Psychological safety and perceived organizational support in emergency medicine residencies

Margaret Goodrich; Kerry McCabe; Jesse Basford; Kimberly Bambach; Aaron Kraut; Jeffrey N Love

doi:10.1002/aet2.10964

Psychological safety and perceived organizational support in emergency medicine residencies

AEM Educ Train. 2024 Apr 13;8(2):e10964. doi: 10.1002/aet2.10964. eCollection 2024 Apr.

Authors

Margaret Goodrich¹, Kerry McCabe^{2

3}, Jesse Basford⁴, Kimberly Bambach⁵, Aaron Kraut⁶, Jeffrey N Love⁷

Affiliations

¹ Department of Emergency Medicine University of Missouri School of Medicine Columbia Missouri USA.
² Department of Emergency Medicine Boston University Chobanian & Avedisian School of Medicine Boston Massachusetts USA.
³ Department of Emergency Medicine Boston Medical Center Boston Massachusetts USA.
⁴ Department Emergency Medicine Southeast Health Dothan Alabama USA.
⁵ Department of Emergency Medicine The Ohio State University Columbus Ohio USA.
⁶ BerbeeWalsh Department of Emergency Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA.
⁷ Department of Emergency Medicine Georgetown University School of Medicine Washington DC USA.

PMID: 38618191
PMCID: PMC11015165 (available on 2025-04-13)
DOI: 10.1002/aet2.10964

Abstract

Background: The clinical learning environment (CLE) is a key focus of the Accreditation Council of Graduate Medical Education. It impacts knowledge acquisition and professional development. A previous single-center study evaluated the psychological safety and perceived organizational support of the CLE across different specialties. Building on this work, we explored and evaluated psychological safety and perceived organizational support across multiple heterogeneous emergency medicine (EM) residencies to identify trends and factors affecting perceptions of the CLE.

Methods: Using the Psychological Safety Scale (PSS) and Survey of Perceived Organizational Support (SPOS), residents from seven U.S. EM residencies were surveyed using REDCap software from September through November 2021, with 300 potential respondents. As an adjunct to these surveys, three open-ended questions were included regarding features of their learning environments.

Results: A total of 137 out of 300 residents completed the survey. The overall response rate was 45.7%. There was a variable response rate across programs (26.0%-96.7%). Pooled results demonstrate an overall positive perception of CLEs, based on positive mean responses (i.e., "Members of my department are able to bring up problems and tough issue" had a mean of 4.2 on a 5-point Likert scale). Open responses identified teaching, collegiality, and support from program leadership as supportive features of the CLE. Confrontational interdisciplinary communication, a sense of being devalued, and off-service rotations were identified as threats or areas for improvement to the CLE.

Conclusions: PSS and SPOS scores were generally positive in this multi-institution study, consistent with the prior single-institution study indicating that EM is often considered psychologically safe and supportive. EM training programs can consider using the PSS/SPOS to audit their own programs to identify areas for improvement and foster supportive features already in place.

Keywords: burnout; clinical learning environment; graduate medical education; perceived organizational support; psychological safety; resident well‐being.