Without Fear: Psychological Safety for Learners & Patients

ORLANDO—2000 saw the release of To Err Is Human: Building a Safer Health System, the first in a series of publications from the Quality of Health Care in America, which was a project initiated by the Institute of Medicine. This landmark report noted that approximately 98,000 deaths occur each year in the U.S. due to medical errors in hospitals.¹ Despite this sobering statistic, many barriers prevent healthcare professionals from feeling comfortable reporting medical errors or other sensitive healthcare work-related concerns.

Karina Torralba, MD

At the 2022 ACR Education Exchange, Karina Torralba, MD, MACM, RhMSUS, professor of medicine and head of the Division of Medicine, Rheumatology and Immunology, Loma Linda University School of Medicine, Loma Linda, Calif., spoke on this subject, offering potential solutions to the problem.

Dr. Torralba began by defining the term psychological safety, which refers to the perception that there are no negative consequences to oneself, status or career when taking interpersonal risks, such as reporting mistakes or problems. Some of the reasons medical trainees refrain from reporting problems and errors include the perceived harm such reporting may have on the reputation of their program, the concern that such reporting will reflect poorly on the individual resident or fellow (i.e., they may appear incompetent) or the legal liability issues that may be involved in reporting a mistake. Dr. Torralba noted that after a trainee commits a medical error, they may experience increased anxiety about future errors, have decreased job confidence and satisfaction, suffer from insomnia and have thoughts of leaving medicine altogether.

Why is it important for trainees and others at medical institutions to feel comfortable discussing problems they have encountered? Creating a safe space for open discussion about such issues can improve a trainee’s sense of wellness and enable growth, making them better learners, scholars and future faculty members.

In this vein, allowing faculty to feel comfortable expressing concerns may improve their sense of wellness and productivity, and enhance a program’s ability to retain talented faculty members in the school or division.

Finally, with regard to patients, who are the most important stakeholders in the healthcare system, promoting psychological safety can lead to improvements in patient safety and quality of care.

Uncertainty

Dr. Torralba described how each rheumatology fellowship training program has two main curricula: the explicit curriculum and the hidden curriculum. The explicit curriculum refers to teaching that allows trainees to acquire specific medical knowledge and skills, which are usually imparted via formal didactics, conferences and workshops.