Psychological Safety in Academic Medicine

Spread the love

Medical education has produced defining concepts to maximize psychological safety in the learning environment. While numerous studies have examined the negative effects of the social, verbal, physical, and sexual harassment experienced by medical students (Amarin et al., 2017), alongside students’ well-being (Eckleberry, et al., 2017; Bynum, et al., 2019).

This emphasis on the frequent absence of a safe learning environment in medical education seems to imply the underlying presumption that psychological safety would be attained by eliminating these detrimental activities.

However, assuming that the elimination of such traumatic experiences would automatically produce a psychologically safe atmosphere would be an erroneous application of reasoning.

The psychological literature that examines happiness alongside unhappiness (Seligman, et al., 2014), clearly shows the importance of medical education in exploring and promoting psychological safety.

Academic medicine has developed concepts around safety by focusing on any form of student harassment, and its implications. The limited scope of psychological safety makes it difficult to comprehend the scope of the issue and potential solutions for creating safer learning environments.

Moving above minimizing unpleasant experiences to promoting the creation of more supportive educational contexts may be made easier by establishing a more sophisticated understanding of psychological safety’s link to learning in medical school.

Ambiguity in Rheumatology and Psychological Safety

In clinical practice, patient safety and quality enhancement are often the contexts of psychological safety. However, the environment of academic discourse should also be considered when discussing psychological safety.

The diagnosis and treatment of rheumatic disorders frequently involve ambiguity and uncertainty. Making decisions for and alongside patients can be stressful due to the lack of conclusive tests or biomarkers and the poor understanding of the immunopathology of the disease.

Ambiguity in rheumatology is worsened because specialists may occasionally be unable to explain how diagnostic and therapeutic recommendations should be applied in particular and frequently complex circumstances (Lee et al., 2018).

The diverse ways in which diseases reveal themselves in rheumatology also add to the uncertainty and ambiguity there. Rheumatology’s fundamental ambiguity fosters a culture that values scientific debate and encourages therapeutic reasoning (Felton et al., 2015; Osbourne et al., 2010).

To this aim, discourse patterns and the development of reasoning skills are determined by the teacher’s capacity to probe or provide feedback. One technique to encourage critical thinking and reasoning is through respectful argumentation discussion or scientific dialogue (Felton et al., 2015; Osbourne et al., 2010).

Psychological Safety and Wellbeing

In order to promote work-based health, people must be able to identify when they need assistance and the difficulty, they are having in keeping up with the demands of their existing jobs.

Accepting help when you need it can be seen as a sign of weakness, and some people may be afraid that doing so will harm their reputation, job security, or opportunities for the future.

However, failing to speak up might result in work-related stress, which can exacerbate this issue and cause more serious health issues in the future (Ilies et al., 2010).

In mental health, medical personnel may support people facing health difficulties, making it extremely challenging to speak up about wellbeing.

Additionally, some medical personnel may think that discussing these challenges may diminish their perceived competency in carrying out their job duties.

Medical personnel must have the self-assurance to speak up during the disease outbreak because many of them may be at risk of developing post-traumatic stress disorder or other types of moral injury, which could have an adverse effect on their health and the care they give (Greenberg et al., 2020).

Measuring Psychological Safety

Psychological safety is a complex idea, and knowing the extent of its success level and how to assess it is quite challenging. A team-level survey is the most used method of psychological safety measurement (Edmondson, 1999).

This survey has been modified by others to assess psychological safety at the individual and organizational levels (Detert et al., 2007; Baer et al., 2003).

Typically, healthcare organizations conduct staff surveys focusing on various elements of employees’ work experiences. Teams or services that may score poorly in these areas may also feel psychologically unsafe.

These surveys frequently include sections that might serve as psychological safety indications (reported management, organizational support, and perceived compassion).

However, for a significant program, it would be desirable to conduct a targeted survey of psychological safety at the outset and at predetermined intervals throughout the program.

Of course, there is always a fear of burdening the employees with more surveys, but these are quick and only take a few minutes to complete.

Careful sampling techniques will help reduce the number of staff members needed to conduct new surveys or add questions to existing ones.

Surveys can be useful in determining groups of people who have scored poorly on psychological safety or who do not have the ability to take a survey, in addition to collecting longitudinal data.

As executive leaders work to win over the trust of the entire organization, these people and groups require special assistance.

Measurement of psychological safety will be useful for future research work.

For instance, observational frameworks linked to the verbal and nonverbal signs of psychologically safe and harmful activities may be especially useful in simulating interventions focused on speaking out and making decisions.

Once psychological safety behaviors have been agreed upon, behavioral markers offer a way to gauge if a practice is good or bad.

In fact, similar frameworks are used in simulation-based education to gauge teamwork and evaluate non-technical skills among medical teams (Flin, 2004; Pian-Smith, 2009).

As a result, behavioral observational frameworks offer a chance to measure behaviors indicative of psychological safety.

Enhancing Psychological Safety

Psychological safety is actually more complex than it first appears to be, although it seems simple and complex on the surface. Making significant, practical changes to improve workplace psychological safety is difficult for several reasons.

In the first place, psychological safety is multifaceted, necessitating a multidimensional strategy to change.

Secondly, improving psychological safety calls for a cultural transformation, and any cultural project necessitates the participation and dedication of the vast majority of the workforce across all levels.

Thirdly, assessing psychological safety is particularly difficult because of how it affects final results like patient safety, healthcare quality, and well-being.

Most significantly, it can be challenging to decide which specific actions to take, when, and in what order to improve psychological safety.

Although many notable organizations have adopted psychological safety, there is very little research that outlines clear-cut steps or interventions.

However, each organization has its mode of operation, so it would be advantageous to outline the key elements of a program to improve psychological safety.


Written by: Emmanuel J. Osemota


Amarin, J. Z, & Borgan, S. M. (2017). The pervasive culture of abuse in medical education: A focus on developing countries. Acad Med, 92:578–579.

Baer, M, & Frese, M. (2003). Innovation is not enough: climates for initiative and psychological safety, process innovations, and from performance. J Organ Behav Intern J Indus Occupy Organ Psychol Behav. 24(1):45–68.

Bynum, W. E, Artino, A. R, Uijtdehaage, S, Webb, A. M, Varpio, L. (2019). Sentinel emotional events: The nature, triggers, and effects of shame experiences in medical residents. Acad Med.94:85–93.

Detert, J. R, & Burris, E. R. (2007). Leadership behavior and employee voice: is the door really open? Journal of Academy Management. 50(4):869–84.

Eckleberry-Hunt J., Kirkpatrick, H, & Hunt, R. B. (2017). Physician burnout and wellness. In: Physician Mental Health and Well-Being. Integrating Psychiatry and Primary Care. Cham, Switzerland: Springer; 3–32.

Edmondson, A. C. (2004). Learning from failure in health care: Frequent opportunities, pervasive barriers. Journal of Quality & Safety In Health Care, 13 Suppl 2, ii3-ii9.

Edmondson, A. C. (2003). Speaking up in the operating room: How team leaders promote learning in interdisciplinary action teams. Journal of Management Studies, 40(6), 1419-1452. doi:10.1111/1467-6486.00386

Edmondson, A. C. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350-383.

Felton, M., Garcia-Mila, M., Villarroel, C. & Gilabert, S. (2015). Arguing collaboratively: argumentative discourse types and their potential for knowledge building. British Journal of Educational Psychology, 85:372–386.

Flin, R, & Maran, N. (2004). Identifying and training non-technical skills for teams in acute medicine. BMJ Qual Saf. 13(suppl 1):i80–4.

Greenberg, N., Docherty, M., Gnanapragasam, S. & Wessely, S. (2020). Managing mental health challenges faced by healthcare workers during covid-19 pandemic. BMJ. 368.

Ilies, R., Dimotakis, N. & De Pater, I. E. (2010). Psychological and physiological reactions to high workloads: implications for well-being. Pers Psychol. 63(2):407–36.

Lee, S. C, & Irving, K. E. (2018). Development of Two-Dimensional Classroom Discourse Analysis Tool (CDAT): scientific reasoning and dialog patterns in the secondary science classes. International Journal of STEM Education, 5:5.

Osbourne, J. (2010). Arguing to learn in science: the role of collaborative, critical discourse. Science 328(5977):463–466.

Pian-Smith, M. C., Simon, R., Minehart, R. D., Podraza, M., Rudolph, J., Walzer, T. & Raemer D. (2009). Teaching residents the two-challenge rule: a simulation-based approach to improve education and patient safety. Simul Healthcare. 4(2):84–91.

Seligman, M., Csikszentmihalyi, M., & Csikszentmihalyi, M. (2014). Positive psychology: An introduction. In: Flow and the Foundations of Positive Psychology: The Collected Works of Mihaly Csikszentmihalyi. Dordrecht, the Netherlands: Springer; 279–298.

Spread the love

Leave a Comment

Your email address will not be published. Required fields are marked *

Scroll to Top