S. Khan1, A. Loftus1, E. Steinhagen1, J. B. Ammori1 1University Hospitals Cleveland Medical Center, Surgery, Cleveland, OH, USA
Introduction:
Psychological safety is the perception that a team environment is safe for interpersonal risk taking, such as asking questions, sharing ideas, and admitting knowledge gaps. High psychological safety in the medical field has a direct impact on patient care and is associated with reporting of errors in care. This is especially important for the post-graduate year 1 (PGY-1) resident in surgical residency given the close contact with patients while more senior residents are occupied in surgery. Psychological safety in surgical residency is not studied. We hypothesize that it is lower in PGY-1 residents. The purpose of this study was to assess differences in levels of psychological safety between PGY-1 residents and PGY-2 and above residents.
Methods:
A survey was developed and distributed to all program directors (PD) of general surgery and surgical subspecialty residencies in the USA. PDs were asked to forward the survey to their residents. The survey included the validated Edmonson psychological safety scale adapted to assess psychological safety in surgical residency during interactions with senior residents (SR), attending surgeons (AS), and PD. Composite scores from the questions were created to assess psychological safety with SR, AS, and PD (highest possible of 126). Median question and composite scores for PGY-1 residents were compared separately to scores for PGY-2 residents and scores for non-PGY-1 residents using the Wilcoxon-Mann Whitney test.
Results:
176 residents completed the survey. Respondents were 36% male, 74% White, 91% non-Hispanic, 25% PGY-1 (n=44), and 24% PGY-2 (n=42) residents. Composite psychological safety scores for all residents were 104, 95, and 104 with regards to SR, AS, and PD, respectively. Compared to PGY-2 residents, PGY-1 residents had lower psychological safety scores with AS (87 vs 97, p = 0.036), but no differences in psychological safety with SR and PD. Compared to non-PGY-1 residents, PGY-1 residents had lower psychological safety scores with AS (87 vs 97, p = 0.012) and PD (98.5 vs 107, p = 0.014), but no differences in safety with SR. Areas of lower psychological safety for PGY-1 residents included criticism for mistakes, ability to raise concerns, and comfort in offering ideas.
Conclusions:
This nationwide survey demonstrates the level of psychological safety in a cohort of residents in surgical specialties. In this study, PGY-1 residents experience lower psychological safety in their interactions with AS and PD compared to non-PGY-1 residents. Although this implies that psychological safety improves after PGY-1 year, strategies should be developed to foster higher levels of psychological safety early in residency to optimize the clinical learning environment and patient care.
