A narrative review of psychological safety in the surgical learning environment

Psychological safety is a critical component of the medical learning environment. While multiple synthesis studies exist for psychological safety within broader medical education, few have focused specifically on surgical training paradigms. This narrative review evaluates psychological safety for surgical trainees. A literature search of PubMed was conducted to identify studies discussing psychological safety within the surgical learning environment. Studies were included if psychological safety was a primary outcome, predictor, or theme. Studies were excluded if surgical trainees were not included or specifically discussed. A total of 53 articles were screened. Of these, 36 were excluded for relevance, and the remaining 17 full texts were reviewed. Reasons for exclusion include: study was conducted internationally; psychological safety was not a critical outcome, predictor, or theme; study focused on nonsurgical medical specialties (ie, anesthesia or psychiatry); and psychological safety of surgical trainees was not discussed despite surgical trainees being within the study cohort. A total of 11 studies were included for comparison. Four studies evaluated the positive impact of psychological safety within care teams that included surgical trainees. Two discussed the importance of building psychological safety as a surgical educator. Five studies evaluated learning environment factors or interventions that predicted psychological safety. Existing literature on psychological safety within the surgical learning environment focuses on educators, surgical teams, and specific aspects of the learning environment. While these studies offer valuable insight, additional studies are needed to identify effective interventions and operationalization of previous recommendations.