Psychological safety in surgical residency: a comparison of PGY-1 s and more advanced residents

Psychological safety (PS) is the perception that a team environment is safe for interpersonal risk taking. High PS amongst medical providers has a direct impact on patient care. PS in surgical residency is not well-studied. We hypothesize that psychological safety is lower in PGY-1 surgical residents compared to more senior residents.

A survey was distributed to program directors (PD) of US surgical residencies. PD were asked to forward the survey to their residents. The survey included an adapted Edmondson psychological safety scale to assess PS in surgical residency. Composite scores from the questions were created to assess PS during interactions with senior residents (SR), attending surgeons (AS), and PD (maximum score of 126). PGY-1 residents were compared to PGY-2 residents and to non-PGY-1 residents using the Wilcoxon Mann–Whitney test.

176 residents responded to the survey. Compared to non-PGY-1 residents, PGY-1 residents had lower overall PS scores and in interactions with AS (87 vs 97, p = 0.012) and PD (98.5 vs 107, p = 0.014). Compared to PGY-2 residents, PGY-1 residents had lower PS scores in interactions with AS (87 vs 97, p = 0.036). Areas of lower psychological safety for PGY-1 residents included criticism for mistakes, ability to raise concerns, and comfort in offering ideas.

Compared to non-PGY-1 residents, PGY-1 surgical residents experience lower PS overall and in interactions with AS and PD. Strategies should be developed to foster psychological safety early in residency to optimize the learning environment and patient care.