Strategies to Promote Psychological Safety in Residency Training in Asian Countries with High Power Distance...

Mistreatment is a chronic issue in residency training in Asian countries with high power distance cultures. Despite the need for culturally appropriate strategies, researchers have yet to assess the literature on learner safety, particularly psychological safety, in these contexts. We conducted a scoping review to identify strategies to foster what might be termed "psychological safety" in Western residency settings and examined what other local framings are used within Asian residency training environments. We followed the Arksey and O'Malley scoping review framework with additional insights from the Joanna Briggs Institute (JBI). We conducted systematic searches from April to July 2024 across nine databases (Medline, Scopus, ERIC, PsychINFO, PubMed, CINAHL, JSTOR, EMBASE, and Google Scholar). To enhance comprehensiveness, we did additional searches across Indonesian databases and journals. We included articles discussing strategies to promote psychological safety. We employed descriptive numerical and inductive content analyses. Out of 1,580 articles identified, 42 met the inclusion criteria. Only four articles (9.52%) mentioned "psychological safety" explicitly. Most articles used alternative terms to describe the broader sense of psychological safety, which we grouped into two categories: "Positive terms" (n = 29, 58.0%) and "Negative terms" (n = 21, 42.0%). We identified 29 strategies to improve psychological safety, including local or alternative framings, and categorised them into four levels: 1) "Organisational level" (n = 49, 48.0%), 2) "Team level" (n = 17, 16.7%), 3) "Interpersonal level" (n = 16, 15.7%), and 4) "Individual level" (n = 20, 19.6%). Direct importation of the Western concept of psychological safety may be incongruous with societal culture in Asian contexts. Thus, foundational research involving stakeholders is essential to develop a culturally appropriate concept of psychological safety that aligns with local linguistic contexts and cultural values. Instead of relying on a single-level strategy, a system-based approach is required, addressing organisational, team, interpersonal, and individual levels. In societies with ingrained high power distance cultures, efforts should focus on marshalling the hierarchy to support residents' learning.