This study reaffirms the reliability and internal validity of the D-RECT in measuring residency training learning climate. Ongoing evaluation of the instrument remains important.
ObjectivesTo translate the 35-item version of the Dutch Residency Educational Climate Test (D-RECT), and assess its reliability, construct validity and concurrent validity in the Spanish language. MethodsFor this validation study, the D-RECT was translated using international recommendations. A total of 220 paper-based resident evaluations covering two Colombian universities were cross-sectionally collected in 2015. A Confirmatory Factor Analysis (CFA) was used to assess the internal validity of the instrument using the Comparative fit index (CFI), Tucker-Lewis index (TLI), Standardized root mean square residual (SRMSR), and Root mean square error of approximation (RMSA). Cronbach’s α was used to assess reliability. The concurrent validity was investigated through Pearson correlations with the Spanish version of the Postgraduate Hospital Educational Environment Measure (PHEEM). ResultsThe original 9-factor structure showed an appropriate fit for the Spanish version of the instrument (CFI = 0.84, TLI = 0.82, SRMSR = 0.06, and RMSA = 0.06). The reliability coefficients were satisfactory (>0.70). The mean total scores of the D-RECT and the PHEEM showed a significant correlation (r = 0.7, p<0.01). ConclusionsThis study confirms the validity and reliability of the Spanish version of the Dutch Residency Educational Climate Test, indicating that the instrument is suitable for the evaluation of departments’ learning climate in the Spanish context. Future research is needed to confirm these findings in other Spanish speaking countries.
Context Residents are expected to ask for help when feeling insufficiently confident or competent to act in patients’ best interests. While previous studies focused on the perspective of supervisor‐resident relationships in residents’ help‐seeking decisions, attention for how the workplace environment and, more specifically, other health care team members influence these decisions is limited. Using a sociocultural lens, this study aimed to explore how residents’ decision‐making processes to seek help are shaped by their workplace environment. Methods Through a constructivist grounded theory methodology, we purposively and theoretically sampled 18 residents: 9 juniors (postgraduate year 1/2) and 9 seniors (postgraduate year 5/6) at Amsterdam University Medical Centers. Using semi‐structured interviews, participating residents’ decision‐making processes to seek help during patient care delivery were explored. Data collection and analysis were iterative; themes were identified using constant comparative analysis. Results Residents described their help‐seeking decision‐making processes as an ‘act of performance’: they considered how asking for help could potentially impact their assessments. They described this act of performance as the product of an internal ‘balancing act’ with at its core the non‐negotiable priority for providing safe and high‐quality patient care. With this in mind, residents weighed up demonstrating the ability to work independently, maintaining credibility and becoming an accepted member of the health care team when deciding to seek help. This ‘balancing act’ was influenced by sociocultural characteristics of the learning environment, residents’ relationships with supervisors and the perceived approachability of other health care team members. Conclusions This study suggests that sociocultural forces influence residents to experience help‐seeking as an act of performance. Especially, a safe learning environment resulting from constructive relationships with supervisors and the approachability of other health care team members lowered the barriers to seek help. Supervisors could address these barriers by having regular conversations with residents about when to seek help.
Departments should focus on establishing a supportive patient safety climate to improve residents' patient safety behavior. Building a supportive learning climate might help to improve the patient safety climate and, in turn, residents' patient safety behavior.
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