Reducing the perceived power gap

Editor – We read with great interest Johnson et al’s paper, which offers practical ways an educator can promote psychological safety in a learning environment.1 Indeed, we believe there is clear responsibility for leaders to create a culture of psychological safety to improve medical practice.2 In Johnson et al’s paper, one pertinent case involved a junior doctor describing his learning experience, which involved a discussion with his educator in which a parent's wishes for their child did not align with his clinical reasoning.1 This was used as an example to show how an educator can display psychological safety by ‘encouraging interactive dialogue.’ It seems unfortunately likely, however, that shared interactive dialogue like this may not be achieved in all learning environments. Indeed, Johnson et al mentioned that this type of conversation was not commonly seen in the educator-learner reports they analysed.1 Perceived power differences often relate to differences in seniority, leading us to anticipate that a medical student would be much less likely to be forthcoming and discuss challenges with a paediatric specialist (like the educator in the scenario above) compared to a junior doctor. As a result, encouraging interactive dialogue may be difficult to achieve in the undergraduate curriculum if there are perceived power gaps between medical students and senior educators, creating a negative correlate with psychological safety.3 Near-peer mentoring offers one solution to promote psychological safety as well as achieving the aims set by Johnson et al.1 A near-peer mentor is someone who is senior enough to serve as a role model for a learner, but close enough to be relatable. The literature suggests that closeness in training creates a more collaborative working environment,4 thus promoting Johnson et al’s notion of ‘educator as ally.’1 Recently qualified junior doctors can appear less intimidating and seem more approachable to medical students due to a greater degree of shared identity. Near-peer mentoring schemes can increase enjoyment and belonging and provide invaluable training for students in preparation for work as junior doctors.5, 6 It thus, may similarly go a long way towards facilitating reliable achievement of psychological safety in undergraduate education

Medical education · Psychological safety · Applied Psychology · Innovations in Medical Education · Medicine · Psychology · Social Psychology

• A critical review of psychological safety in clinical learning environments

  Maree Martinussen, Neera R Jain et al.•Medical Teacher•2025

  Add to list

• Balancing pedagogical innovation with psychological safety

  Open Access•Stephanie Wake, Madeleine Pownall et al.•Assessment & Evaluation in Higher…•2024

  Add to list

• Psychological safety in feedback

  Open Access•Christina Johnson, Christina E Johnson et al.•Medical Education•2020

  Add to list