Actionable companion · Teams and psychological safety
From leadership research to district action: Medical Student Perceptions of Psychological Safety in the Clinical Learning Environment
AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.
Evidence and transfer
Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.
Original authors’ abstract, reproduced under the source license:
ABSTRACT Introduction Psychological safety in the learning environment allows students to take risks without fear of humiliation or negative consequences. The psychological safety of healthcare teams has been studied at three levels: organizational, team and individual. Prior work has shown how leadership behaviours contribute to student perceptions of psychological safety in the clinical learning environment, but less is known about the impact of organizational and individual factors. The present study explored student perceptions of facilitators and barriers of psychological safety in the clinical learning environment. Methods We conducted a qualitative case study in Academic Year 2022–2023. We held four focus groups with 23 third‐ and fourth‐year medical students at Spencer Fox Eccles School of Medicine. Focus groups were recorded and transcribed verbatim; transcripts were analysed using thematic analysis. Results Thematic analysis revealed that there were organizational supports and barriers, inclusive and exclusive leadership behaviours and individual student characteristics that affected psychological safety in the learning environment. Psychological safety exists when high levels of organizational support and inclusive behaviour are present. However, it is also possible for an organizational support or an inclusive leader behaviour to overcome an exclusive leader behaviour or an organizational barrier, respectively. Conclusions Organizational support and inclusive leadership behaviours foster psychological safety. Furthermore, it appears that psychological safety factors do not exist in isolation, but rather in tandem with one another. This makes it possible for an individual medical educator or organizational support to foster psychological safety even when organizational barriers or exclusionary behaviours from other supervisors exist. Keywords: clinical learning environment, individual, medical student, organizational, psychological safety, team
Study methods
Using an interpretivist paradigm, we conducted a qualitative case study to understand third‐ and fourth‐year medical students' perceptions of psychological safety in the clinical learning environment during Academic Year (AY) 2022–2023 [22]. Interpretivists believe that knowledge is not objective but subjective and influenced by experience [23]. Case studies are used to study ‘society and culture in a group, a program, or an organization’ [24]. Using an interpretivist case study approach was useful to this study because we were examining psychological safety within the confines of one institution through the experiences and viewpoints of a particular population.
Limitations
No passage was selected automatically. Inspect the complete source before adopting a practice.
A 90-day district inquiry
- Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
- Days 16–30 · Design. Pilot a structured team debrief in one voluntary staff team. Invite dissent, record a specific improvement action and assign responsibility without collecting identifiable criticism. Agree participation, privacy protections, baseline and stopping rules before starting.
- Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
- Days 61–90 · Decide. Compare participation distribution, action completion, near-miss reporting and a consistent voluntary team-climate measure. Increased reporting may reflect greater openness rather than more errors. Make a dated decision to stop, revise or extend the inquiry.
Board decision brief
Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.
Attribution and reuse
Katie Lappé; Jennifer O'Donohoe; Rachel Bonnett; Jorie Colbert‐Getz; Heather Campbell; Katherine Hastings; Kirstyn E Brownson; Sara Lamb; Candace Chow. Medical Student Perceptions of Psychological Safety in the Clinical Learning Environment. The Clinical Teacher (2026-04-01). https://doi.org/10.1111/tct.70342
Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.