April 29, 2016By Lance Baily

Medical Education Research: The Effects of Power, Leadership and Psychological Safety on Resident Event Reporting

Recently on Med Ed Conversations I saw an interesting research article supported by the ASME entitled “The effects of power, leadership and psychological safety on resident event reporting” by Nital P Appelbaum et all. The paper suggests that “Although the reporting of adverse events is a necessary first step in identifying and addressing lapses in patient safety, such events are under-reported, especially by frontline providers such as resident physicians.” The research attempted to describe and test relationships between power distance and leader inclusiveness on psychological safety and the willingness of residents to report adverse events.


A total of 106 resident physicians from the departments of neurosurgery, orthopaedic surgery, emergency medicine, otolaryngology, neurology, obstetrics and gynaecology, paediatrics and general surgery in a mid-Atlantic teaching hospital were asked to complete a survey on psychological safety, perceived power distance, leader inclusiveness and intention to report adverse events.

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Psychological safety was found to be a predictor of intention to report adverse events. Perceived power distance and leader inclusiveness both influenced the reporting of adverse events through the concept of psychological safety. Because adverse event reporting is shaped by relationships and culture external to the individual, it should be viewed as an organisational as much as a personal function. Supervisors and other leaders in health care should ensure that policies, procedures and leadership practices build psychological safety and minimise power distance between low- and high-status members in order to support greater reporting of adverse events.


How can simulation better create a culture of psychological safety for medical and other healthcare personnel? Simulation is a perfect place to safely practice creating  learning behaviors.

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Read the full study on Wiley

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