A cross-sectional study of psychological safety

Barriers and facilitators in a non-western clinical setting

Dados Bibliográficos

ID21448522
AutoresFatima Msheik‐El Khoury (0009-0006-0925-7648, Department of Anesthesiology and Pain Medicine, American University of Beirut Medical Center, autor correspondente), Halah Ibrahim (0000-0002-9240-7726, Accreditation Council for Graduate Medical Education), Monique Chaaya (0000-0002-2695-8079, American University of Beirut), Carine Zeeni (0000-0003-3452-6927, Department of Anesthesiology, American University of Beirut Medical Center), Reine Obeid (American University of Beirut), Andrea Chedid (Department of Anesthesiology and Pain Medicine, American University of Beirut Medical Center), Patrick Maroun (Department of Internal Medicine, American University of Beirut Medical Center), Muin J Khoury (0000-0002-9887-443X, American University of Beirut Medical Center), Marianne El Khoury (Department of Anesthesiology and Pain Medicine, American University of Beirut Medical Center), Lea B Farhat (American University of Beirut), Anne Marie-Daou (Department of Otorhinolaryngology - Head and Neck Surgery, American University of Beirut Medical Center), Salah Zeineldine (0000-0002-3696-8668, Graduate Medical Education Office, American University of Beirut)
Ano2026
Volume48
Fascículo5
Páginas879-892
Data de publicação2026-05-04
Peer ReviewedSim
Open AccessNão
TipoARTICLE
PeriódicoMedical Teacher (JOURNAL)
Identificadores do periódicoISSN: 0142-159X • E-ISSN: 1466-187X
EditoraInforma UK Limited (PUBLISHER • GB)
DOI10.1080/0142159x.2025.2603348
PMID41416761
OpenAlexW4417511768
IdiomaEN
Referências citadas79

PURPOSE: Psychological safety is a cornerstone of effective clinical learning. While extensively studied in Western contexts, little is known about its barriers and facilitators, as well as its relationship to feedback-seeking and competence development in high power-distance, non-Western residency programs. This study explored barriers and facilitators of psychological safety and examined its associations with residents' feedback-seeking behaviors and self-perceived clinical competence. MATERIALS AND METHODS: We conducted a cross-sectional study in a large Lebanese academic medical center. An online survey assessed psychological safety, feedback-seeking behaviors, and self-perceived clinical competence. Open-ended questions explored barriers and facilitators in the clinical environment. Descriptive statistics, correlation, and mediation analyses were performed, along with inductive qualitative 'conventional content analysis' of narrative responses. RESULTS: = 0.2886, BootSE = 0.1479, 95% CI [0.0478, 0.6188]), whereas reflective appraisal and indirect inquiry were not significant mediators. Five themes shaped residents' sense of psychological safety [1]: hierarchy and psychological distance [2], social belonging and interpersonal safety [3], workload, burnout, and learning identity [4], leadership responsiveness and institutional climate, and [5] feedback and day-to-day communication. DISCUSSION: Residents' experiences of psychological safety were linked to more proactive feedback-seeking, which was in turn associated with higher self-perceived competence. However, more passive feedback strategies appeared less sensitive to psychological safety, likely reflecting cultural norms and hierarchical barriers. These safety perceptions were shaped by interpersonal relationships, leadership accessibility, workload pressures, and broader institutional culture, with hierarchy emerging as a dominant concern. Multi-level interventions, including leadership training, faculty development, and structural reforms, are needed to foster psychologically safe learning environments that promote resident growth, team functioning, and patient safety

Cognitive dissonance · Hierarchy · Interpersonal communication · Patient safety · Perception · Psychological safety · Workload · Counseling Practices and Supervision · Innovations in Medical Education · Patient Safety and Medication Errors