Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study
Abstract 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...
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | BMC Medical Education |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12909-023-04622-5 |
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| author | Robyn A. Latessa Shelley L. Galvin Robert A. Swendiman Joshua Onyango Bayla Ostrach Amy C. Edmondson Scott A. Davis David A. Hirsh |
| author_facet | Robyn A. Latessa Shelley L. Galvin Robert A. Swendiman Joshua Onyango Bayla Ostrach Amy C. Edmondson Scott A. Davis David A. Hirsh |
| author_sort | Robyn A. Latessa |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-03-10T17:37:35Z |
| format | Article |
| id | doaj.art-7765178f16024f0eb06ab9b362de8d7c |
| institution | Directory Open Access Journal |
| issn | 1472-6920 |
| language | English |
| last_indexed | 2024-03-10T17:37:35Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Education |
| spelling | doaj.art-7765178f16024f0eb06ab9b362de8d7c2023-11-20T09:47:34ZengBMCBMC Medical Education1472-69202023-10-0123111010.1186/s12909-023-04622-5Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative studyRobyn A. Latessa0Shelley L. Galvin1Robert A. Swendiman2Joshua Onyango3Bayla Ostrach4Amy C. Edmondson5Scott A. Davis6David A. Hirsh7Department of Family Medicine, University of North Carolina School of MedicineDepartment of Obstetrics and Gynecology, Mountain Area Health Education CenterDepartment of Pediatric General Surgery, University of Utah School of MedicineDepartment of Internal Medicine, Yale School of MedicineUniversity of North Carolina Health Sciences at Mountain Area Health Education CenterHarvard Business SchoolDivision of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of PharmacyHarvard Medical SchoolAbstract 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.https://doi.org/10.1186/s12909-023-04622-5Psychological safetyAccountabilityLongitudinal integrated clerkshipsClinical educationTrustMedical student-teacher relationship |
| spellingShingle | Robyn A. Latessa Shelley L. Galvin Robert A. Swendiman Joshua Onyango Bayla Ostrach Amy C. Edmondson Scott A. Davis David A. Hirsh Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study BMC Medical Education Psychological safety Accountability Longitudinal integrated clerkships Clinical education Trust Medical student-teacher relationship |
| title | Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study |
| title_full | Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study |
| title_fullStr | Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study |
| title_full_unstemmed | Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study |
| title_short | Psychological safety and accountability in longitudinal integrated clerkships: a dual institution qualitative study |
| title_sort | psychological safety and accountability in longitudinal integrated clerkships a dual institution qualitative study |
| topic | Psychological safety Accountability Longitudinal integrated clerkships Clinical education Trust Medical student-teacher relationship |
| url | https://doi.org/10.1186/s12909-023-04622-5 |
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