The culture of medical training has long grappled with a paradox: environments designed to produce high-performing clinicians often suppress the very behaviors — speaking up, admitting errors, asking questions — that improve both learning and patient outcomes. New data from a Lebanese academic medical center add important cross-cultural texture to this ongoing conversation, probing exactly what drives psychological safety in residency settings outside the well-studied Western context.
Among 204 residents at a tertiary center in Lebanon (response rate 69%), psychological safety scores fell in the moderate range, averaging 3.02 out of 5 on a validated scale. Faculty-resident relationship quality, measured via the JHLES Faculty Relationship Subscale, emerged as a consistent predictor of how safe residents felt to express ideas or acknowledge mistakes. Faculty professional behaviors also showed meaningful association with resident perceptions. The study incorporated personality trait assessment via the Ten-Item Personality Inventory (TIPI) and employed multivariable regression alongside mediation and exploratory factor analyses to disentangle direct and indirect pathways.
This finding aligns with a growing body of evidence — largely from U.S. and European graduate medical education — linking supervisory relationships to trainee psychological safety, but its non-Western, hierarchical cultural context is genuinely underrepresented in the literature. The moderate safety scores warrant attention: scores clustering at the midpoint often signal that residents are cautious rather than truly secure, which research elsewhere associates with underreporting of near-misses and reduced learning behaviors. The cross-sectional design prevents causal inference, and self-report measures introduce social desirability bias, particularly in hierarchical settings where vulnerability may be stigmatized. Single-center Lebanese data also limits generalizability. Still, this study makes an incremental but meaningful contribution by confirming that relationship quality — not personality traits alone — is the more modifiable lever. Institutions seeking to improve training culture may find more traction by investing in faculty development around relational behaviors than by screening for resident personality profiles.