Medical Students' and Faculty's Perceptions of Psychological Safety in the Core Clerkships: Experience From Harvard Medical School and Faculty of Medicine, Universitas Indonesia

Abstract

Background: Psychological safety describes people's perceptions of feeling safe to take interpersonal risks. The medical education literature encourages educators to foster a psychologically safe environment, but few studies explore what educational approaches create psychological safety in clinical clerkships. This study aimed to characterize psychological safety in clinical clerkships in two medical schools in different cultural contexts, Harvard Medical School (HMS) and Universitas Indonesia (UI). Method: We carried out a mixed-methods study at HMS and UI. We distributed an online survey using Edmondson's psychological safety scale to measure students' psychological safety. We then conducted semi-structured interviews of students and faculty. We transcribed the interviews verbatim and analyzed them using qualitative content analysis. Results: Survey results indicated that for HMS and UI students' psychological safety did not significantly differ. Students and faculty in each school also shared a similar understanding of the construct of psychological safety. Students and faculty reported that students learn better in psychologically safe environments. Both students and faculty described that students feel psychologically safe in their clerkships when students feel they are able to have their concerns addressed, to act without fear, and to not be preoccupied with portraying themselves as competent. Differences between the two schools appeared in the factors participants described that influence students' psychological safety, including social, personal, and organizational factors. Discussion and Conclusions: We described the construct of psychological safety in a medical school in the US and one in Indonesia and characterized factors that influence psychological safety in these contexts. Study participants at HMS and UI similarly characterized the construct of psychological safety and its consequences even though these schools are located in countries with different cultural values. We consider psychological safety and the factors that influence it through the lens of the cultural context and Hofstede's cultural dimensions framework. Take-home Messages: Psychological safety is a construct that can be determined in medical schools in different cultural settings. Psychological safety may be influenced by a cultural context, and education leaders should consider these factors when formulating culturally appropriate interventions to foster psychological safety.