Etti Nicola, Weigl Matthias, Gambashidze Nikoloz
Institute for Patient Safety, University Hospital Bonn, 53127 Bonn, Nordrhein-Westfalen, Germany.
Städtisches Klinikum Solingen GmbH, Gotenstr.1, Solingen 42653, Germany.
Int J Qual Health Care. 2025 Feb 21;37(1). doi: 10.1093/intqhc/mzaf002.
Healthcare systems worldwide experience shortages of healthcare professionals. Retention of physicians is becoming an increasing problem. The psychological safety among physicians affects not only performance but also their emotional well-being and job satisfaction. This study aims to evaluate early career physicians' perception of psychological safety and its influence on job satisfaction and intention to leave.
In a cross-sectional study, early career physicians, currently in fellowship programs in Germany were invited to fill in an electronic survey. The instrument consisted of demographic variables and sections from validated and well-established questionnaires. Psychological safety was evaluated on three levels-in relation to the team leader, team as a whole, and peers. Also, job satisfaction was assessed with standardized measures, and participants were asked if they were considering leaving their current employer. Participants were recruited via a nationwide learning platform-an online educational portal for medical students and early career physicians. Data analyses included descriptive, correlation analysis, and regression analyses to determine univariate and multivariate associations with job satisfaction and intention to leave.
The study sample consisted of 432 early career physicians. Most were fulltime employed (85.6%), female (78.2%), and in first 3 years of their postgraduate education (77.5%). A total of 47.2% indicated intention to leave their current employment. On a Likert-10 agreement scale, with high scores indicating greater psychological safety, the mean scores for leader-related, team-related, and peer-related psychological safety were 6.01 [95% confidence interval = 5.81-6.21), 7.30 (7.11-7.49), and 7.95 (7.78-8.12), respectively. In correlation analysis, all dimensions of psychological safety showed significant associations with job satisfaction and the intention to leave. In the multiple regression analyses, female gender (B = -0.10; P = .04) and age group (B = -0.08; P < .01) were associated with lower job satisfaction. High leader and team-related psychological safety were significantly associated with higher job satisfaction (B = 0.18, P < .01; B = 0.10, P < .01), and negatively related to intention to leave (OR = 0.53, P < 0.01; OR = 0.77, P < .01).
This survey enhances our understanding of the nuances of psychological safety among early career physicians. In Germany, they reported low-to-medium levels of psychological safety related to the leader and low job satisfaction. Almost every second participant indicated intention to leave the organization. Leader-related psychological safety had highest effect on job satisfaction and intention to leave. Our findings corroborate the eminent role of leadership, workplace, and safety culture for job satisfaction and retention of early career physicians, what consequently affects quality and safety of healthcare.
全球医疗保健系统都面临医疗专业人员短缺的问题。医生的留用正成为一个日益严重的问题。医生之间的心理安全感不仅会影响工作表现，还会影响他们的情绪健康和工作满意度。本研究旨在评估处于职业生涯早期的医生对心理安全感的认知及其对工作满意度和离职意向的影响。
在一项横断面研究中，邀请了目前在德国参加专科培训项目的处于职业生涯早期的医生填写电子调查问卷。该问卷包括人口统计学变量以及来自经过验证且成熟的问卷的部分内容。心理安全感从三个层面进行评估——与团队领导、整个团队以及同事的关系。此外，采用标准化措施评估工作满意度，并询问参与者是否考虑离开当前雇主。参与者通过一个全国性的学习平台招募，该平台是一个面向医学生和处于职业生涯早期的医生的在线教育门户网站。数据分析包括描述性分析、相关性分析和回归分析，以确定与工作满意度和离职意向的单变量和多变量关联。
研究样本包括432名处于职业生涯早期的医生。大多数人是全职工作（85.6%），女性（78.2%），且处于研究生教育的前3年（77.5%）。共有47.2%的人表示有离开当前工作岗位的意向。在10分制的李克特量表上，高分表示更高的心理安全感，与领导相关、团队相关和同事相关的心理安全感的平均得分分别为6.01（95%置信区间 = 5.81 - 6.21）、7.30（7.11 - 7.49）和7.95（7.78 - 8.12）。在相关性分析中，心理安全感的所有维度均与工作满意度和离职意向显示出显著关联。在多元回归分析中，女性（B = -0.10；P = 0.04）和年龄组（B = -0.（此处原文有误，推测应为B = -0.08）；P < 0.01）与较低的工作满意度相关。与领导和团队相关的高心理安全感与较高的工作满意度显著相关（B = 0.18，P < 0.01；B = 0.10，P < 0.01），并与离职意向呈负相关（OR = 0.53，P < 0.01；OR = 0.7（此处原文有误，推测应为OR = 0.77），P < 0.01）。
这项调查增进了我们对处于职业生涯早期的医生心理安全感细微差别的理解。在德国，他们报告与领导相关的心理安全感处于中低水平，工作满意度也较低。几乎每两名参与者中就有一人表示有离开组织的意向。与领导相关的心理安全感对工作满意度和离职意向的影响最大。我们的研究结果证实了领导、工作场所和安全文化在工作满意度以及处于职业生涯早期的医生留用方面的重要作用，这进而会影响医疗保健的质量和安全。
