Abstract
Background
The clinical learning environment (CLE) is a key focus of the Accreditation Council of Graduate Medical Education. It impacts knowledge acquisition and professional development. A previous single‐center study evaluated the psychological safety and perceived organizational support of the CLE across different specialties. Building on this work, we explored and evaluated psychological safety and perceived organizational support across multiple heterogeneous emergency medicine (EM) residencies to identify trends and factors affecting perceptions of the CLE.
Methods
Using the Psychological Safety Scale (PSS) and Survey of Perceived Organizational Support (SPOS), residents from seven U.S. EM residencies were surveyed using REDCap software from September through November 2021, with 300 potential respondents. As an adjunct to these surveys, three open‐ended questions were included regarding features of their learning environments.
Results
A total of 137 out of 300 residents completed the survey. The overall response rate was 45.7%. There was a variable response rate across programs (26.0%–96.7%). Pooled results demonstrate an overall positive perception of CLEs, based on positive mean responses (i.e., “Members of my department are able to bring up problems and tough issue” had a mean of 4.2 on a 5‐point Likert scale). Open responses identified teaching, collegiality, and support from program leadership as supportive features of the CLE. Confrontational interdisciplinary communication, a sense of being devalued, and off‐service rotations were identified as threats or areas for improvement to the CLE.
Conclusions
PSS and SPOS scores were generally positive in this multi‐institution study, consistent with the prior single‐institution study indicating that EM is often considered psychologically safe and supportive. EM training programs can consider using the PSS/SPOS to audit their own programs to identify areas for improvement and foster supportive features already in place.
Keywords: clinical learning environment, graduate medical education, psychological safety, perceived organizational support, burnout, resident well‐being
INTRODUCTION
Annual workplace studies in medicine report that physicians experience a high rate of burnout. 1 For residents, the day‐to‐day work environment is an important contributor to that experience. 2 Recent literature outlines the importance of psychological safety in the clinical environment and the impact of burnout on team performance and patient safety which may ultimately affect patient outcomes. 3 , 4 , 5 They noted that a culture where members of the team were willing to report mistakes or near misses allowed the whole team to learn and ultimately improve patient outcomes. 5 Several studies have noted that interpersonal relationships or experiences can impact the development of psychological safety, positively or negatively, or contribute to development of burnout as residency progresses. 3 , 6 , 7
The Accreditation Council of Graduate Medical Education (ACGME) acknowledges the importance of the clinical learning environment (CLE) by devoting resources to the annual resident survey and the Clinical Learning Environment Review (CLER) program, a stance reinforced by a Belgian study linking resident burnout and the CLE. 8 , 9 Although the 2022 CLER National Report of Findings: The COVID‐19 Pandemic and Its Impact on the Clinical Learning Environment had many themes speaking directly to the impact of COVID‐19, Theme 3 specifically noted that many CLEs fall short in addressing issues of well‐being for the clinical care team and how that ultimately can impact clinician performance as well as patient care and call upon leaders to be proactive rather than reactive in their approach to the CLE. 10 While there is limited literature on the impact of the CLE on core content assimilation, it plays a role in knowledge integration and application. 11 , 12 , 13 Feeling safe to ask questions, explore misunderstandings, and learn from mistakes allows for deep engagement with material and, thus, augments learning and by extension, patient care. 14 , 15
Business literature uses the Psychological Safety Scale (PSS) and Short Survey of Perceived Organizational Support (SPOS) to assess the working environment. 16 , 17 , 18 A study by Appelbaum et al. 19 established validity evidence for the PSS and SPOS in comparison to annual ACGME survey results at a single site. An additional study by Feeser et al. 20 reported that emergency medicine (EM) residents had a favorable perception of their CLE compared to residents from other specialties within that single institution using the PSS and SPOS.
As the CLE is a core pillar of residency training, we, as educators of the next generation of EM physicians, have a duty to ensure that our training environments provide them with a safe and supportive space to learn. While information from single institutions indicates that EM training environments are perceived as safe and supportive by residents, it is unclear if these results are generalizable to the EM resident population at large. We sought to understand how EM CLEs perform on a larger scale and explore the factors shaping them and hope to provide education leaders with meaningful insights to strengthen their own learning environments.
METHODS
Study design
This study was approved by the institutional review boards at the institutions of authors MG, KM, JB, KB, and AK. The PSS and SPOS surveys used were taken from the study by Appelbaum et al. 19 The PSS includes seven questions and the SPOS includes 16 questions, both utilizing Likert‐type scales from “strongly disagree” to “strongly agree.” The PSS is on a 5‐point scale and the SPOS is on a 7‐point scale. Both the PSS and SPOS have previous validity evidence when examining resident perceptions of the CLE. 19 , 20 Like in the studies by Appelbaum et al. 19 and Feeser et al. 20 studies, the words “organization” and “team” were replaced by “department.” Three open‐ended questions were added to the survey to identify threats, supporting factors, and opportunities for improvement to the CLE. These questions were developed through an iterative process and consensus reached by all authors. These open‐ended questions were not developed using specific qualitative methods as qualitative analysis was not performed as part of the study. These questions were intended to augment the understanding of the quantitative results of the PSS and SPOS portions of the survey. The combined survey is available in Supplemental Materials S1.
Study setting and population
EM residents from seven training programs across the United States were chosen to participate. Sites were selected based on affiliation with study coinvestigators, and additional sites were selected as a convenience sample to increase geographic diversity as well as represent both community and academic programs. The surveys were distributed electronically via REDCap.
Study protocol
The survey including the PSS, SPOS, and free‐response questions was sent electronically to EM residents at the participating programs from September through November 2021. Residents were given a 3 weeks response window with weekly reminders via email.
Measurements and outcomes
Our main objective in this study was to determine EM resident perceptions of the CLE across multiple sites as previous works had evaluated this at a single site. The primary measure is the numerical scores of each question and how it relates to the neutral response. This is to say, that indications of a supportive or psychologically safe environment would have responses “in agreement” with positively phrased questions (above the neutral response score) and “in disagreement” with negatively phrased questions (below the neutral response score). Additional insights from the open‐ended questions would be secondary outcomes in hopes that they would provide additional context to the numerical data.
Data analysis
To investigate the representativeness of our response sample compared to the EM resident population at large, we conducted a bias analyses on key demographic variables with chi‐square tests using VassarStats and QuantPsy. 21 , 22 To compensate for empty cells and cells with expected values of less than 5, we had to combine some race/ethnicity categories.
Statistical analysis was performed after data deidentification. For each question in the PSS and SPOS, means and standard deviations (SDs) were calculated. Both the PSS and SPOS tools include negatively phrased statements. For these statements, lower mean values indicate a disagreement with these statements and correspond to a positive response/feeling related to that aspect of psychological safety or perceived organizational support. After reverse coding of the negatively phrased questions, an aggregate score was calculated for each survey tool.
Open‐ended responses were categorized using the Pololi et al. 23 construct of institutional vitality. An institution's vitality determines the degree of satisfaction, productivity, and engagement that allows the employee to maximize their professional success and achieve goals. The five categories are: relationships/inclusion, values alignment, institutional/departmental support, work‐life integration and ethical/moral distress. The responses were analyzed and categorized separately by three authors (MG, KM, and JL) who then reviewed them collectively to establish a final consensus among them. Complex responses were coded into multiple categories.
RESULTS
A total of 300 surveys were distributed with 137 residents completing the combined survey, for an overall response rate of 45.7% across all seven programs. Demographics of the study cohort compared to the national demographics of EM residents are reported (Table 1). Our respondents were generally representative of the population of EM residents in the United States with regard to self‐identified race/ethnicity groups and postgraduate year (PGY) Level. However, our response subjects were significantly more female than the general population (χ2 = 5.4, df = 1, p ≤ 0.05). There was a variable response rate across programs (26.0%–93.3%; Table 2).
TABLE 1.
Demographic information of study respondents versus ACGME EM Residency demographic data including Chi‐square analysis comparing the two populations.
| Our cohort, % (n = 137) | National data, 24 % (n = 9037) | |
|---|---|---|
| Sex | Female 48.9% (67) | Female 39.4% (3560) |
| Male 49.6% (68) | Male 62.5% (5473) | |
| Not reported 1.5% (2) | Not reported 0.0% (4) | |
|
χ2 = 5.4, df = 1, p ≤ 0.05 Note: Not reported subjects are not included | ||
| Self‐identified race/ethnicity groups | American Indian or Alaska Native 1.5% (2) | American Indian or Alaska Native 0.1% (12) |
| Asian 13.1% (18) | Asian 15.2% (1376) | |
| Black or African American 2.9% (4) | Black or African American 5.1% (462) | |
| Native Hawaiian or Pacific Islander (0) | Native Hawaiian or Pacific Islander 0.1% (5) | |
| White 77.4% (106) | White 62.7% (5670) | |
| Hispanic, Latinx, or Spanish 8.0% (11) | Hispanic, Latinx, or Spanish 9.3% (842) | |
| Multiple race/ethnicity 2.3% (3) | Multiple race/ethnicity 4.3% (392) | |
| Self‐described 0.7% (1) | Other 2.5% (225) | |
| No response 1.5% (2) | Unknown 0.6% (53) | |
|
χ2 = 5.8, df = 3, p = 0.12 Note: Cells < 5 were grouped together | ||
| PGY‐1 | 33.6% (46) | 32.5% (2936) |
| PGY‐2 | 30.7% (42) | 30.9% (2796) |
| PGY‐3 | 26.3% (36) | 29.4% (2656) |
| PGY‐4 | 9.5% (13) | 7.2% (649) |
| Chi‐square = 1.49, df = 3, p = 0.68 | ||
Abbreviation: ACGME, Accreditation Council of Graduate Medical Education.
TABLE 2.
Program/site information related to response rate, location, and length of participating programs.
| Program | Response rate, % (n) | Region | 3 years vs. 4 years |
|---|---|---|---|
| 1 | 35.1% (13) | Midwest | 3 |
| 2 | 33.3% (20) | Midwest | 3 |
| 3 | 26.0% (10) | Northeast | 4 |
| 4 | 33.3% (10) | Southeast | 3 |
| 5 | 62.2% (28) | Southwest | 3 |
| 6 | 93.3% (28) | West | 4 |
| 7 | 56.3% (27) | Northeast | 3 |
The PSS tool (Table 3) had a mean (±SD) overall aggregate score of 4.0/5 (±0.2). The highest mean scores were observed for “Members of my department are able to bring up problems and tough issues” (4.2/5 [±0.8]) and “Working with members of my department, my unique skills and talents are valued and utilized” (4.1/5 [±0.8]). The lowest mean (±SD) scores were seen in the negatively worded statements “It is difficult to ask other members of my department for help” (1.7/5 [±0.8]), “People in my department sometimes reject others for being different” (2.0/5 [±1.0]) and “If you make a mistake in my department, it is often held against you” (2.1/5 [±0.8]).
TABLE 3.
PSS questions with corresponding response results from the study cohort and overall study cohort aggregate PSS score.
| 5‐point Likert scale (1 = strongly disagree, 5 = strongly agree) | |||||
|---|---|---|---|---|---|
| Mean/SD | Strongly disagree/disagree a | Neutral a | Strongly agree/agree a | N/A a | |
| If you make a mistake in my department, it is often held against you b | 2.1/0.8 | 110 (80.3) | 18 (13.1) | 9 (6.6) | 0 (0) |
| Members of my department are able to bring up problems and tough issues | 4.2/0.8 | 7 (5.1) | 10 (7.3) | 120 (87.6) | 0 (0) |
| People in my department sometimes reject others for being different b | 2.0/1.0 | 102 (74.5) | 20 (14.6) | 15 (10.9) | 0 (0) |
| It is safe to take a risk in my department | 3.7/0.9 | 12 (8.8) | 27 (19.7) | 97 (70.8) | 1 (0.7) |
| It is difficult to ask other members of my department for help b | 1.7/0.8 | 121 (88.3) | 12 (8.8) | 4 (2.9) | 0 (0) |
| No one in my department would deliberately act in a way that undermines my efforts | 3.9/1.2 | 23 (16.8) | 12 (8.8) | 102 (74.5) | 0 (0) |
| Working with members of my department, my unique skills and talents are valued and utilized | 4.1/0.8 | 7 (5.1) | 16 (11.7) | 113 (82.5) | 1 (0.7) |
| Aggregate PSS score (accounting for reverse coding) | 4.0/0.2 | ‐ | ‐ | ‐ | ‐ |
Abbreviation: N/A, not applicable; PSS, Psychological Safety Scale.
Data reported as n (%).
Item is a negatively worded statement.
The SPOS tool (Table 4) had a mean (±SD) overall aggregate score of 5.6/7 (±0.4). The highest mean (±SD) scores were observed for “Help is available from my department when I have a problem” (6.3/7 [±1.0]) and “My department really cares about my well‐being” (6.1/7 [±1.0]). The lowest mean (±SD) scores were seen in the negatively phrased statements “My department shows very little concern for me” (2.0/7 [±1.2]) and “My department would ignore any complaint from me” (2.2/7 [±1.3]). The statement with a mean nearing neutral was “If my department could hire someone to replace me at a lower salary it would do so” (3.4/7 [±1.9]) and was also the only statement with a bimodal distribution.
TABLE 4.
SPOS questions with corresponding response results from the study cohort.
| SPOS: 7‐point Likert scale (1 = strongly disagree, 7 = strongly agree) | |||||
|---|---|---|---|---|---|
| Mean/SD | Strongly disagree/moderately disagree/disagree a | Neither agree nor disagree a | Strongly agree/moderately agree/agree a | N/A a | |
| My department values my contribution to its well‐being | 5.7/1.3 | 8 (5.8) | 12 (8.8) | 117 (85.4) | 0 (0) |
| If my department could hire someone to replace me at a lower salary it would do so b , c | 3.4/1.9 | 62 (45.3) | 26 (19.0) | 36 (26.3) | 13 (9.5) |
| My department fails to appreciate any extra effort from me c | 2.9/1.5 | 95 (69.3) | 22 (16.1) | 20 (14.6) | 0 (0) |
| My department strongly considers my goals and values | 5.6/1.2 | 9 (6.6) | 12 (8.8) | 116 (84.5) | 0 (0) |
| My department would ignore any complaint from me c | 2.2/1.3 | 118 (86.1) | 9 (6.6) | 10 (7.3) | 0 (0) |
| My department disregards my best interests when it makes decisions that affect me c | 2.6/1.4 | 103 (75.2) | 18 (13.1) | 16 (11.7) | 0 (0) |
| Help is available from my department when I have a problem | 6.3/1.0 | 2 (1.5) | 7 (5.1) | 128 (93.4) | 0 (0) |
| My department really cares about my well‐being | 6.1/1.0 | 3 (2.2) | 6 (4.4) | 128 (93.4) | 0 (0) |
| Even if I did the best job possible, my department would fail to notice c , d | 2.4/1.4 | 111 (81.6) | 13 (9.6) | 12 (8.8) | 0 (0) |
| My department is willing to help me when I need a special favor | 5.7/1.2 | 7 (5.1) | 10 (7.3) | 118 (86.1) | 2 (1.5) |
| My department cares about my general satisfaction at work | 5.6/1.2 | 10 (7.3) | 12 (8.8) | 115 (84.0) | 0 (0) |
| If given the opportunity, my department would take advantage of me c | 2.7/1.6 | 97 (70.1) | 19 (13.9) | 21 (15.3) | 0 (0) |
| My department shows very little concern for me c | 2.0/1.2 | 123 (89.8) | 7 (5.1) | 7 (5.1) | 0 (0) |
| My department cares about my opinions | 5.4/1.4 | 16 (11.7) | 14 (10.2) | 107 (78.1) | 0 (0) |
| My department takes pride in my accomplishments at work | 5.6/1.2 | 6 (4.4) | 17 (12.4) | 113 (82.5) | 1 (0.7) |
| My department tries to make my job as interesting as possible | 5.7/1.2 | 6 (4.4) | 18 (13.1) | 112 (81.8) | 1 (0.7) |
| Aggregate SPOS score (accounting for reverse coding) | 5.6/0.4 | — | — | — | — |
Abbreviation: N/A, not applicable; SPOS, Survey of Perceived Organizational Support.
Data reported as n (%).
Indicates bimodal distribution of responses.
One no‐response to this question.
Item is a negatively worded statement.
Open responses included 110 comments on supportive features within the programs, 105 comments on threatening features, and 54 suggestions for improvement. Responses referring to institutional/departmental support were the most frequently found, with relationships/inclusion noted as the second most common theme. There were a total of 24 comments that were not able to be categorized. The supportive features question did not have any responses coded for ethical/moral distress (Table 5).
TABLE 5.
Breakdown of open‐ended responses, frequency of categorization into vitality themes with representative quotes.
| Open responses | Supportive features | Threatening features |
|---|---|---|
| Total number of comments | 110 | 105 |
| Vitality themes (in order of frequency of responses) |
Frequency Representative comment |
Frequency Representative comment |
| Institutional/departmental support—perception of commitment to resident education and success |
76 “The leadership staff are all very welcoming and excited about teaching. There has been a tremendous amount of support in the transition to residency from medical school.” |
38 “Sufficient/appropriate supervision when learning/performing procedures. additionally it can be hard to ask for help or the opportunity to perform a procedure when the dept is really busy, knowing that that would pull time and resources from another resident/attending.” |
| Relationships/inclusion—feelings of trust, inclusion, connection |
68 “All of the staff and faculty are amazing at comprehending just how hard it can be at times.” |
36 “Nursing staff that does not appear to respect or trust residents. Hostile relationship with trauma service.” |
| Values alignment—alignment of resident's personal values and observed department/ institutional values |
24 “Regular meeting with chiefs and leadership where we can talk about what we would like to change to make the residency and department better.” |
16 “Judgment from faculty. Ask too many questions, and people assume you are ignorant. But how do we fill knowledge gaps if not by asking questions? You can only do so much self‐study.” |
| Work–life integration—department supports for managing work and personal responsibilities |
16 “Focus on wellness, taking necessary breaks.” |
15 “Duty hours, particularly off‐service.” |
| Ethical/moral distress—feeling ethical or moral distress and being adversely changed by the culture | 0 |
14 “Seeing patients in the waiting room and new/temporary care areas that make me question the ability to care for patients as well as if they were in a room.” |
| Uncategorized | 0 |
19 “Being inadequate at my job compared to colleagues/where I should be.” |
There were several comments that spanned three or more vitality themes, both in positive features and in threats, such as those below.
Positive:
Attendings and fellow residents who go out of their way to teach. Accommodating scheduling around important life events. The support and comradery (sic) of my class.
Faculty, educational or otherwise, are on the whole very supportive and invested in both resident education and well‐being. there is active dialogue on what is working and what could be improved on a regular basis and leadership is receptive to suggestions and proactive in working with residents to find solutions.
Threats:
Not being valued for my individual strengths, seeing others valued for reasons that I do not feel are worthy of value (cavalier, cowboy behavior with patient care and smooth talkers > actual doers), flagrant sexism.
Difficult staff and patients, completing endless non physician tasks, boarding requiring me to take sign out on 15–20 patients when I arrive on shift.
DISCUSSION
The primary aim of this study was to evaluate the perception of EM residents as it relates to psychological safety and organizational support in their CLEs. Data from our multisite analysis are consistent with the single‐site results of Feeser et al., 20 indicating that the CLE within EM residencies is perceived as generally psychologically safe and supportive across multiple sites. This is indicated by aggregate PSS and SPOS scores.
Based on these results, it appears that the EM community is doing several things well: creating a culture where learners can ask for help, caring for resident well‐being, valuing unique skills and goals, and providing a space for discussion of difficult issues. It is encouraging that particularly on survey questions related to these items, the SDs are lower and the means are at the further end of the spectrum. Although the sample size is small, we believe this signals these items as positive and consistent themes across residencies. Open‐ended responses indicated that a pillar of positive impact was the supportive relationships with their peers and attendings as well as support from the residency program leadership and department leadership. As such, current practices related to fostering relationships and a supportive culture should be explicitly identified and continued.
Although the CLE appears to be supportive, there does seem to be a smoldering sense of being devalued. Questions related to rejection for being different, being deliberately undermined, replaced by someone for a lower salary, and being taken advantage of had increased SD size, means closer to the neutral, or both. Insights from the open‐ended questions indicate a sense of being replaceable or less of a priority. In combination, we take this to indicate that residents are left feeling as an outsider on a larger, institutional scale and find it disheartening that several participants mentioned a sense of being replaceable or that others within the CLE were prioritized over them. Perhaps this is why we are seeing a trend toward unionization of residents, to create a greater sense of belonging and value on a larger scale.
Although our intention was to place each comment into a single vitality category, 23 it quickly became clear that many aspects of the CLE are intertwined and, thus, many comments were coded into several categories. For both supportive and threatening features of the CLE, the two most common vitality categories were relationships/inclusion and institutional/departmental support, speaking to their influence, good or bad.
Moving forward, we would encourage programs to consider using the PSS and SPOS as tools to audit their own CLE and to identify potential threats early, rather than waiting for the results of the annual ACGME survey. They can highlight where current practices are providing sufficient support and areas for focused improvement. As indicated in the CLER report, 10 the issue of clinician well‐being (with downstream effects on patient care) needs to be addressed on a systemwide scale. The results from the PSS and SPOS can provide education leaders with information needed to influence institution‐wide factors impacting the CLE and communicate effectively with hospital administrators. For example, the question “if my department could hire someone to replace me at a lower salary, it would do so” was the only question that had a mean approaching neutral, the largest SD, and a bimodal distribution. In reviewing the data, it appeared that responses from one institution differed from the others, creating the bimodal distribution. Although we have highlighted key areas where EM generally is performing well and has areas to improve, this distribution suggests that each program may identify specific, unique opportunities for improvement. A negative perception on a single question does not indicate an unsafe CLE overall but can indicate an opportunity for improvement for that individual program.
We believe that future research should include a qualitative evaluation of the specific elements affecting the CLE, which could provide more concrete guidance on how to improve it. While the information from our survey indicates that EM is often considered psychologically safe and supportive, the questions from the PSS and SPOS do not delve into the root cause of the factors driving those responses. In turn, this could drive future department‐ and systemwide change to improve the CLE.
LIMITATIONS
Our study had several limitations. Because potential respondents were limited to EM residents, care should be taken to generalize these results to residents in other specialties. There was a wide range of response rates among the programs, potentially skewing the data. Our demographic data collection was not worded consistently with the ACGME standard, limiting comparisons. Our study population represented a convenience sample, and while our cohort was mostly representative of the national EM resident population, we did have a significantly greater proportion of female respondents. Our overall response rate was <50%; therefore, nonresponse bias may skew the results based on those with strong opinions. Although we attempted to reach many geographical areas, it is possible that some may be underrepresented. Finally, several open‐ended question responses did not provide enough information for them to be categorized or evaluated such as “COVID,” “trauma surgery rotation,” and “my patients.”
CONCLUSIONS
Overall, emergency medicine residents across multiple programs rated their clinical learning environments as generally psychologically safe and supportive. In our cohort, interpersonal relationships and institutional/departmental support appear to be top factors in creating this supportive clinical learning environment. Interestingly, interpersonal interactions can also be a leading threat to the clinical learning environment, along with unrealistic expectations, and a sense of being devalued. Education leaders can consider using the Psychological Safety Scale and Short Survey of Perceived Organizational Support to internally audit their own programs.
AUTHOR CONTRIBUTIONS
Study concept/design: Margaret Goodrich, Kerry McCabe, Jesse Basford, Kimberly Bambach, Aaron Kraut, Jeffrey N. Love. Acquisition of data: Margaret Goodrich, Kerry McCabe, Jesse Basford, Kimberly Bambach. Analysis and interpretation of data: Jesse Basford, Kerry McCabe, Margaret Goodrich, Kimberly Bambach, Jeffrey N. Love. Drafting of manuscript: Margaret Goodrich, Kerry McCabe, Jesse Basford, Kimberly Bambach. Critical revision of manuscript for intellectual content: Margaret Goodrich, Kerry McCabe, Jesse Basford, Kimberly Bambach, Aaron Kraut, Jeffrey N. Love. Statistical expertise: Jesse Basford, Kerry McCabe. Acquisition of funding: N/A.
CONFLICT OF INTEREST STATEMENT
All authors report no conflicts of interest.
Supporting information
Data S1:
ACKNOWLEDGMENTS
The study was developed through the MERC at CORD Program. The authors thank Nicole Mitchell, MA, MLIS; Audrey Vasauska, PhD; and the Alabama College of Osteopathic Medicine Research Committee for their assistance in providing our survey tool and support. We also thank Sorraya Jaiprasert, MPH, and Elizabeth Pino, PhD, for statistical support; Lucienne Lutfy‐Clayton, MD, as a sponsoring attending; Andrew King, MD, as a sponsoring attending; and our participating programs for their time and responses.
Goodrich M, McCabe K, Basford J, Bambach K, Kraut A, Love JN. Psychological safety and perceived organizational support in emergency medicine residencies. AEM Educ Train. 2024;8:e10964. doi: 10.1002/aet2.10964
Presented at the Society for Academic Emergency Medicine Annual Meeting, New Orleans, LA, May 2022; NERDS22: The New England Regional Meeting of the Society for Academic Emergency Medicine (Virtual), Worcester, MA, April 2022; and the SAEM Great Plains Regional Meeting, Milwaukee, WI, September 2022.
Supervising Editor: Holly Caretta‐Weyer
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