Faculty-resident relationships, professional behaviors, and psychological safety: a cross-sectional study

BACKGROUND: Clinical training happens in high-stress environments where patient safety is prioritized but trainees need to feel safe to express ideas, seek help, and admit mistakes without fear of judgment. Limited studies exist on how psychological safety manifests in residency programs, particularly in a non-Western context, where hierarchy is important. This study aims to evaluate the psychological safety of residents in clinical settings and examine its association with faculty-resident relationship quality and faculty professional behaviors. It also explores whether demographic characteristics and personality traits influence residents' perceptions of psychological safety. METHODS: We conducted a cross-sectional study among residents at a tertiary academic medical center in Lebanon. Data were collected using an online survey that included validated scales for psychological safety, faculty-resident relationship quality (JHLES-Faculty Relationship Subscale), and faculty professional behaviors. Personality traits were assessed using the Ten-Item Personality Inventory (TIPI). Statistical analyses included descriptive measures, correlation analyses, multivariable regression models, and additional post-hoc exploratory factor and mediation analyses. RESULTS: A total of 204 residents participated in the study (response rate: 69.12%). Psychological safety scores were moderate (mean: 3.02 ± 0.40 on a 5-point scale). Faculty-resident relationship quality was consistently associated with psychological safety (p < 0.001). Faculty professional behaviors were positively associated with psychological safety (p < 0.001) but became statistically non-significant in mutually adjusted models including relationship quality. Exploratory analyses supported the conceptual distinction between the two constructs and suggested that faculty-resident relationship quality may account for part of the association between faculty professional behaviors and psychological safety. No statistically significant associations were found between psychological safety and trainees' demographic characteristics or personality traits. CONCLUSION: This study underscores the critical role of interpersonal dynamics in fostering psychological safety within hierarchical clinical settings. While professional behaviors remain important, meaningful faculty engagement and mentorship may play a more central role in promoting a psychologically safe learning environment. Future longitudinal work should explore interventions to improve these relationships with particular attention to communication styles and feedback mechanisms that foster psychological safety.