Pediatric Resident Psychological Safety, Learning, and Family Trust During Family-Centered Rounds

Resident psychological safety (PS) during family-centered rounds (FCR), thought to be important for learning, remains understudied. Furthermore, it is uncertain whether resident concerns that learning on rounds impedes family trust are corroborated by families. The study objectives were to (1) describe pediatric residents' experiences with PS during FCR and (2) explore families' perspectives on learning and trust during FCR.

Informed by PS as a theoretical construct, we performed a qualitative study using grounded theory methodology to conduct focus groups/interviews during the 2022-2023 academic year with 25 pediatric residents who completed a pediatric hospital medicine rotation and 15 family members of hospitalized children. Sampling continued until it reached thematic saturation. Three coders analyzed data with the constant comparative method. Codes were built using an iterative approach and organized into 6 themes. Discrepancies were resolved by consensus.

Residents described PS as comfort proposing a plan and asking questions and being wrong without feeling judged. Residents worried about losing the trust of families. Supervisor support of resident autonomy and team dynamics (eg, showing respect) influenced PS. Families recognized the value of experiential learning for trainees during FCR. Residents' interpersonal skills were the principal drivers of family trust, as families were reassured by attending physician oversight.

Pediatric residents have varied levels of PS during FCR. Support of resident autonomy promotes PS. Resident concerns that expressions of uncertainty negatively impact family perceptions of their competence are not corroborated by families. Instead, resident interpersonal skills are a primary driver of family trust.