Theses Doctoral

Understanding Learner Trauma in the Emergency Medicine Clerkship: An Analysis of Self-Efficacy and Psychological Safety in the Clinical Learning Environment

Papanagnou, Dimitrios

As third-year medical students transition from the classroom to the high-stakes, high-stress environment of the emergency department (ED), they confront a unique set of challenges that result in significant personal trauma. The literature offers limited insight into the trauma experienced specifically during the shift to emergency medicine (EM) as medical students’ first clinical rotation. The purpose of this study was to bridge this gap by examining the interplay between students’ perceived psychological safety of their ED teams and their own self-efficacy on the trauma they experienced as learners when working in this unique learning environment.

This mixed-methods study included interviews with 17 third-year medical students who immediately completed the EM clerkship at an urban, academic ED. The study addressed four main questions: 1) What types of trauma do students experience in the EM clerkship as they transition from the classroom into the clinical learning environment for the first time in their training? What are the factors of the learning environment that trigger trauma? 2) In what ways, if any, do students’ intersectional demographics affect their experiences of trauma during the EM clerkship? 3) To what extent does general self-efficacy predict medical students’ perceptions of the psychological safety afforded by their clinical team during the EM clerkship? 4) How are students’ experiences of trauma associated, if at all, with perceived psychological safety? What factors in the clinical learning environment contribute to psychological safety or its lack?

This study utilized several data collection methods: (a) a pre-interview questionnaire soliciting information on student demographics and responses to items on the General Self-Efficacy Scale, (b) in-depth interviews using the critical incident technique, and (c) responses to items from the Team Psychological Safety Questionnaire.

Several key findings emerged. A substantial amount of trauma that students experienced was rooted in a lack of peer support and student empowerment. Various triggers for trauma were identified that transcended different types of trauma. Demographic factors, such as race/ethnicity and gender, influenced the prevalence and nature of these traumatic experiences, with students from underrepresented backgrounds reporting deeper emotional connections with patients. While student self-efficacy was generally high, it did not correlate with the perceived psychological safety provided by their clinical teams. Furthermore, the perception of psychological safety within ED teams correlated with the nature of trauma experienced; those with lower safety scores reported trauma connected to peer support or issues related to cultural, historical, and gender considerations. Lastly, the opportunity for students to safely take risks or learn from mistakes, coupled with their own medical knowledge limitations, emerged as central to their perception of psychological safety within the team dynamic.

Deeper insights into the data were revealed through a cross-interview analysis, and several analytical categories were used to further synthesize and interpret the data. Six conclusions were drawn from the study’s findings and analysis: 1) Medical students experience different types of primary trauma when immersed in the ED. 2) Several forces that are intrinsic to the ED workplace influence the trauma students experience. 3) Clerkship leadership must be aware of the unique experiences underrepresented students have in the EM clerkship. 4) The psychological safety provided to students by their teams impacts their experiences of trauma in the ED. 5) Self-efficacy offers a lens to understand students’ experiences of trauma in the ED, but it is insufficient. 6) Clerkship-specific interventions exist to amplify the team psychological safety afforded to medical students.


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More About This Work

Academic Units
Organization and Leadership
Thesis Advisors
Marsick, Victoria J.
Ed.D., Teachers College, Columbia University
Published Here
May 22, 2024