¿Cómo la seguridad psicológica favorece el aprendizaje en los entornos de práctica clínica de estudiantes de especializaciones médico-quirúrgicas?

Abstract

Introduction: Despite the fact that the evidence suggests that the presence of PS (psychological safety) favors learning in clinical practice settings, there are no studies that analyze this relationship and what would be the mechanisms that would mediate it. In this study we seek to clarify how psychological safety facilitates the learning of medical-surgical residency students in clinical practice settings. We hope that the results obtained will be useful to develop strategies that optimize the learning of residents in these environments. Methods: A qualitative research was carried out under the constructivist paradigm, the co-participatory theory of learning as a theoretical framework and with the grounded theory as a methodology, in the context of learning in clinical practice; with a sampling of maximum variation in focus groups with the participation of 18 residents of medical-surgical specializations; followed by theoretical sampling through 3 individual semi-structured interviews. An iterative analysis of the data obtained was carried out, with the generation of memoranda and coding of terms (open, focused and axial) in the search to explain how SP favors learning in practice sites. Results: SP instances were identified in which it acted as a facilitator of engagement with learning opportunities; the main mediators of this relationship include self-efficacy management, the transformation of guilt into learning opportunities, and motivation. In circumstances without SP, the loss of perception of self-efficacy, humiliation in the face of the error, and lack of motivation acted as obstacles to engagement. Additionally, we identified that peers can provide SP conditions or promote support tools so that residents can navigate during rotations in the absence of it. Conclusions: In scenarios perceived as psychologically safe, motivation, the transformation of guilt into learning opportunities, and the perception of self-efficacy are mediating factors for taking advantage of learning opportunities. We recommend that student-teacher relations be framed in this construct and programs aimed at evaluating the perception of PS be developed as part of the analysis of clinical-surgical rotations of postgraduates in medical education, in order to optimize their results through the empowerment of actions that favor the three factors mentioned as learning facilitators.