A.H. McClintock is assistant professor of medicine, University of Washington, Seattle, Washington.
T.L. Fainstad is associate professor of medicine, University of Colorado Anschutz School of Medicine, Aurora, Colorado.
Acad Med. 2022 Nov 1;97(11S):S46-S53. doi: 10.1097/ACM.0000000000004913. Epub 2022 Aug 9.
Psychological safety is the perception that a group environment is safe for interpersonal risk taking, exposing vulnerability, and contributing perspectives without fear of negative consequences. The presence of psychological safety has been tied to wellness, retention, and inclusiveness. National data demonstrate that many of the fundamental components of psychological safety are lacking in clinical learning environments. There is evidence that leadership behaviors can create psychological safety in traditional work environments. The authors sought to understand how clinical teachers' leadership behaviors can create, destroy, and rescue psychological safety in the clinical learning environment.
This was a multicenter, cross-sectional, qualitative study of fourth-year medical students from 2 institutions using semistructured interviews. Verbatim transcripts underwent constant comparison and iterative data reduction and analysis, continuing beyond thematic sufficiency.
Eighteen students participated in interviews. Participants described key themes of relationships, an emphasis on learning, clear expectations, autonomy, and frequent feedback as promoting psychological safety. Safe environments lead to a sense of belonging and agency. They reported educator disinterest in students, dismissal of questions, lack of autonomy, and unclear expectations as destructive of psychological safety. Unsafe environments lead to withdrawal and a high extraneous cognitive load. Most students were unable to describe a time psychological safety was restored if lost.
Clinical teachers' leadership behaviors can directly impact students' perception of psychological safety in the clinical learning environment. Psychological safety increases students' sense of belonging, self-efficacy, and engagement. The findings demonstrate that while it is difficult to repair an atmosphere that is psychologically unsafe, there are several actions that can be put into motion early on to ensure the learning environment is safe and remains so. Future research should investigate whether psychologically safe environments lead to meaningful differences in assessments of student learning and effective cultural change.
心理安全感是一种认知，即一个群体环境对于人际风险承担、暴露脆弱性和贡献观点是安全的，而不会担心负面后果。心理安全感的存在与健康、保留和包容性有关。国家数据表明，许多临床学习环境中缺乏心理安全的基本组成部分。有证据表明，领导行为可以在传统工作环境中创造心理安全感。作者试图了解临床教师的领导行为如何在临床学习环境中创造、破坏和挽救心理安全感。
这是一项多中心、横断面、定性研究，来自 2 所机构的四年级医学生参加了半结构化访谈。逐字记录的文字记录经过不断比较和迭代数据缩减和分析，直至达到主题充分性。
18 名学生参加了访谈。参与者描述了促进心理安全感的关键主题，包括关系、强调学习、明确的期望、自主权和频繁的反馈。安全的环境会产生归属感和代理权。他们报告说，教育者对学生不感兴趣、对问题不屑一顾、缺乏自主权和期望不明确会破坏心理安全感。不安全的环境会导致学生退缩和认知负担过重。大多数学生无法描述心理安全感丧失后如何恢复。
临床教师的领导行为会直接影响学生对临床学习环境中心理安全感的感知。心理安全感增加了学生的归属感、自我效能感和参与度。研究结果表明，虽然修复心理不安全的氛围很困难，但有几种措施可以及早采取，以确保学习环境安全并保持安全。未来的研究应调查心理安全环境是否会导致学生学习评估和有效文化变革方面的有意义差异。
