Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study

• Published in: BMC medical education Vol. 23; no. 1; pp. 1 - 760
• Main Authors: Latessa, Robyn A, Galvin, Shelley L, Swendiman, Robert A, Onyango, Joshua, Ostrach, Bayla, Edmondson, Amy C, Davis, Scott A, Hirsh, David A
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 12.10.2023; BioMed Central; BMC
• Subjects: Accountability; Analysis; Clinical education; Coding; Data Analysis; Educational accountability; Educational Development; Elementary Secondary Education; Faculty Development; Graduates; Gynecology; Hospitals; Instructional Leadership; Integrated Curriculum; Internal Medicine; Interviews; Learning; Longitudinal integrated clerkships; Medical education; Medical research; Medical Schools; Medical student-teacher relationship; Medical students; Medicine; Modeling (Psychology); Patients; Physicians; Professional development; Psychological aspects; Psychological research; Psychological safety; Qualitative research; Research Assistants; Researchers; Safety and security measures; Security (Psychology); Training; Trust; United States
• DOI: 10.1186/s12909-023-04622-5
• ISSN: 1472-6920

Background Psychological safety and accountability are frameworks to describe relationships in the workplace. Psychological safety is a shared belief by members of a team that it is safe to take interpersonal risks. Accountability refers to being challenged and expected to meet expectations and goals. Psychological safety and accountability are supported by relational trust. Relational continuity is the educational construct underpinning longitudinal integrated clerkships. The workplace constructs of psychological safety and accountability may offer lenses to understand students' educational experiences in longitudinal integrated clerkships. Methods We performed a qualitative study of 9 years of longitudinal integrated clerkship graduates from two regionally diverse programs--at Harvard Medical School and the University of North Carolina School of Medicine. We used deductive content analysis to characterize psychological safety and accountability from semi-structured interviews of longitudinal integrated clerkship graduates. Results Analysis of 20 graduates' interview transcripts reached saturation. We identified 109 discrete excerpts describing psychological safety, accountability, or both. Excerpts with high psychological safety described trusting relationships and safe learning spaces. Low psychological safety included fear and frustration and perceptions of stressful learning environments. Excerpts characterizing high accountability involved increased learning and responsibility toward patients. Low accountability included students not feeling challenged. Graduates' descriptions with both high psychological safety and high accountability characterized optimized learning and performance. Conclusions This study used the workplace-based frameworks of psychological safety and accountability to explore qualitatively longitudinal integrated clerkship graduates' experiences as students. Graduates described high and low psychological safety and accountability. Graduates' descriptions of high psychological safety and accountability involved positive learning experiences and responsibility toward patients. The relational lenses of psychological safety and accountability may inform faculty development and future educational research in clinical medical education. Keywords: Psychological safety, Accountability, Longitudinal integrated clerkships, Clinical education, Trust, Medical student-teacher relationship, Preceptor