin Teacher. 2016; 13: 427-431Crossref PubMed Scopus (12) Google Scholar]. Interestingly, this pragmatic mnemonic was developed with a focus on clinical team functioning and has since been used to navigate a wide variety of circumstances, such as clinical family meetings, mentorships, and other professional arrangements [[4]Cave D. Pearson H. Whitehead P. Rahim-Jamal S. CENTRE: creating psychological safety in groups.Clin Teacher. 2016; 13: 427-431Crossref PubMed Scopus (12) Google Scholar]. As stated by the developers, the tool was created with the goal of providing flexibility in a time-pressured environment and clinicians are encouraged to freely modify the guidelines according to the specific needs of their group [[4]Cave D. Pearson H. Whitehead P. Rahim-Jamal S. CENTRE: creating psychological safety in groups.Clin Teacher. 2016; 13: 427-431Crossref PubMed Scopus (12) Google Scholar]. For instance, the tool may be simplified to ENTER in teams where confidentiality is not a primary concern, or may be changed to CENTRE+ in situations where additional guidelines are required to resolve ambiguity [[4]Cave D. Pearson H. Whitehead P. Rahim-Jamal S. CENTRE: creating psychological safety in groups.Clin Teacher. 2016; 13: 427-431Crossref PubMed Scopus (12) Google Scholar]. To further assist you on your quest, the following are various combinations of components that can be used to build psychological safety, thereby establishing a safe space for individual and team mental health and well-being:1.Shared goals + shared knowledge + mutual respect + learning from failure [[5]Carmeli A. Gittell J.H. High-quality relationships, psychological safety, and learning from failures in work organizations.J Org Behav. 2008; 30: 709-729Crossref Scopus (419) Google Scholar].2.Proactive personality + emotional stability + learning orientation [[6]Frazier M.L. Fainshmidt S. Klinger R.L. Pezeshkan A. Vracheva V. Psychological safety: a meta-analytic review and extension.Pers Psychol. 2017; 70: 113-165Crossref Scopus (327) Google Scholar].3.Inclusive leadership + leader member exchange + transformational leadership + trust in leadership [[6]Frazier M.L. Fainshmidt S. Klinger R.L. Pezeshkan A. Vracheva V. Psychological safety: a meta-analytic review and extension.Pers Psychol. 2017; 70: 113-165Crossref Scopus (327) Google Scholar].4.Safety and autonomy + interdependence + role clarity + supportive work context [[6]Frazier M.L. Fainshmidt S. Klinger R.L. Pezeshkan A. Vracheva V. Psychological safety: a meta-analytic review and extension.Pers Psychol. 2017; 70: 113-165Crossref Scopus (327) Google Scholar].5.Framing the work as a learning problem + acknowledging your own fallibility + modeling curiosity [[7]Edmondson A. Building a Psychologically Safe Workplace. Harvard Graduate School of Education Cambridge, 2014https://www.youtube.com/watch?v=LhoLuui9gX8Google Scholar].6.Setting the scene for dialogue and candour + educator as ally + a continuing improvement orientation + encouraging interactive dialogue [[8]Johnson C.E. Keating J.L. Molloy E.K. Psychological safety in feedback: what does it look like and how can educators work with learners to foster it?.Med Educ. 2020; 54: 559-570Crossref PubMed Scopus (27) Google Scholar]. In multiplayer games, players are typically given the choice between different classes or roles. Depending on your preferences, you may decide to take on the job of a support player - focused on healing other characters and keeping things working behind the scenes. Alternatively, you may find more enjoyment being a damage dealer - focused on setting up plays and seeing them through. Depending on which role you gravitate towards, your knowledge of the game and how you build items will change drastically. Similarly, the way that psychological safety is implemented will differ depending on the environment you're in and the perspective you're taking. The relevance of this concept is extraordinarily widespread for medical radiation technologists (MRTs) who have not one, but three roles to fulfill: colleague, practitioner, and instructor. It can become a difficult task to establish a safe environment that is inclusive, respectful, and encourages open collaboration for not only their patients and co-workers, but also their successors (students) who will someday shape the field. To better illustrate this, take a minute to reflect on the relationships you have in your own career. In a colleague scenario where an MRT is working with another MRT, studies of healthcare teams have shown that creative team performance and knowledge sharing are predicted by feelings of safety and security, which are fostered by psychological safety [[9]Kessel M. Kratzer J. Schultz C. Psychological safety, knowledge sharing, and creative performance in healthcare teams.Creat Inf Manag. 2012; 21: 147-157Crossref Scopus (174) Google Scholar]. On the other hand, from a student-MRT perspective, an exploratory study has found that when psychological safety is established, it allows medical students to focus on the present moment without having to worry about being judged by their preceptors [[10]Tsuei S.H.T. Lee D. Ho C. Regehr G. Nimmon L. Exploring the construct of psychological safety in medical education.Acad Med. 2019; 94: S28-S35Crossref PubMed Scopus (70) Google Scholar]. That is, supportive relationships with peers and mentors, where one does not feel judged and is free to focus on learning in the present moment, can lead to enhanced relationship building. Finally, from a patient-MRT perspective, it is essential for patients to feel that they can voice their concerns freely when receiving care [[11]Lauren P.E. Vessey J.A. Psychological safety on the healthcare team.Nurs Manag. 2018; 50: 32-38Google Scholar]. This can only be achieved when patients feel psychologically safe in the healthcare setting and with those caring for them. In order to master your role(s), it's imperative that you develop a full understanding of the psychological safety stages described in Patch 1.0 and how these stages intertwine with the needs of your team-mates. While an instructor may focus on learner safety and a practitioner may focus on inclusion safety, a colleague may alternatively choose to focus on contributor safety or challenger safety. Regardless, it is a combination of these perspectives and a shift from task orientation to process orientation that will lead to the most success and progression throughout the game. In case you're unfamiliar with the term, a gaming guild is a group of individuals who chose to form an alliance in the hopes of reaching a shared in-game goal. In some cases, these guilds maintain their relationships for years and even choose to meet up outside of the game they're playing. Most of the time however, guilds only last until the mission has been accomplished and for one reason or another, people decide to distance themselves from the group. If this sounds familiar, chances are that you're thinking of your experiences working interprofessionally. Be it with physicians, receptionists, nursing staff, or other healthcare professionals, it's not uncommon for MRTs to be put into situations where they have to optimize a patient's journey by working collaboratively. As you may recall from Patch 1.0, my first encounter with psychological safety occurred a little less than a year ago - during a structured interprofessional education course. At the time, I was still a first-year radiation therapy student struggling to find her place in a program that predominantly took place through computer screens and pre-recorded lectures. Given that I had spent the last 4 years establishing an identity reliant on developing interpersonal relationships and sharing meaningful in-person experiences with one another, the circumstances were not ideal. Often, I felt isolated by the nature of online schooling and felt that I lacked the social support I had grown accustomed to. I found my mental health and general wellbeing declining as the pandemic progressed. Luckily, my first round of clinical placements brought about the opportunity to take part in a non-mandatory, 5-week long program with students across various healthcare fields. To me, this opportunity sounded like a safe haven; the type of environment I found myself returning to time and time again during my undergraduate career. The topic? Psychological safety. To be frank, I had decided to partake in this experience solely for the purpose of meeting new individuals and to escape from the mundane routines of living through a pandemic. What I didn't expect was to resonate with the topic of the program so deeply, to feel and see myself emerging from a mental slumber, and to simultaneously gain five new friends across my social media platforms. Importantly, it was the psychological safety that was established and felt through this group that set us apart from the average guild. Having gone through this experience, I offer you the following advice when joining a guild. 1. Start off with introductions of who you are beyond your role (see patch 1.2 for more on character roles). 2. Have a shared goal, but don't let it be the only thing you talk about. 3. Trade items and see what is most beneficial for the group, as a whole (see patch 1.1 for more on item recipes). You see, joining a guild isn't hard. In fact, it's almost a daily occurrence for most players. The key, however, is understanding that the effort you put into making a connection is the same effort you'll receive back from your peers. And this starts with establishing a safe space. Every now and then, video game companies will keep their player base engaged by adding a few new updates to the game. While these changes can be small, there are times when the update will be as big as adding an entirely new map or character to the game. That said, the COVID-19 pandemic has been one of the most pivotal changes to date. As referenced in Patch 1.3, the pandemic has made it extraordinarily different for players to interact with one another, but please note that the word different is not synonymous with the word unfavourable. As with any change that occurs, humans have a tendency to resist and protest against the unfamiliar [[12]De Val M.P. Fuentes C.M. Resistance to change: a literature review and empirical study.Manag Decis. 2003; 41: 148-155Crossref Scopus (265) Google Scholar]. Indeed, if you were to scour the internet for reviews of any major game update that has occurred in the last century, you're likely to be met with negative reviews and comments from players who have found comfort in understanding their game inside and out. Likewise, the arrival of the pandemic has been met with protest and outrage from students and educators alike. What is important to note here is that game updates are an opportunity to adapt and expand your existing skill set in a stimulating way. Though these updates often prove to be challenging, viewing them as solely negative events will only limit your growth as a player. For instance, the popularization of Zoom as a virtual conferencing platform has introduced us to a unique set of tools that completely alter our understanding of how a meeting or learning can be delivered. In order to maintain psychological safety under these conditions, one must evaluate the benefits and consequences of these tools and explore their relationship to the concepts presented in the Patches thus far. Below, you will find a brief summary of the functionalities in question. It should be noted that the list is not exhaustive and does not take into account the social and individual challenges involved with the use of virtual conferencing platforms. As an example, broadband connectivity and access to appropriate technology devices continue to be lingering issues [[13]Eruchalu C.N. Pichardo M.S. Bharadwaj M. Rodriguez C.B. Rodriguez J.A. Bergmark R.W. Bates D.W. Ortega G. The expanding digital divide: digital health access inequities during the COVID-19 pandemic in New York City.J Urban Health. 2021; 98: 183-186Crossref PubMed Scopus (78) Google Scholar]. And, although many virtual conferencing platforms offer enableable captions through auto-live transcription, the function may not sufficiently support all users living with hearing or visual impairments [[14]Saldanha K. Currin-McCulloch J. Muskat B. Simon S.R. Bergart A.M. Mesbur E.S. Guy D. Kelly D. Turning boxes into supportive circles: enhancing online groupwork teaching during the COVID-19 pandemic.Soc Work Groups. 2021; 44: 310-327Crossref Scopus (6) Google Scholar].Raise-hand: While this function does provide the opportunity for orderly speech and conduct, it may also lead to “false negative” results when participants are uncomfortable with singling themselves out during a discussion. In these situations, an anonymous poll or yes/no function may be preferred [[15]Edmondson A.C., Daley G. How to foster psychological safety in virtual meetings. Harv Bus Rev. 2020;25. https://hbr.org/2020/08/how-to-foster-psychological-safety-in-virtual-meetings Accessed January 31, 2022Google Scholar].Yes/No: This function is beneficial in the sense that it allows for quick input and provides an opportunity for missing voices to participate in discussion. However, not all questions have a binary answer and therefore, the voice, poll, or chat tools may be preferential when the topic is more complex [[15]Edmondson A.C., Daley G. How to foster psychological safety in virtual meetings. Harv Bus Rev. 2020;25. https://hbr.org/2020/08/how-to-foster-psychological-safety-in-virtual-meetings Accessed January 31, 2022Google Scholar].Polls: Unlike the raise-hand function, polls provide anonymity and prevent individuals from feeling singled out. Furthermore, the results of the poll can be easily followed with continued dialog, brainstorming, or action planning [[15]Edmondson A.C., Daley G. How to foster psychological safety in virtual meetings. Harv Bus Rev. 2020;25. https://hbr.org/2020/08/how-to-foster-psychological-safety-in-virtual-meetings Accessed January 31, 2022Google Scholar].Chat: Beneficially, the chat function allows participants to contribute at their own pace and to address issues regardless of whether or not the conversation has taken a different direction. However, messages may be lost when there are several responses and may also distract the primary speaker from the present conversation [[15]Edmondson A.C., Daley G. How to foster psychological safety in virtual meetings. Harv Bus Rev. 2020;25. https://hbr.org/2020/08/how-to-foster-psychological-safety-in-virtual-meetings Accessed January 31, 2022Google Scholar].Breakout rooms: As often observable in educational settings, breakout rooms provide an environment to test ideas, build relationships, and grow confidence. Oftentimes, participants feel that they are able to speak more freely when placed in groups of 3-5 [[15]Edmondson A.C., Daley G. How to foster psychological safety in virtual meetings. Harv Bus Rev. 2020;25. https://hbr.org/2020/08/how-to-foster-psychological-safety-in-virtual-meetings Accessed January 31, 2022Google Scholar].Video: The use of video conferencing can be beneficial in that it more closely simulates in person interactions by allowing for, non-verbal cues such as facial expressions and hand gestures [[14]Saldanha K. Currin-McCulloch J. Muskat B. Simon S.R. Bergart A.M. Mesbur E.S. Guy D. Kelly D. Turning boxes into supportive circles: enhancing online groupwork teaching during the COVID-19 pandemic.Soc Work Groups. 2021; 44: 310-327Crossref Scopus (6) Google Scholar,[16]Castelli F.R. Sarvary M.A. Why students do not turn on their video cameras during online classes and an equitable and inclusive plan to encourage them to do so.Ecol Evolut. 2021; 11: 3565-3576Crossref PubMed Scopus (138) Google Scholar. Additionally, when actions are immediately observable, participants are forced to focus and engage with the session more closely, thereby creating a sense of connectedness [[14]Saldanha K. Currin-McCulloch J. Muskat B. Simon S.R. Bergart A.M. Mesbur E.S. Guy D. Kelly D. Turning boxes into supportive circles: enhancing online groupwork teaching during the COVID-19 pandemic.Soc Work Groups. 2021; 44: 310-327Crossref Scopus (6) Google Scholar]. However, it is also important to note that too much stimuli can be overwhelming or distracting. In turn, this may create difficulties in reading social cues due to increased cognitive load. Finally, the use of the video tool may also increase self-consciousness and inhibit psychological safety for those who are uncomfortable with seeing themselves on camera [[15]Edmondson A.C., Daley G. How to foster psychological safety in virtual meetings. Harv Bus Rev. 2020;25. https://hbr.org/2020/08/how-to-foster-psychological-safety-in-virtual-meetings Accessed January 31, 2022Google Scholar] or who are impacted by varying living conditions [[14]Saldanha K. Currin-McCulloch J. Muskat B. Simon S.R. Bergart A.M. Mesbur E.S. Guy D. Kelly D. Turning boxes into supportive circles: enhancing online groupwork teaching during the COVID-19 pandemic.Soc Work Groups. 2021; 44: 310-327Crossref Scopus (6) Google Scholar,[16]Castelli F.R. Sarvary M.A. Why students do not turn on their video cameras during online classes and an equitable and inclusive plan to encourage them to do so.Ecol Evolut. 2021; 11: 3565-3576Crossref PubMed Scopus (138) Google Scholar.Audio-only: In purely audio-based meetings, misinterpretations may occur when silences are confused with agreement and therefore, extra care is required to ensure that participant voices are heard [[15]Edmondson A.C., Daley G. How to foster psychological safety in virtual meetings. Harv Bus Rev. 2020;25. https://hbr.org/2020/08/how-to-foster-psychological-safety-in-virtual-meetings Accessed January 31, 2022Google Scholar]. Taken together, the COVID-19 update has drastically changed the process of team functioning and how one can establish psychological safety. However, these changes present us with an opportunity to acquire new skills and to further develop our in-game characters. Thereby, returning control back to the user. Congratulations on reaching the end of How Video Games Saved Me During the Pandemic: A Gamer's Guide to Psychological Safety! Evidently, this concept has been, and continues to be, a vital aspect of team functioning. For many, psychological safety is a foreign term and somewhat difficult to fully identify with. Despite this, the value of psychological safety is clearly indicated in situations where individuals feel excluded, restricted, or unappreciated within their teams. I can say this with confidence because I have experienced it myself, on multiple occasions. Luckily, I've also been able to navigate through these situations using the strategies outlined above. Bearing that in mind, this guide was developed with the goal of relating the concept of psychological safety to an existence that has likely infiltrated its way into numerous lives during the pandemic and the ensuing social isolation - video games. For me, video games have always been an outlet to turn to when overrun with stress. In many ways, the mental relief I gain when playing a video game is parallel to that of the security I feel when psychological safety has been implemented in my environment. That said, I hope that you were able to take away something new from reading this guide and encourage you to venture into uncharted lands with the knowledge you have gained. In short, game on!