Medical Student Perceptions of Psychological Safety in the Clinical Learning Environment

INTRODUCTION: Psychological safety in the learning environment allows students to take risks without fear of humiliation or negative consequences. The psychological safety of healthcare teams has been studied at three levels: organizational, team and individual. Prior work has shown how leadership behaviours contribute to student perceptions of psychological safety in the clinical learning environment, but less is known about the impact of organizational and individual factors. The present study explored student perceptions of facilitators and barriers of psychological safety in the clinical learning environment. METHODS: We conducted a qualitative case study in Academic Year 2022-2023. We held four focus groups with 23 third- and fourth-year medical students at Spencer Fox Eccles School of Medicine. Focus groups were recorded and transcribed verbatim; transcripts were analysed using thematic analysis. RESULTS: Thematic analysis revealed that there were organizational supports and barriers, inclusive and exclusive leadership behaviours and individual student characteristics that affected psychological safety in the learning environment. Psychological safety exists when high levels of organizational support and inclusive behaviour are present. However, it is also possible for an organizational support or an inclusive leader behaviour to overcome an exclusive leader behaviour or an organizational barrier, respectively. CONCLUSIONS: Organizational support and inclusive leadership behaviours foster psychological safety. Furthermore, it appears that psychological safety factors do not exist in isolation, but rather in tandem with one another. This makes it possible for an individual medical educator or organizational support to foster psychological safety even when organizational barriers or exclusionary behaviours from other supervisors exist.