Helping clinicians debrief themselves: a simple how-to guide.

The operating theatre is a dynamic and challenging environment where effective teamwork is essential. Routine clinical debriefings, which involve brief reflections on collaboration to identify successes and areas for improvement, have proved to enhance teamwork, particularly in the operating theatre. However, barriers such as time constraints, conflicting priorities, and a lack of standardised debriefing processes hinder their regular use. Implementation of TALK©, a voluntary self-debriefing method, showed significant improvements in debriefing performance and integration of debriefing into routine practice, although long-term consistency remains a challenge.

The role of a team psychological safety feeling in teamwork in the classroom.

Active cooperation is expected from the student in the education center, which is associated with fears of expressing their opinions, because a possible mistake may result in a negative reaction from the environment. In our research, we investigated the impact of team psychological safety feelings on students' willingness to engage in active learning. 244 students aged 18 and 19 participated in the research. A mixed methods approach was used to obtain the necessary data. By data analysis, we revealed three separate dimensions in respondents' answers to questionnaire items. According to our findings, students' involvement in active learning is strongly supported by their internal motivation to acquire new knowledge and trust in the class collective. A sense of psychological team safety has an important place in encouraging the student to engage in common activities. At the same time, we found that the teacher has a decisive influence on building the student's trust in the class team.

Emotional and Psychological Safety in Healthcare Digitalization: A Design Ethnographic Study.

Objectives: Emotional and psychological safety is important during the use of digital technologies in healthcare. We aimed to gain comprehensive insight into needs, influencing factors and outcomes in the context of perceived safety and digital technologies in healthcare. Methods: We employed a participatory, design ethnographic research approach with 16 participants in 10 use cases. The methods included in an iterative process were, think-aloud, guideline-based interviews, process mapping, storyboard creation, and photo documentation. A qualitative, primarily inductive data analysis and synthesis was performed. Results: Perceived safety is influenced by various factors and unmet needs. Increased perceived safety can positively support the use of digital technologies, whereas low perceived safety can limit or even hinder its use. Conclusion: The needs of the different target groups should be considered throughout the entire process of digital technology development and healthcare provision to support their implementation. These findings support further research by providing specific aspects of emotional and psychological safety regarding target groups, settings, and ages and those with different levels of affinity for digital technologies.

Social media ostracism and creativity: moderating role of emotional intelligence.

The goal of this study is to learn more about social media ostracism, a stressor associated with online social networks, defined by feelings of rejection, exclusion, or ignoring. We investigate the connection between social media ostracism and worker creativity. We suggest that psychological safety and psychological rumination serve as intermediaries in this relationship. Furthermore, we investigate emotional intelligence as a relationship regulator. To verify our hypothesis, we gathered data with the help of the HR department from 244 workers of nine Chinese organizations. Our research shows that psychological rumination and social media exclusion are significantly correlated, but only in workers with low emotional intelligence. Furthermore, for individuals with strong emotional intelligence, we did not discover a statistically negative association between psychological safety and social media exclusion. Findings suggest that psychological safety and psychological rumination serve as mediating factors in the relationship between employee creativity and social media exclusion. This study illuminates the negative aspects of social media ostracism and reveals how it might hinder creativity. It also emphasizes how emotional intelligence functions as a moderator. Organizations may learn a lot from this study on how to lessen the negative impacts of social media exclusion on employee creativity.

Sparking nurses' creativity: the roles of ambidextrous leadership and psychological safety.

BACKGROUND: The leadership practices of nurse managers significantly impact the creativity of staff nurses; however, the effects of ambidextrous leadership on nurses' creativity are not yet clear. Additionally, the underlying mechanism of this relationship remains to be identified. AIM: The study aimed to examine the effect of ambidextrous leadership on nurses' creativity, directly and indirectly through psychological safety. METHODS: In this cross-sectional study, data were collected from October 2023 to January 2024 involving 241 nurses working at three hospitals in Port Said, Egypt. The Ambidextrous Leadership Scale, Psychological Safety Scale, and the Individual Creativity Scale were employed. Descriptive analysis, correlation analysis, and structural equation modeling were conducted. RESULTS: Nurse managers' ambidextrous leadership was positively associated with nurses' creativity. Psychological safety fully mediated the association between ambidextrous leadership and nurses' creativity. CONCLUSION: The study suggests that enhancing the ambidexterity of nurse leaders can foster a sense of psychological safety, which, in effect, contributes to increased creativity among nurses. IMPLICATION FOR NURSING POLICYMAKING: There is a need for healthcare policies and strategies that are supportive of the implementation of ambidextrous leadership practices and promote psychological safety among nurses.

Why do acute healthcare staff behave unprofessionally towards each other and how can these behaviours be reduced? A realist review.

Background: Unprofessional behaviour in healthcare systems can negatively impact staff well-being, patient safety and organisational costs. Unprofessional behaviour encompasses a range of behaviours, including incivility, microaggressions, harassment and bullying. Despite efforts to combat unprofessional behaviour in healthcare settings, it remains prevalent. Interventions to reduce unprofessional behaviour in health care have been conducted - but how and why they may work is unclear. Given the complexity of the issue, a realist review methodology is an ideal approach to examining unprofessional behaviour in healthcare systems. Aim: To improve context-specific understanding of how, why and in what circumstances unprofessional behaviours between staff in acute healthcare settings occur and evidence of strategies implemented to mitigate, manage and prevent them. Methods: Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards reporting guidelines. Data sources: Literature sources for building initial theories were identified from the original proposal and from informal searches of various websites. For theory refinement, we conducted systematic and purposive searches for peer-reviewed literature on databases such as EMBASE, Cumulative Index to Nursing and Allied Health Literature and MEDLINE databases as well as for grey literature. Searches were conducted iteratively from November 2021 to December 2022. Results: Initial theory-building drew on 38 sources. Searches resulted in 2878 titles and abstracts. In total, 148 sources were included in the review. Terminology and definitions used for unprofessional behaviours were inconsistent. This may present issues for policy and practice when trying to identify and address unprofessional behaviour. Contributors of unprofessional behaviour can be categorised into four areas: (1) workplace disempowerment, (2) organisational uncertainty, confusion and stress, (3) (lack of) social cohesion and (4) enablement of harmful cultures that tolerate unprofessional behaviours. Those at most risk of experiencing unprofessional behaviour are staff from a minoritised background. We identified 42 interventions in the literature to address unprofessional behaviour. These spanned five types: (1) single session (i.e. one-off), (2) multiple sessions, (3) single or multiple sessions combined with other actions (e.g. training session plus a code of conduct), (4) professional accountability and reporting interventions and (5) structured culture-change interventions. We identified 42 reports of interventions, with none conducted in the United Kingdom. Of these, 29 interventions were evaluated, with the majority (n = 23) reporting some measure of effectiveness. Interventions drew on 13 types of behaviour-change strategy designed to, for example: change social norms, improve awareness of unprofessional behaviour, or redesign the workplace. Interventions were impacted by 12 key dynamics, including focusing on individuals, lack of trust in management and non-existent logic models. Conclusions: Workplace disempowerment and organisational barriers are primary contributors to unprofessional behaviour. However, interventions predominantly focus on individual education or training without addressing systemic, organisational issues. Effectiveness of interventions to improve staff well-being or patient safety is uncertain. We provide 12 key dynamics and 15 implementation principles to guide organisations. Future work: Interventions need to: (1) be tested in a United Kingdom context, (2) draw on behavioural science principles and (3) target systemic, organisational issues. Limitations: This review focuses on interpersonal staff-to-staff unprofessional behaviour, in acute healthcare settings only and does not include non-intervention literature outside the United Kingdom or outside of health care. Study registration: This study was prospectively registered on PROSPERO CRD42021255490. The record is available from: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR131606) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 25. See the NIHR Funding and Awards website for further award information.

For this study, we asked: how, why and in what situations can unprofessional behaviour between healthcare staff working in acute care (usually hospitals) be reduced, managed and prevented? We wanted to research how people understand unprofessional behaviour, explore the circumstances leading to unprofessional behaviour and understand how existing approaches to addressing unprofessional behaviour worked (or did not work) across staff groups and acute healthcare organisations. We used a literature review method called a 'realist review', which differs from other review methods. A realist review focuses on understanding not only if interventions work but how and why they work, and for whom. This allowed us to analyse a wider range of relevant international literature ­ not only academic papers. We found 148 sources, which were relevant either because they described unprofessional behaviour or because they provided information on how to address unprofessional behaviour. Definitions of unprofessional behaviour varied, making it difficult to settle on one description. For example, unprofessional behaviour may involve incivility, bullying, harassment and/or microaggressions. We examined what might contribute to unprofessional behaviour and identified factors including uncertainty in the working environment. We found no United Kingdom-based interventions and only one from the United States of America that sought to reduce unprofessional behaviour towards minority groups. Strategies often tried to encourage staff to speak up, provide ways to report unprofessional behaviour or set social standards of behaviour. We also identified factors that may make it challenging for organisations to successfully select, implement and evaluate an intervention to address unprofessional behaviour. We recommend a system-wide approach to addressing unprofessional behaviour, including assessing the context and then implementing multiple approaches over a long time (rather than just once), because they are likely to have greater impact on changing culture. We are producing an implementation guide to support this process. Interventions need to enhance staff ability to feel safe at work, work effectively and support those more likely to experience unprofessional behaviour.

Beginning with the End in Mind: Creating a Practice that Centers Equity-Part 2.

The concept of equity recognizes historical and current barriers and promotes thriving for veterinary teams and people and animals in the community. It is possible to design equitable workplace systems to prevent and respond to harm using learnings from human medicine and the social sciences. These systems are grounded in the principles of health equity and must incorporate both formal policies and intentional cultivation of supportive culture and relationships. This article is part 2 of 2 articles reviewing how the concept of equity applies and could transform well-being in companion animal veterinary practice in North America.

The effects of psychological safety and employee voice behavior on flight attendants' mindful safety practices adoption.

Introduction: Flight attendants, as the front-line staff in the cabin, play a crucial role in improving air travel safety. This research explores how psychological safety affects flight attendants' adoption of mindful safety practices through voice participation. This mechanism also identifies ethical leadership and traditionality as two moderators. Methods: A self-reported questionnaire was used to collect data from 621 flight attendants in Chinese private commercial airline companies. PLS-SEM (partial least square structured equation modeling) is used to examine the hypotheses proposed in the present study. Results: After data analysis, the results reveal that the underlying mechanism covering both mediating and moderating effects through which flight attendants' voluntary and extra-role safety behavior could be improved. Discussion: The findings extend the existing literature regarding the antecedents of flight attendants' mindful safety practices adoption and obstacles to employee voice participation. Managerial implications are also provided in the commercial aviation industry and discussed along with future research directions.

Beginning with the End in Mind: Creating a Practice that Centers Equity-Part 1.

The concept of equity recognizes historical and current barriers and promotes thriving for veterinary teams and people and animals in the community. Veterinary medicine lacks sociodemographic diversity; veterinarians and other team members who identify with systemically excluded groups offer valuable contributions but are at risk of workplace discrimination. Client families who face barriers for financial and other reasons are at risk of poor animal health and welfare outcomes, including separation from their animals. This article is part one of 2 articles reviewing how the concept of equity applies and could transform well-being in companion animal veterinary practice in North America.

Enhancing Healthcare Accountability for Administrators: Fostering Transparency for Patient Safety and Quality Enhancement.

Transparency in healthcare organizations is essential for creating a culture of patient-centered care where patients are respected, informed, and actively engaged in their health and well-being. Organizational transparency is a crucial element in healthcare, enhancing patient safety and quality improvement. Transparency involves open communication about healthcare organizations' performance, outcomes, and processes, leading to improved accountability, trust, and patient engagement. Transparent organizations prioritize patient-centered care, involving patients in decision-making and fostering shared mental models between healthcare providers and patients. Psychological safety is vital for organizational transparency. Patient safety reporting systems play a key role in transparency, allowing anonymous reporting of safety concerns and incidents. These systems facilitate early risk identification, continuous improvement, and compliance with regulatory requirements. Transparency in reporting encourages a culture of openness, learning from near misses, and addressing systemic issues and human errors. It aligns with ethical principles, potentially mitigating legal challenges. This review synthesizes key themes, including the importance of patient-centered care, the role of psychological safety in fostering transparency, and the effectiveness of patient safety reporting systems.

How can we measure psychological safety in mental healthcare staff? Developing questionnaire items using a nominal groups technique.

There have been growing concerns about the well-being of staff in inpatient mental health settings, with studies suggesting that they have higher burnout and greater work-related stress levels than staff in other healthcare sectors. When addressing staff well-being, psychological safety can be a useful concept. However, there is no measure of psychological safety that is suitable for use in inpatient mental health settings. Edmondson (1999) is the most commonly used measure of psychological safety, but it was designed for use in general physical healthcare settings. As inpatient mental health settings are unique environments, transferability of knowledge from physical to mental healthcare settings cannot be assumed. We sought to develop questionnaire items that capture psychological safety among healthcare staff working in acute inpatient mental healthcare settings. We used the nominal group technique, a consensus method involving rounds of discussion, idea generation, and item rating/ranking to identify priorities. Twenty-eight stakeholders participated, including 4 who had lived experience of mental health problems, 11 academics and 18 healthcare professionals (8 participants identified with more than 1 category). The study involved a workshop with three parts: (i) an overview of current research and limitations of the Edmondson (1999) measure as outlined above, (ii) discussion on what items should be retained from the Edmondson (1999) measure, and (iii) discussion on what items should be added to the Edmondson (1999) measure. Twenty-one items were generated and retained to capture psychological safety in inpatient mental health settings. These measure professionals' sense of being valued by their team and organization, feeling supported at work, feeling physically safe and protected from physical harm, and knowing they can raise concerns about risk and safety. This is the first study to generate questionnaire items suitable for measuring staff psychological safety in mental health settings. These have been generated via a consensus method to ensure stakeholders' views are reflected. Further research is needed to evaluate factor structure, internal reliability, and convergent validity.

The Pediatric Heart Center Melting Pot: Sharing Recipes for Success: Proceedings from the 8th World Congress of Pediatric Cardiology and Cardiac Surgery.

The challenges of present-day healthcare are urgent; there is a shortage of clinicians, patient care is increasingly complex, resources are limited, clinician turnover seems ever-increasing, and the expectations of providers and patients are monumental. To transform problems into innovative opportunities, diverse perspectives and a sense of possibility are needed. The following is a collaborative manuscript authored by the speakers of the 8th World Congress of Pediatric Cardiology and Cardiac Surgery session, "Teamwork, Culture Change, and Strategy." Although this panel was diverse in the clinical roles, nationalities, and genders represented, several consistent themes emerged which are explored in this work.

The Art of Speaking Up: Supporting a Culture of Safety in the OR.

Considering the high-risk, stressful, and fast-paced nature of the perioperative environment and vulnerability of surgical patients, the quest for maintaining a safety culture in the OR is ongoing. Speaking up-an interaction between perioperative team members to address a concern-requires team member empowerment to advocate for patient safety when needed. Hierarchical gradients, lack of psychological safety, incivility, and a nonsupportive organizational culture can impede speaking-up behaviors. Strategies to improve speaking up include using multimethod education initiatives, enhancing psychological safety, and managing conflict. Perioperative nurses can experience barriers to speaking up, such as lack of team familiarity, normalization of deviance, and differing perceptions among team members. The logistics of whole-team training initiatives can be challenging; however, such initiatives can help participants improve their understanding of the perspectives and communication goals of all involved personnel. Perioperative nurses and leaders should collaborate to promote speaking up for safety when warranted.

Psychological Safety: Creating a Transformative Culture in a Faculty Group Peer-Mentoring Intervention.

We investigated psychological safety (PS) in a randomized controlled study of a group peer mentoring intervention. Forty mid-career academic medicine research faculty participated in the year-long C-Change Mentoring & Leadership Institute, completing a survey after the first session and post-intervention. Qualitative data included ethnographic observations, interviews, and participant writings. A codebook thematic analysis used PS as one sensitizing concept. PS mean scores increased from 5.6 at baseline to 6.1 (range 1-7) post-intervention (t=3.03, p=.005, mean difference=0.48, 95% CI=0.33, 0.81). In qualitative analysis, PS resulted from intervention structure, storytelling/listening curriculum, and skilled facilitation, fostering norms that enabled sharing, repaired trust, and nurtured belonging. PS enabled faculty to be authentic, vulnerable, and responsive, and to develop social bonds within a peer community.

Evolution of the roles of family physicians through collaboration with rehabilitation therapists in rural community hospitals: a grounded theory approach.

BACKGROUND: The role of rural family physicians continues to evolve to accommodate the comprehensive care needs of aging societies. For older individuals in rural areas, rehabilitation is vital to ensure that they can continue to perform activities of daily living. In this population, a smooth discharge following periods of hospitalization is essential and requires management of multimorbidity, and rehabilitation therapists may require support from family physicians to achieve optimal outcomes. Therefore, this study aimed to investigate changes in the roles of rural family physicians in patient rehabilitation. METHODS: An ethnographic analysis was conducted with rural family physicians and rehabilitation therapists at a rural Japanese hospital. A constructivist grounded theory approach was applied as a qualitative research method. Data were collected from the participants via field notes and semi-structured interviews. RESULTS: Using a grounded theory approach, the following three themes were developed regarding the establishment of effective interprofessional collaboration between family physicians and therapists in the rehabilitation of older patients in rural communities: 1) establishment of mutual understanding and the perception of psychological safety; 2) improvement of relationships between healthcare professionals and their patients; and 3) creation of new roles in rural family medicine to meet evolving needs. CONCLUSION: Ensuring continual dialogue between family medicine and rehabilitation departments helped to establish understanding, enhance knowledge, and heighten mutual respect among healthcare workers, making the work more enjoyable. Continuous collaboration between departments also improved relationships between professionals and their patients, establishing trust in collaborative treatment paradigms and supporting patient-centered approaches to family medicine. Within this framework, understanding the capabilities of family physicians can lead to the establishment of new roles for them in rural hospitals. Family medicine plays a vital role in geriatric care in community hospitals, especially in rural primary care settings. The role of family medicine in hospitals should be investigated in other settings to improve geriatric care and promote mutual learning and improvement among healthcare professionals.

The last resort: reducing avoidable employee harm by improving the application of the disciplinary policy and process.

Introduction: There is growing evidence within the healthcare sector that employee investigations can harm individuals involved in the process, an organization's culture and the delivery of its services. Methods: This paper details an intervention developed by an NHS Wales organization to reduce the number of its employee investigations through an organization-wide focus that promoted a 'last resort' approach and introduced the concept of 'avoidable employee harm'. A range of associated improvement initiatives were developed to support behavior change among those responsible for determining whether an employee investigation should be initiated. Results: Over a 13-month period, organizational records showed an annual reduction of 71% in investigation cases post-intervention, resulting in an estimated 3,308 sickness days averted annually and total estimated annual savings of £738,133 (based on direct savings and costs averted). This indicates that the organization has started to embrace the "last resort" approach to using employee investigations to address work place issues. The programme was supported with training for those responsible for commissioning and leading the organization's employee investigations. Analysis of survey data from those who attended training workshops to support the programme indicated that participants showed an increased awareness of the employee investigation process post-workshop and an understanding of the concept of avoidable employee harm. Discussion: The programme is congruent with the Healthy Healthcare concept, as the study illustrates how its practices and processes have a beneficial impact on staff, as well as potentially on patients. This study highlights wider issues for consideration, including the: (1) the role of Human Resources (HR), (2) taking a multi-disciplinary approach, (3) culture and practice, (4) the responsibility of the wider HR profession.

Medical Professionals' Responses to a Patient Safety Incident in Healthcare.

Objectives: Patient safety incidents (PSIs) are common in healthcare. Open communication facilitated by psychological safety in healthcare could contribute to the prevention of PSIs and enhance patient safety. The aim of the study was to explore medical professionals' responses to a PSI in relation to psychological safety in Slovak healthcare. Methods: Sixteen individual semi-structured interviews with Slovak medical professionals were performed. Obtained qualitative data were transcribed verbatim and analysed using the conventional content analysis method and the consensual qualitative research method. Results: We identified eight responses to a PSI from medical professionals themselves as well as their colleagues, many of which were active and with regard to ensuring patient safety (e.g., notification), but some of them were passive and ultimately threatening patients' safety (e.g., silence). Five superiors' responses to the PSI were identified, both positive (e.g., supportive) and negative (e.g., exaggerated, sharp). Conclusion: Medical professionals' responses to a PSI are diverse, indicating a potential for enhancing psychological safety in healthcare.

Linking ethical leadership to nurses' internal whistleblowing through psychological safety.

Background: Cultivating internal whistleblowing among nurses is of paramount importance to nurse leaders. Yet, the literature on how nurse leaders can foster this phenomenon among nurses is limited. Additionally, the underlying mechanisms linking leadership behaviors to internal whistleblowing intentions remain underexplored.Aim: This study aimed to examine how ethical leadership is linked to internal whistleblowing intentions among nurses through the mediating effect of psychological safety.Research design: A multicenter cross-sectional research design was used for this study.Participants and research context: This study involved 201 nurses working in three tertiary governmental hospitals across three cities in Egypt. Data were collected between October and December 2023, using an introductory information form, the Ethical Leadership Scale, the Psychological Safety Scale, and the Internal Whistleblowing Intentions Scale. Structural equation modeling was used to evaluate study hypotheses.Ethical consideration: Research Ethics Committee of Faculty of Nursing, Port Said University, Egypt approved the study (reference number: NUR (6/8/2023)(28)), and each participant signed the informed consent form before participation in the study.Results: Ethical leadership was positively linked to nurses' psychological safety and internal whistleblowing intentions. Psychological safety mediated the link between ethical leadership and nurses' internal whistleblowing intentions.Conclusion: Our study suggests that nurse leaders can foster nurses' intentions to blow the whistle internally by adopting ethical leadership behaviors and enhancing psychological safety among nurses.

Antecedents and Consequences of Violence in Homeless Shelters: Perspectives and Experiences of Service Users and Shelter Staff.

Violence is a critical issue in homeless shelters that affects service users and staff, yet there is limited evidence on how shelter-based violence occurs. The objective of this qualitative study was to investigate the antecedents and consequences of shelter-based violence from the perspectives of service users and staff. Purposive sampling was used to recruit individuals experiencing homelessness and shelter staff in a large metropolitan city in Ontario, Canada. Data from in-depth interviews with 56 individuals experiencing homelessness and 30 shelter staff were analyzed. Findings showed that shelter-based violence toward service users and staff was perceived to manifest in response to three interacting factors: (a) burden of homelessness and shelter living, (b) individual histories and marginalization, and (c) interpersonal conflict. These antecedents had a hierarchical structure in that each subsequent factor exacerbated the risk of previous ones and culminated with the most proximal factor for violence. There were three primary outcomes of shelter-based violence reported by service users and staff: (a) health and environmental harms, (b), procedural enforcement, and (c) avoidant behaviors. Avoidance was often a subsequent impact following health harms, as was procedural enforcement to a lesser extent. Overall, the study findings demonstrate that shelter-based violence is a complex and dynamic problem that is perceived to be the result of interacting structural, environmental, programmatic, interpersonal, and individual factors, with similar consequences for service users and staff. Implications for preventing violence through shelter design and service delivery are discussed.

Improving departmental psychological safety through a medical school-wide initiative.

BACKGROUND: Psychological safety is a team-based phenomenon whereby group members are empowered to ask questions, take appropriate risks, admit mistakes, propose novel ideas, and candidly voice concerns. Growing research supports the benefits of psychological safety in healthcare and education for patient safety, learning, and innovation. However, there is a paucity of research on how to create psychological safety, especially within academic medicine. To meet this need, the present study describes and evaluates a multi-year, medical school-wide psychological safety initiative. METHODS: We created, implemented, and assessed a multi-pronged psychological safety initiative including educational training sessions, departmental champions, videos, infographics, and targeted training for medical school leaders. Employees' perceptions of psychological safety at both the departmental and institutional levels were assessed annually. The impact of educational training sessions was quantified by post-session surveys. RESULTS: Deidentified employee surveys revealed a statistically significant increase in departmental psychological safety between the first and second annual surveys. Perceived psychological safety remained lower at the institution-wide level than at the departmental level. No significant differences in psychological safety were observed based on gender, position, or employment length. Post-educational training session surveys showed that the sessions significantly increased knowledge of the topic as well as motivation to create a culture of psychological safety within the medical school. CONCLUSIONS: This study establishes an evidence-based method for increasing psychological safety within medical school departments and serves as a template for other health professions schools seeking to promote psychological safety. Training leadership, faculty, and staff is an important first step towards creating a culture of psychological safety for everyone, including trainees.