Characterizing the Relationships Amongst Psychological Safety, the Learning Environment, and Well-Being in Surgical...

Learning environments affect the well-being of surgical faculty and trainees. Psychological safety (PS) has been linked with learning behaviors and aspects of well-being within medicine; however, given the unique challenges inherent to the surgical learning environment, there is a need to more closely examine these concepts for surgical faculty and trainees. The objective of this study is to examine the relationships between learning environment and PS, as well as PS and well-being with surgery.

Multi-institutional, cross-sectional survey study. The electronic survey included assessments of PS, professional fulfillment, and the learning environment. Exploratory and confirmatory factor analyses were performed to identify learning environment constructs. Index construct scores were generated. Multivariable multivariate regression analyses were used to examine the relationships between constructs in the learning environment and PS as well as PS and well-being.

The electronic survey was distributed to surgical faculty, fellows, and residents at 8 institutions across the United States.

For faculty, higher levels of professional interactions and rapport/climate within the learning environment were significantly associated with higher levels of PS (β = 0.39, p < 0.01; β = 0.34, p < 0.01, respectively). Higher levels of PS were significantly associated with lower levels of interpersonal disengagement (β = -0.16, p = 0.04). For trainees, higher levels of disrespect/retaliation and personal performance worry within the learning environment were significantly associated with lower levels of PS (β = -0.45, p < 0.001; β = -0.11, p = 0.048, respectively). Higher levels of PS were significantly associated with higher levels of professional fulfillment (β = 0.24, p = 0.01) and lower levels of work exhaustion (β = -0.27, p < 0.01) and interpersonal disengagement (β = -0.36, p < 0.001).

This study identified factors within the learning environment that were positively and negatively associated with psychological safety for surgical faculty and trainees. In addition, it identified a direct relationship between psychological safety and elements of well-being and burnout.