Psychological safety in the clinical learning environment: exploring the discrepancies between faculty members’ and trainees’ experiences and perspectives in a pediatric residency program in Canada

Abstract

Background: Psychological safety (PS) is an issue of growing interest and remains a relatively unfamiliar concept in health professions education. Exploring the construct may help medical educators working on the clinical teaching units (CTU) improving PS in the clinical learning environment (CLE), aligning their behaviors towards PS and, therefore, improve trainees learning and experience. Objective: The objective of this research project is to explore the discrepancies between residents’ and faculty members’ perspectives and experiences about PS in the CLE of a general pediatric residency program in Canada. Methods: The project was based on a mixed-method, sequential design. First, a survey targeting residents and attendings from one pediatric teaching hospital was conducted, utilizing a validated instrument on PS and related organizational characteristics. Following, semi-structured individual interviews were conducted with participants from the same population, selected using purposeful sampling. Questions based on the quantitative survey results were embedded in the semi-structured interview guide as a point of interface between both components. Thematic analysis was used to explore and organize participants’ perspectives and experiences about PS. Results: Nineteen residents in pediatrics and 21 attendings participated in the survey. No statistically significant differences were found between both groups. Twelve people, 6 residents and 6 pediatricians, participated in the individual interviews. Four themes were identified as areas of potential discrepancies between both groups: (1) Organization, roles and hierarchy on the CTU; (2) Attending’s leadership and approach on the CTU; (3) Evaluation paradigm on the CTU; and (4) Culture and climate in the CLE. We described how these themes were related to the perspectives and experiences from both groups, in regard to the main dimensions of PS. Conclusion: In this exploratory research project, we have enriched the construct of PS by targeting issues specific to medical education in clinical settings by describing 4 areas where discrepancies can be found between residents’ and attendings’ experiences and perspectives about the construct on the CTU: (1) Organization, roles and hierarchy; (2) Attending's leadership and approach; (3) Evaluation paradigm and (4) Culture and climate.