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A cross-sectional study of psychological safety: Barriers and facilitators in a non-western clinical setting.

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Title: A cross-sectional study of psychological safety: Barriers and facilitators in a non-western clinical setting.
Authors: Msheik-El Khoury, Fatima1 (AUTHOR) fm50@aub.edu.lb, Ibrahim, Halah2 (AUTHOR), Chaaya, Monique3 (AUTHOR), Zeeni, Carine4 (AUTHOR), Obeid, Reine5 (AUTHOR), Chedid, Andrea1 (AUTHOR), Maroun, Patrick6 (AUTHOR), El Khoury, Marianne1 (AUTHOR), Farhat, Lea B.5 (AUTHOR), Marie-Daou, Anne7 (AUTHOR), Zeineldine, Salah8 (AUTHOR)
Source: Medical Teacher. May2026, Vol. 48 Issue 5, p879-892. 14p.
Subject Terms: *School environment, *Corporate culture, *Medical education, *Academic medical centers, *Data analysis, *Qualitative research, *Psychological burnout, *Internship programs, *Content analysis, *Emotions, *Clinical competence, *Bullying, *Communication, *Factor analysis, *Information-seeking behavior, *Employees' workload, Psychology of physicians, Cross-sectional method, Power (Social sciences), Statistical hypothesis testing, Occupational achievement, Kruskal-Wallis Test, Questionnaires, Sex distribution, Leadership, Psychological safety, Descriptive statistics, Mann Whitney U Test, Chi-squared test, Age distribution, Mentoring, Hospital medical staff, Surveys, Social integration, Statistics, Confidence intervals, Data analysis software, Social support, Regression analysis, Self-perception, Time, Social isolation
Geographic Terms: Lebanon
Abstract: Purpose: Psychological safety is a cornerstone of effective clinical learning. While extensively studied in Western contexts, little is known about its barriers and facilitators, as well as its relationship to feedback-seeking and competence development in high power-distance, non-Western residency programs. This study explored barriers and facilitators of psychological safety and examined its associations with residents' feedback-seeking behaviors and self-perceived clinical competence. Materials and Methods: We conducted a cross-sectional study in a large Lebanese academic medical center. An online survey assessed psychological safety, feedback-seeking behaviors, and self-perceived clinical competence. Open-ended questions explored barriers and facilitators in the clinical environment. Descriptive statistics, correlation, and mediation analyses were performed, along with inductive qualitative 'conventional content analysis' of narrative responses. Results: Of 340 residents, 235 (69.1%) consented to participate, 204 (86.8%) completed the survey, and 160 (68.1%) provided narrative responses. Psychological safety was positively associated with direct feedback-seeking (rho = 0.194, p=.005) and perceived competence (rho = 0.184, p=.008). Adjusted mediation analysis suggested that direct inquiry may partially account for the association between psychological safety and competence (b = 0.2886, BootSE = 0.1479, 95% CI [0.0478, 0.6188]), whereas reflective appraisal and indirect inquiry were not significant mediators. Five themes shaped residents' sense of psychological safety [1]: hierarchy and psychological distance [2], social belonging and interpersonal safety [3], workload, burnout, and learning identity [4], leadership responsiveness and institutional climate, and [5] feedback and day-to-day communication. Discussion: Residents' experiences of psychological safety were linked to more proactive feedback-seeking, which was in turn associated with higher self-perceived competence. However, more passive feedback strategies appeared less sensitive to psychological safety, likely reflecting cultural norms and hierarchical barriers. These safety perceptions were shaped by interpersonal relationships, leadership accessibility, workload pressures, and broader institutional culture, with hierarchy emerging as a dominant concern. Multi-level interventions, including leadership training, faculty development, and structural reforms, are needed to foster psychologically safe learning environments that promote resident growth, team functioning, and patient safety. [ABSTRACT FROM AUTHOR]
Copyright of Medical Teacher is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: <searchLink fieldCode="DE" term="%22Lebanon%22">Lebanon</searchLink>
– Name: Abstract
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  Data: Purpose: Psychological safety is a cornerstone of effective clinical learning. While extensively studied in Western contexts, little is known about its barriers and facilitators, as well as its relationship to feedback-seeking and competence development in high power-distance, non-Western residency programs. This study explored barriers and facilitators of psychological safety and examined its associations with residents' feedback-seeking behaviors and self-perceived clinical competence. Materials and Methods: We conducted a cross-sectional study in a large Lebanese academic medical center. An online survey assessed psychological safety, feedback-seeking behaviors, and self-perceived clinical competence. Open-ended questions explored barriers and facilitators in the clinical environment. Descriptive statistics, correlation, and mediation analyses were performed, along with inductive qualitative 'conventional content analysis' of narrative responses. Results: Of 340 residents, 235 (69.1%) consented to participate, 204 (86.8%) completed the survey, and 160 (68.1%) provided narrative responses. Psychological safety was positively associated with direct feedback-seeking (rho = 0.194, p=.005) and perceived competence (rho = 0.184, p=.008). Adjusted mediation analysis suggested that direct inquiry may partially account for the association between psychological safety and competence (b = 0.2886, BootSE = 0.1479, 95% CI [0.0478, 0.6188]), whereas reflective appraisal and indirect inquiry were not significant mediators. Five themes shaped residents' sense of psychological safety [1]: hierarchy and psychological distance [2], social belonging and interpersonal safety [3], workload, burnout, and learning identity [4], leadership responsiveness and institutional climate, and [5] feedback and day-to-day communication. Discussion: Residents' experiences of psychological safety were linked to more proactive feedback-seeking, which was in turn associated with higher self-perceived competence. However, more passive feedback strategies appeared less sensitive to psychological safety, likely reflecting cultural norms and hierarchical barriers. These safety perceptions were shaped by interpersonal relationships, leadership accessibility, workload pressures, and broader institutional culture, with hierarchy emerging as a dominant concern. Multi-level interventions, including leadership training, faculty development, and structural reforms, are needed to foster psychologically safe learning environments that promote resident growth, team functioning, and patient safety. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Medical Teacher is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=ehh&AN=193123987
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        Value: 10.1080/0142159X.2025.2603348
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