Creating a psychologically safe learning environment

A psychologically safe learning environment — one that is conducive to interpersonally risky behaviours such as speaking up or asking for help — is critically important to medical students and residents. 

The safety of a learning environment is often affected by the “hidden curriculum”: the everyday interactions that implicitly teach medical students acceptable values and behaviours. (Learn more about the hidden curriculum through the CMA Sound Mind podcast.)

The importance of safe learning environments

The safety of learning environments can have a range of long-lasting impacts that can ultimately affect patient care.

Learning environment outcomes

Psychological safety in medicine is a feeling of comfort expressing oneself, including expressing mistakes and concerns, without fear of embarrassment or ridicule. An unsafe learning environment can cause medical learners to feel anxious, ashamed or inadequate. As a result, they may ask fewer questions or speak out less. 

In contrast, a safe learning environment prompts engagement. Students feel free to ask questions and pay more attention to the task at hand. A study published in Academic Medicine found that medical students who did not feel judged were better able to focus on their learning and build supportive mentor-mentee relationships.

Psychological safety and adverse event reporting

Psychological safety is a crucial factor in encouraging resident physicians to report adverse events. A study published in Medical Education* found that reducing perceived power imbalances and increasing leader inclusiveness led to residents feeling more psychologically safe and, in turn, more likely to report an event.

Psychological safety in feedback

Psychological safety also encourages medical learners to engage in interactive dialogue and the co-construction of knowledge. In another study published in Medical Education,* researchers analyzed videos of routine formal feedback in clinical practice. They found that educators who fostered psychologically safe learning environments did so by:

• Setting the scene for dialogue and candour
• Acting as an ally
• Focusing on continuing improvement
• Encouraging interactive dialogue

*Note: This article must be purchased or rented.

Establishing a culture of wellness

Promoting wellness for physicians, students and residents is important in all contexts, including learning environments, as discussed in the Making the Rounds podcast. To support wellness, barriers such as personal insecurities, traumatic experiences, immense time commitments and the stress of navigating a complex system must be overcome.

An article published by the AMA details some of the ways these barriers can be reduced. They include:

• Changing the medical education culture
• Holding wellness events
• Expanding mental health resources
• Building resiliency
• Focusing on the positives
• Strengthening social networks

Find more school-specific wellness resources.