A national stakeholder consensus study of challenges and priorities for clinical learning environments in postgraduate medical education

Abstract

BackgroundHigh quality clinical learning environments (CLE) are critical to postgraduate medical education (PGME). The understaffed and overcrowded environments in which many residents work present a significant challenge to learning. The purpose of this study was to develop a national expert group consensus amongst stakeholders in PGME to; (i) identify important barriers and facilitators of learning in CLEs and (ii) indicate priority areas for improvement. Our objective was to provide information to focus efforts to provide high quality CLEs.MethodsGroup Concept Mapping (GCM) is an integrated mixed methods approach to generating expert group consensus. A multi-disciplinary group of experts were invited to participate in the GCM process via an online platform. Multi-dimensional scaling and hierarchical cluster analysis were used to analyse participant inputs in regard to barriers, facilitators and priorities.ResultsParticipants identified facilitators and barriers in ten domains within clinical learning environments. Domains rated most important were those which related to residents’ connection to and engagement with more senior doctors. Organisation and conditions of work and Time to learn with senior doctors during patient care were rated as the most difficult areas in which to make improvements.ConclusionsHigh quality PGME requires that residents engage and connect with senior doctors during patient care, and that they are valued and supported both as learners and service providers. Academic medicine and health service managers must work together to protect these elements of CLEs, which not only shape learning, but impact quality of care and patient safety.

The clinical learning environment

“…A national stakeholder consensus document identified overcrowded clinical environments, understaffing and service pressures and clinical workload as barriers to learning in the CLE (Kilty et al 2017). Consistent with other studies, the domains identified as most challenging from an improvement perspective were the "organization and conditions of work" and "time to learn with senior doctors during patient care" (Kilty et al 2017). The Bawa-Garba case in the United Kingdom is a poignant example of this (Vaughan 2018).…”

“…The subject of the clinical learning environment (CLE) is at the forefront of discussions by educators, accreditors, educational organizations, and health care professionals and has long been a focus of research and improvement efforts in medical education. A suboptimal CLE has been associated with adverse patient care and learning outcomes (GMC 2016;Kilty et al 2017;Gruppen et al 2018;Macy Foundation 2018). The current climate of financially constrained and understaffed health systems has increased pressure and expectation of, and negative consequences for trainee well-being.…”

“…The current climate of financially constrained and understaffed health systems has increased pressure and expectation of, and negative consequences for trainee well-being. Financial constraints and clinical productivity expectations have negatively affected available time for educational pursuits (Norman and Dogra 2014;Kilty et al 2017;Weiss et al 2018) and have contributed to higher levels of stress, burnout, depersonalization, and emotional exhaustion in medical trainees and in their teachers (Gruppen et al 2018;Macy Foundation 2018). This in turn has added negative effect on the working and learning climate for trainees and their trainers.…”

“…Early definition focused on the climate and overall ambiance of the medical education environment (Genn and Harden 1986) and highlighted the importance of the climate in which learning occurs (Roff and McAleer 2001). The CLE has been described as foundation of postgraduate medical education (Weiss et al 2013;Kilty et al 2017) by comprising "the social, cultural and material context is which residents learn while they work" (Kilty et al 2017, p. 1) The Macy Foundation (2018) defined the learning environment as: " … social interactions, organizational cultures and structures, and physical and virtual spaces that surround and shape participants' experiences, perceptions, and learning." These differences in existing definitions highlight the complexity of the CLE concept, with different dimensions and elements examined in prior studies and editorials (e.g.…”

Do radiologists detect chronic thromboembolic disease on computed tomography?

“…A high standard of quality in the residency program is important to achieve well-qualified radiologists. In fact, there is an established relationship between clinical learning environment and patient safety (71). Furthermore, with the rapid technical development within the field of radiology it must be argued that continuous learning throughout the career is required.…”