Barriers and Facilitators to Surgical Trainee Psychological Safety: The Role of Self, Team & System
Document Type
Conference Proceeding
Publication Date
2025
Abstract
Introduction: While the presence of psychological safety (PS) has been shown to be imperative for effective learning, specific factors contributing to its presence in surgical residency have not been well characterized. We aimed to identify barriers and facilitators to psychological safety in the clinical learning environment for surgical trainees. Methods: This was a cross-sectional qualitative study of surgical trainees from October 2023 to May 2024. Purposive sampling was used to recruit participants for semi-structured interviews. Transcripts were coded inductively using interpretive description methodology, iteratively analyzed, and themes were identified. Three authors (JC, AP, JE) conducted interviews and four authors (JC, AP, JE, GS) participated in coding and thematic analysis. Patterns related to barriers and facilitators to psychological safety are reported. Results: In total, 13 surgical trainees (general surgery and two surgical sub-specialties) from six institutions (4 University-based, 1 Community-based, 1 Community-based, University-affiliated) were included. Participants consisted of 61.5% (8) junior residents (PGY1-3), 46.2% (6) women, and 30.8% (4) race/ethnic minoritized trainees. Seven themes in total, three barriers and four facilitators, were identified. Trainees cited 1) public humiliation, 2) culture fostered by faculty, and 3) influence of flawed system factors as barriers to PS. Learners described instances of mistreatment and public shaming as detrimental to establishing PS. While faculty played a key role in dictating whether PS was present in the learning environment, trainees also noted overarching system-level factors, such as understaffing and lack of resources, as obstacles to promoting PS. Conversely, 1) normalizing vulnerability in the clinical learning environment, 2) giving grace, 3) role of chief residents, and 4) resident accountability were significant facilitators of PS. Trainees emphasized not only the importance of normalizing vulnerability and asking for help in establishing PS, but also the value of being given grace when mistakes were made. While chief residents were perceived as key mediators of PS, trainees also expressed a personal responsibility in cultivating psychologically safe environments for themselves. Conclusion: This qualitative study identified seven key individual, interpersonal, and organizational factors impacting psychological safety for surgical trainees. These findings may help inform future development of interventions aimed to promote PS in the learning environment for surgical trainees.
Recommended Citation
Chen J, Pradarelli A, Evans J, Matusko N, Naughton N, Phitayakorn R, et al. [Ivascu F]. Barriers and facilitators to surgical trainee psychological safety: the role of self, team & system. Presented at: Academic Surgical Congress; 2025 Feb 11-13; Las Vegas, NV. Available from:https://www.asc-abstracts.org/abs2025/96-04-barriers-and-facilitators-to-surgical-trainee-psychological-safety-the-role-of-self-team-system/
Comments
Academic Surgical Congress, February 11-13, 2025, Las Vegas, NV