When Learning Isn’t Safe: What Nurse Anesthesia Residents Are Telling Us About Preceptor Incivility

Rigor Without Harm: Re-examining Teaching Culture in Anesthesia Education

There’s an unspoken rule in anesthesia training: you’re supposed to be tough.

Long hours. High stakes. Zero margin for error. Somewhere along the way, that expectation has been quietly conflated with the idea that harshness, dismissal, or public criticism are just “part of the process.”

But what if they’re not? What if those behaviors are doing real harm to learners, to professional identity, and ultimately, to patient safety?

That question sat at the center of our recent mixed-methods study examining nurse anesthesiology residents’ experiences with clinical preceptor incivility. And what residents shared should make all of us pause.

The Numbers Tell One Story. The Voices Tell Another.

In a national survey of 313 nurse anesthesiology residents, approximately 77% reported experiencing or witnessing incivility from a clinical preceptor. The most common behaviors weren’t overt bullying or yelling……they were quieter, more insidious:

• Dismissive or condescending communication

• Public criticism in the operating room

• Exclusion from learning opportunities

• Sarcasm, eye-rolling, or hostile body language

On a Likert scale, residents rated both the frequency of incivility and its negative impact on learning as moderate. But when the qualitative data were analyzed, a much deeper picture emerged. Residents didn’t just describe uncomfortable moments; they described unsafe learning environments.

Four Themes That Keep Showing Up

Across hundreds of narrative responses, four consistent themes surfaced. Together, they tell a story not just about behavior, but about culture, power, and survival.

Erosion of Psychological Safety

Residents repeatedly described clinical environments where asking questions felt risky. Not inconvenient—dangerous. Incivility communicated, often implicitly, that curiosity was weakness and uncertainty was unacceptable.

Eye-rolling, sarcasm, or dismissive comments after a question taught residents a powerful lesson: stay quiet. Over time, many described modifying their behavior by asking fewer questions, avoiding clarification, and disengaging from active learning in order to protect themselves emotionally.

“Every time I asked a question, my preceptor rolled their eyes or made sarcastic comments. I stopped asking questions altogether because it wasn’t worth the embarrassment.”

This erosion of psychological safety matters deeply in anesthesia, where learning depends on real-time dialogue, rapid feedback, and the ability to speak up when something doesn’t feel right. When residents feel silenced, learning narrows and vigilance suffers.

Professional Identity Disruption

Incivility didn’t stay confined to the clinical day. Residents described carrying these interactions home, replaying comments, and questioning their competence long after cases ended.

What made this particularly damaging was who the incivility came from. Preceptors are not just supervisors; they are gatekeepers to the profession. When criticism crossed from feedback into personal attack, many residents internalized it as evidence that they didn’t belong.

“When a preceptor tells you you’re not cut out for anesthesia, you start to believe it. I went home questioning if I’d made the right decision to become a CRNA.”

For some, this led to chronic self-doubt. For others, it triggered anxiety, loss of confidence, and thoughts of leaving the program or profession altogether. Instead of shaping strong professional identity, the clinical environment became a site of identity fracture.

Silence and Systemic Tolerance

Despite the high prevalence of incivility, most residents did not report it. This wasn’t because the behavior didn’t matter but because the system didn’t feel safe.

Residents described fear of retaliation, lack of anonymity, and skepticism that reporting would lead to meaningful change. Some worried about evaluations. Others feared being labeled “difficult” or “not resilient enough.” Many believed reporting would simply make their situation worse.

“We’re told to report issues, but everyone knows it just makes things worse. Nothing changes, and you risk being labeled as difficult.”

Over time, this silence becomes self-reinforcing. Incivility is tolerated, normalized, and quietly absorbed into the culture. The message becomes clear: this is the cost of training.

Coping and Resilience

In the absence of institutional support, residents adapted. They leaned heavily on peers and classmates became safe spaces for validation and emotional processing. Some learned to compartmentalize, emotionally distancing themselves during clinical days just to get through. Others reframed the experience as motivation: a reminder of what not to do when they eventually became preceptors themselves.

“My classmates became my safe space. We talked about our experiences and tried to learn what not to do when we become preceptors.”

This resilience is real and admirable. But it came at a cost. Coping strategies helped residents survive training but they shouldn’t be the primary defense against a harmful learning environment. Resilience should support growth, not compensate for systemic failure.

This Isn’t About “Softening” Training

Let’s be clear: anesthesia education is demanding, and it should be. But rigor and respect are not opposites.

The data showed a strong correlation between higher incivility and worse perceived learning and emotional well-being. When psychological safety erodes, so does communication and that has implications far beyond education.

In high-acuity environments, psychologically safe teams:

• Speak up sooner

• Ask better questions

• Catch errors earlier

Incivility doesn’t make clinicians sharper. It makes them quieter.

So What Do We Do With This?

The study points toward solutions that are intentional, not performative:

• Structured preceptor development that includes civility, communication, and feedback—not just clinical teaching

• Clear, confidential, non-punitive reporting pathways that residents actually trust

• Bidirectional feedback mechanisms, so preceptors receive timely, constructive input

• Shared accountability between academic programs and clinical partners

Most importantly, it calls for a cultural shift away from normalizing “that’s just how it is.” Because culture is taught every day, in every interaction.

A Final Thought

Not all preceptors are uncivil. Many are generous, thoughtful mentors navigating intense workload pressures and burnout of their own. But when incivility becomes tolerated, especially from those in positions of power, it sends a message to the next generation about what professionalism looks like.

Residents are watching. And one day, they’ll be the ones teaching. The question is: What will they carry forward?