Characterizing the Relationships Amongst Psychological Safety, the Learning Environment, and Well-Being in Surgical Faculty and Trainees

Alyssa A Pradarelli; Julie Evans; Niki Matusko; Norah N Naughton; Roy Phitayakorn; John T Mullen; Lily Chang; Melissa Johnson; Thavam Thambi-Pillai; Jon Ryckman; Melissa Alvarez-Downing; Sebastiano Cassaro; Felicia Ivascu; David T Hughes; Gurjit Sandhu

doi:10.1016/j.jsurg.2024.103375

Characterizing the Relationships Amongst Psychological Safety, the Learning Environment, and Well-Being in Surgical Faculty and Trainees

J Surg Educ. 2024 Dec 21;82(2):103375. doi: 10.1016/j.jsurg.2024.103375. Online ahead of print.

Authors

Affiliations

¹ Department of Surgery; Education Research Sciences Collaborative; Center for Surgical Training and Research; University of Michigan; Ann Arbor; MI. Electronic address: mazureka@med.umich.edu.
² Department of Surgery; Education Research Sciences Collaborative; Center for Surgical Training and Research; University of Michigan; Ann Arbor; MI.
³ Department of Anesthesiology; University of Michigan; Ann Arbor; MI.
⁴ Department of Surgery; Massachusetts General Hospital; Boston; MA.
⁵ Department of Surgery; Virginia Mason Medical Center; Seattle; WA.
⁶ Department of Surgery; Gundersen Health System; La Crosse; WI.
⁷ Department of Surgery; University of South Dakota Sanford School of Medicine; Sioux Falls; SD.
⁸ Department of Surgery; Rutgers New Jersey Medical School; Newark; NJ.
⁹ Department of Surgery; Kaweah Health; Visalia; CA.
¹⁰ Department of Surgery; Corewell Health Beaumont; Royal Oak; MI.
¹¹ Department of Surgery; University of Michigan; Ann Arbor; MI.

PMID: 39718309
DOI: 10.1016/j.jsurg.2024.103375

Abstract

Objective: Learning environments affect the well-being of surgical faculty and trainees. Psychological safety (PS) has been linked with learning behaviors and aspects of well-being within medicine; however, given the unique challenges inherent to the surgical learning environment, there is a need to more closely examine these concepts for surgical faculty and trainees. The objective of this study is to examine the relationships between learning environment and PS, as well as PS and well-being with surgery.

Design: Multi-institutional, cross-sectional survey study. The electronic survey included assessments of PS, professional fulfillment, and the learning environment. Exploratory and confirmatory factor analyses were performed to identify learning environment constructs. Index construct scores were generated. Multivariable multivariate regression analyses were used to examine the relationships between constructs in the learning environment and PS as well as PS and well-being.

Setting & participants: The electronic survey was distributed to surgical faculty, fellows, and residents at 8 institutions across the United States.

Results: For faculty, higher levels of professional interactions and rapport/climate within the learning environment were significantly associated with higher levels of PS (β = 0.39, p < 0.01; β = 0.34, p < 0.01, respectively). Higher levels of PS were significantly associated with lower levels of interpersonal disengagement (β = -0.16, p = 0.04). For trainees, higher levels of disrespect/retaliation and personal performance worry within the learning environment were significantly associated with lower levels of PS (β = -0.45, p < 0.001; β = -0.11, p = 0.048, respectively). Higher levels of PS were significantly associated with higher levels of professional fulfillment (β = 0.24, p = 0.01) and lower levels of work exhaustion (β = -0.27, p < 0.01) and interpersonal disengagement (β = -0.36, p < 0.001).

Conclusions: This study identified factors within the learning environment that were positively and negatively associated with psychological safety for surgical faculty and trainees. In addition, it identified a direct relationship between psychological safety and elements of well-being and burnout.

Keywords: learning environment; psychological safety; surgery; well-being.