Exploring Psychological Safety in Physical Therapist Clinical Education: A Mixed Methods Study

Psychological safety (PS) is a feeling that individuals are comfortable being themselves and sharing concerns and mistakes without fear of embarrassment, shame, ridicule, or retribution. The purpose of this study was to describe the phenomenon of PS and relationships between PS with general psychological distress, depression, anxiety, stress, and general self-efficacy in the clinical learning environment with physical therapist students.

Psychological safety may influence student engagement and impact learning. During physical therapist student clinical experiences, PS is important for learning and patient safety.

Second-year students from 2 entry-level Doctor of Physical Therapy academic programs were invited to complete a survey before and after their first clinical experience.

This was an explanatory sequential, mixed methods design. The Depression, Anxiety, and Stress Scale-21, General Self-Efficacy Scale, and questions about PS were completed by students before and after their initial clinical experiences. Survey respondents were subsequently invited to participate in a semistructured interview.

Of the 188 students invited, 27 completed both preclinical and postclinical surveys. Nine of those 27 students completed the qualitative portion. All students reported experiencing PS during their clinical experience. General psychological distress, anxiety, and stress all decreased, and general self-efficacy increased significantly during the clinical experience. Themes identified included characteristics of a safe psychological environment and signs of unsafe psychological environment.

Having a sense of PS during clinical rotations has a positive influence on students' perceived ability to fully engage in their learning and may play a role in decreasing stress and anxiety and building self-efficacy. Students and clinical instructors have a shared responsibility for the cocreation of a PS learning environment, which can be established during a preclinical brief and maintained through consistent communication and authentic feedback.