A cross-sectional study of psychological safety: Barriers and facilitators in a non-western clinical setting
Year: 2025
Type: article
Study design: Observational Study
Abstract: Psychological safety is a cornerstone of effective clinical learning. While extensively studied in Western contexts, little is known about its barriers and facilitators, as well as its relationship to feedback-seeking and competence development in high power-distance, non-Western residency programs. This study explored barriers and facilitators of psychological safety and examined its associations with residents’ feedback-seeking behaviors and self-perceived clinical competence. We conducted a cross-sectional study in a large Lebanese academic medical center. An online survey assessed psychological safety, feedback-seeking behaviors, and self-perceived clinical competence. Open-ended questions explored barriers and facilitators in the clinical environment. Descriptive statistics, correlation, and mediation analyses were performed, along with inductive qualitative ‘conventional content analysis’ of narrative responses. Of 340 residents, 235 (69.1%) consented to participate, 204 (86.8%) completed the survey, and 160 (68.1%) provided narrative responses. Psychological safety was positively associated with direct feedback-seeking (rho = 0.194, p=.005) and perceived competence (rho = 0.184, p=.008). Adjusted mediation analysis suggested that direct inquiry may partially account for the association between psychological safety and competence (b = 0.2886, BootSE = 0.1479, 95% CI [0.0478, 0.6188]), whereas reflective appraisal and indirect inquiry were not significant mediators. Five themes shaped residents’ sense of psychological safety [1]: hierarchy and psychological distance [2], social belonging and interpersonal safety [3], workload, burnout, and learning identity [4], leadership responsiveness and institutional climate, and [5] feedback and day-to-day communication. Residents’ experiences of psychological safety were linked to more proactive feedback-seeking, which was in turn associated with higher self-perceived competence. However, more passive feedback strategies appeared less sensitive to psychological safety, likely reflecting cultural norms and hierarchical barriers. These safety perceptions were shaped by interpersonal relationships, leadership accessibility, workload pressures, and broader institutional culture, with hierarchy emerging as a dominant concern. Multi-level interventions, including leadership training, faculty development, and structural reforms, are needed to foster psychologically safe learning environments that promote resident growth, team functioning, and patient safety.
Source: Figshare
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7116335650