Growth, Engagement, and Belonging in the Clinical Learning Environment: the Role of Psychological Safety and the Work Ahead.

Psychological safety is the perception that an environment is safe for interpersonal risk taking, exposing vulnerability, and contributing perspectives without fear of being shamed, blamed, or ignored. The presence of psychological safety has been associated with improved team learning and innovation, leader inclusivity, and team members' sense of belonging. In medical education, psychological safety has additional benefits: it allows learners to be present in the moment and to focus on the tasks at hand, and reduces trainee focus on image. Several key features of psychologically safe environments have already been described, including the presence of high-quality relationships, the absence of social positioning, a learner-driven and flexible learning agenda, the lack of formal assessment, and time for debriefing. However, many of the structures and cultural traditions in medical education are in clear opposition to these features. This paper describes the current barriers to psychological safety in medical education, and sets out an agenda for change. In accordance with benefits seen in other sectors, we anticipate that an emphasis on relationships and psychological safety will support the learning, inclusion, and success of medical trainees.