Investigating Workplace Support and the Importance of Psychological Safety in General Surgery Residency Training

•Residents consider currently implemented enhancers of support that involve aspects of increasing psychological safety in residency training as acceptable and effective (i.e., allyship of mentors).•Residents propose enhancing support via ways that foster psychological safety in residents (i.e., nonpunitive analysis of mistakes)•Cultural and system-level factors inhibit workplace support and negatively affect perceptions of psychological safety in residents.•Lower perception of psychological safety with residency program leadership is associated with languishing among residents.•Fostering psychological safety may be a high impact target to increase perception of support in surgical training. Workplace interventions that increase support can mitigate burnout, improve workplace satisfaction, and increase well-being. Our aim is to provide evidence-based targets to inform future work for operationalizing support in general surgery residency. This is a 2-part mixed-methods cross-sectional study. Part 1 analyzed qualitative data from focus groups (April 2021-May 2022). Part 2 comprised an online survey (informed by findings in Part 1) in May 2022 to assess the association between perceived psychological safety (PS) and flourishing, as well as PS and languishing. National multi-center study including 16 ACGME-accredited academic programs. General surgery residents at various training levels, in both clinical and research. A total of 28 residents participated in the focus groups which revealed both enhancers and inhibitors of support pertaining to PS in the workplace. Enhancers of support included those currently implemented (i.e., allyship of mentors) and those proposed by residents (i.e., nonpunitive analysis of mistakes). Inhibitors of support included both systems (i.e., wellness initiatives as a ‘band-aid’ for systems issues) and culture (i.e., indefatigability, stoicism). About 251 residents (31%) responded to the survey which revealed higher perception of PS was significantly associated with flourishing at the level of residency program and departmental leadership. Lower perception of PS was significantly associated with languishing at the level of residency program leadership only. Our findings highlight the promotion of PS, such as expansion of mentorship to include advocacy (advocating on a resident's behalf, recognition when mistreated) and affirmation (i.e., soliciting opinions on controversial social matters/events, recognizing different life experienc