Exploring the construct of psychological safety in the graduate medical education learning environment: a scoping...

Scholarship on psychological safety (PS) in medicine has focused on improving patient safety on interprofessional teams. In medical education, PS literature has focused on the role of PS in simulation and on undergraduate medical education learners. However, less is written about the role of PS in shaping the learning of graduate medical education (GME) trainees. As a step toward better understanding the relationship between PS and the GME clinical learning environment (CLE), the authors conducted a scoping review exploring the phenomenon of PS in the CLE for GME learners.

The authors used Arksey and O'Malley's 5-step framework: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing, and reporting results. The authors included Levac's sixth step-consulting with key informants. The authors searched PubMed, Scopus, Web of Science, Embase, and PsychInfo in November 2022 and again in February 2025 for peer-reviewed English-language articles published from database inception to the search date using broad search terms designed to include all works discussing PS in the CLE. They developed an extraction tool to catalog search results and used thematic analysis to code and thematically cluster findings.

After screening 1,234 articles, 44 articles published from 2014 to 2025 met criteria for inclusion, of which 28 were original research. Findings clustered around 3 roles for PS: (1) a foundational component of trainee well-being and learning, (2) a proxy for residents' satisfaction with their CLE, and (3) a hallmark of successful teaching or supervisory behaviors.

Works in this review correlate the presence of PS with trainee well-being, resident learning, and supervisory behaviors; however, significant gaps remain in the literature regarding the specifics of how PS can and should be created for GME trainees, particularly for marginalized individuals.