Psychological safety in medical education: A scoping review and synthesis of the literature

Abstract

Purpose

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.

Materials and methods

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.

Results

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.

Discussion

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.

Keywords:

• Psychological safety
• medical education
• clinical learning environment
• team culture

Acknowledgements

The authors thank Lynly Beard, our Health Sciences Librarian, for her assistance with our search development and tracking. Additionally, the authors thank Nital Appelbaum, MS, PhD for providing feedback as a field expert. The authors also thank the reviewers who added significant value to the quality of this manuscript with their feedback.

Ethical approval

Not applicable.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

None.

Notes on contributors

Adelaide H. McClintock

Adelaide McClintock, MD, is an Assistant Professor of Medicine, University of Washington School of Medicine, Seattle, WA, USA.

Tyra Fainstad

Tyra Fainstad, MD, is an Associate Professor of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.

Kevin Blau

Kevin Blau, MD, is an Acting Instructor of Medicine, University of Washington School of Medicine, VA Puget Sound Health Care System, Seattle, WA, USA.

Joshua Jauregui

Joshua Jauregui, MD, is an Associate Professor of Emergency Medicine, University of Washington School of Medicine, Seattle, WA, USA.