Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, NC, USA.
BMC Med Educ. 2023 Oct 12;23(1):760. doi: 10.1186/s12909-023-04622-5.
Psychological safety and accountability are frameworks to describe relationships in the workplace. Psychological safety is a shared belief by members of a team that it is safe to take interpersonal risks. Accountability refers to being challenged and expected to meet expectations and goals. Psychological safety and accountability are supported by relational trust. Relational continuity is the educational construct underpinning longitudinal integrated clerkships. The workplace constructs of psychological safety and accountability may offer lenses to understand students' educational experiences in longitudinal integrated clerkships.
We performed a qualitative study of 9 years of longitudinal integrated clerkship graduates from two regionally diverse programs-at Harvard Medical School and the University of North Carolina School of Medicine. We used deductive content analysis to characterize psychological safety and accountability from semi-structured interviews of longitudinal integrated clerkship graduates.
Analysis of 20 graduates' interview transcripts reached saturation. We identified 109 discrete excerpts describing psychological safety, accountability, or both. Excerpts with high psychological safety described trusting relationships and safe learning spaces. Low psychological safety included fear and frustration and perceptions of stressful learning environments. Excerpts characterizing high accountability involved increased learning and responsibility toward patients. Low accountability included students not feeling challenged. Graduates' descriptions with both high psychological safety and high accountability characterized optimized learning and performance.
This study used the workplace-based frameworks of psychological safety and accountability to explore qualitatively longitudinal integrated clerkship graduates' experiences as students. Graduates described high and low psychological safety and accountability. Graduates' descriptions of high psychological safety and accountability involved positive learning experiences and responsibility toward patients. The relational lenses of psychological safety and accountability may inform faculty development and future educational research in clinical medical education.
心理安全感和责任感是描述工作场所关系的框架。心理安全感是团队成员共同持有的一种信念，即进行人际风险是安全的。责任感是指受到挑战并期望达到期望和目标。心理安全感和责任感得到关系信任的支持。关系连续性是纵向综合实习的教育构建。工作场所的心理安全感和责任感结构可以为理解学生在纵向综合实习中的教育经验提供视角。
我们对来自哈佛医学院和北卡罗来纳大学医学院两个地区多样化项目的 9 年纵向综合实习毕业生进行了定性研究。我们使用演绎内容分析，从纵向综合实习毕业生的半结构化访谈中描述心理安全感和责任感。
对 20 名毕业生的访谈记录进行了分析，达到了饱和。我们确定了 109 个描述心理安全感、责任感或两者的离散摘录。具有高心理安全感的摘录描述了信任关系和安全的学习空间。低心理安全感包括恐惧和挫折感以及对紧张学习环境的看法。描述高责任感的摘录涉及增加对患者的学习和责任。低责任感包括学生感觉没有受到挑战。具有高心理安全感和高责任感的毕业生的描述特征是优化了学习和表现。
本研究使用基于工作场所的心理安全感和责任感框架，从定性角度探讨了纵向综合实习毕业生作为学生的经历。毕业生描述了高和低心理安全感和责任感。毕业生对高心理安全感和责任感的描述涉及积极的学习体验和对患者的责任感。心理安全感和责任感的关系视角可以为临床医学教育中的教师发展和未来教育研究提供信息。
