From the Virginia Commonwealth University School of Medicine, Richmond, Virginia.
J Patient Saf. 2022 Jun 1;18(4):370-375. doi: 10.1097/PTS.0000000000000927. Epub 2021 Sep 27.
To develop physicians who can practice safely, we need better understanding of how the clinical learning environment affects trainee well-being. Two psychosocial constructs may help us understand the context: psychological safety (belief one can speak up without concerns) and perceived organizational support (degree to which members feel that their organization cares for them and values their contributions). The objective of this study is to test a moderated mediation model to determine how humiliation (X) impacts trainees' well-being (Y) while taking into account psychological safety (mediator) and organizational support (moderator).
Between May and June 2018, a single health system recruited resident physicians across 19 programs to complete an anonymous electronic survey to assess facets of the clinical learning environment, well-being, and experiences of humiliation. In a moderated mediation analysis, mediation helps explain how a predictor variable (X) impacts an outcome variable (Y) through a mediating variable, whereas moderation helps explain under what conditions such a relationship exists.
Of 428 residents, 303 responded (71%) to the survey across 19 training programs. The effects of humiliation on well-being were mitigated by psychological safety, which varied depending on the levels of perceived organizational support. Environments rated 1 SD below the mean on perceived organization support by residents had a stronger negative impact of public humiliation on psychological safety.
The findings suggest that humiliation is associated with well-being through the effects of psychological safety and influenced by organizational support. Further work might explore the relationship by investing resources (e.g., faculty development, mentorship) to increase psychological safety and reduce humiliation during training, especially within environments prone to be perceived as unsupportive of trainees.
为了培养能够安全行医的医生，我们需要更好地了解临床学习环境如何影响学员的健康。两个社会心理结构可以帮助我们理解这种关系：心理安全感（相信自己可以畅所欲言而不必担心）和感知组织支持（成员感受到组织对他们的关心以及对他们贡献的重视程度）。本研究的目的是检验一个调节中介模型，以确定羞辱（X）如何在考虑心理安全感（中介）和组织支持（调节）的情况下影响学员的健康（Y）。
在 2018 年 5 月至 6 月期间，一个单一的医疗系统从 19 个项目中招募住院医师完成一项匿名电子调查，以评估临床学习环境、健康和羞辱经历的各个方面。在调节中介分析中，中介有助于解释预测变量（X）如何通过中介变量影响结果变量（Y），而调节有助于解释在什么条件下存在这种关系。
在 428 名住院医师中，有 303 名（71%）在 19 个培训项目中对调查做出了回应。羞辱对健康的影响被心理安全感所缓解，而心理安全感取决于感知到的组织支持的水平。居民对感知到的组织支持的评价比平均值低 1 个标准差的环境中，公开羞辱对心理安全感的负面影响更强。
这些发现表明，羞辱通过心理安全感的影响与健康相关，并受到组织支持的影响。进一步的研究可能会通过投资资源（如教师发展、指导）来增加心理安全感和减少培训期间的羞辱，特别是在那些被认为对学员缺乏支持的环境中，来探索这种关系。
