Conceptual Framework and Methods for Evaluating an Intervention to Improve Psychological Safety in Graduate Medical Education

Background and Objectives: Psychological safety in graduate medical education influences key aspects of the clinical learning environment, including feedback and assessment. This study aimed to evaluate a 6-month, workshop-based intervention targeting four elements of psychological safety: culture, bias, power, and the hidden curriculum. The study used qualitative and quantitative methods to assess changes in knowledge, attitudes, and observable behaviors. Methods: The participants were residents and faculty from two Chicago-area family medicine residency programs. The intervention was a series of four 2-hour workshops exploring different aspects of psychological safety and the clinical learning environment. Outcomes included change in the clinical learning environment, assessed by change in faculty feedback behavior on resident assessment forms and change in resident and faculty precepting room behavior. Additional outcomes included impact on individuals, assessed by responses to workshop surveys, pre- and poststudy surveys, and the standardized Postgraduate Hospital Educational Environment Measure. The study applied the Kirkpatrick Model to structure the evaluation of psychological safety interventions, focusing on reaction, learning, and behavior outcomes. A modified version of Miller’s Pyramid of Clinical Competence informed the design of evaluation methods for behavior change. Data were analyzed using descriptive statistics and logistic regression to evaluate differences before and after the intervention. Conclusions: Conceptual frameworks for program evaluation, clinical competence, and workshop content informed the design of this study. We evaluated outcomes for psychological safety, including observed change in teaching behaviors, observed change in written feedback behaviors, and participant self-report.