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J Grad Med Educ. 2018 Dec;10(6):651-656. doi: 10.4300/JGME-D-18-00286.1.

Psychological Safety and Support: Assessing Resident Perceptions of the Clinical Learning Environment.



Assessments of the clinical learning environment could allow early interventions to improve graduate medical education. To date, measurement tools for this have not been identified.


We established the concurrent validity of 2 instruments that assess cultural facets of the clinical learning environment by correlating them with external program evaluation data.


In 2017 we surveyed residents across 19 training programs on their perceptions of organizational support by using the Short Survey of Perceived Organizational Support (SPOS), and psychological safety by using the Psychological Safety Scale (PSS). Data were aggregated to the program level and correlated with results from the Accreditation Council for Graduate Medical Education (ACGME) Resident Survey.


Of 511 residents, 322 (63%) completed the survey, and 496 of 516 residents (96%) completed the ACGME Resident Survey. Perceived organizational support correlated positively with overall program evaluation score (r = 0.75, P < .001); faculty (r = 0.72, P < .001); evaluation (r = 0.73, P < .001); educational content (r = 0.52, P = .022); and resources domains (r = 0.55, P =  .014). Psychological safety had a positive correlation with overall program evaluation (r = 0.57, P = .011); faculty (r = 0.50, P = .028); and evaluation (r = 0.62, P < .005).


The SPOS and PSS correlated with key ACGME Resident Survey domains. Programs showing greater support of residents were likely to show more positive ratings on program evaluation metrics. Teaching institutions may benefit from actively monitoring and improving aspects of their learning environment through internal assessments.

[Available on 2019-12-01]

Conflict of interest statement

Conflict of interest: The authors declare they have no competing interests.

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