McClintock Adelaide H, Fainstad Tyra, Blau Kevin, Jauregui Joshua
Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Med Teach. 2023 Nov;45(11):1290-1299. doi: 10.1080/0142159X.2023.2216863. Epub 2023 Jun 2.
Psychological safety (PS) is the belief that the environment is safe for risk taking. Available data point to a lack of PS in medical education. Based on literature in other fields, PS in clinical learning environments (CLEs) could support trainee well-being, belonging, and learning. However, the literature on PS in medical education has not been broadly assessed.
In 2020, authors searched PubMed, Web of Science, CINAHL, Scopus, ERIC, PsycInfo, and JSTOR for articles published prior to January 2020. Authors screened all search results for eligibility using specific criteria. Data were extracted and thematic analysis performed.
Fifty-two articles met criteria. The majority focused on graduate medical education (45%), and 42% of studies took place within a CLE. Articles addressed organizational and team level constructs (58%), with fewer descriptions of specific behaviors of team members that promote or hinder safety. The impacts of safe environments for trainees and patients are areas in need of more exploration.
Future research should focus on defining specific organizational and interpersonal leader behaviors that promote PS, seek to understand how PS is determined by individual trainees, and measure the impact of PS on learners, learning, and patient care outcomes.
心理安全（PS）是指相信环境对于冒险是安全的。现有数据表明医学教育中缺乏心理安全。基于其他领域的文献，临床学习环境（CLE）中的心理安全可以支持实习生的幸福感、归属感和学习。然而，医学教育中关于心理安全的文献尚未得到广泛评估。
2020年，作者检索了PubMed、科学网、护理学与健康领域数据库、Scopus、教育资源信息中心、心理学文摘数据库和JSTOR，查找2020年1月之前发表的文章。作者使用特定标准筛选所有检索结果以确定其是否符合要求。提取数据并进行主题分析。
52篇文章符合标准。大多数文章聚焦于毕业后医学教育（45%），42%的研究在临床学习环境中进行。文章涉及组织和团队层面的构建（58%），对促进或阻碍安全的团队成员具体行为的描述较少。安全环境对实习生和患者的影响是需要更多探索的领域。
未来的研究应专注于定义促进心理安全的特定组织和人际领导行为，试图了解心理安全是如何由个体实习生决定的，并衡量心理安全对学习者、学习和患者护理结果的影响。
