Analysis of the Emergency Medicine Clinical Learning Environment

Abstract

Background: Residencies are grappling with ways to identify methods to internally monitor and improve their learning environments. Building on prior work, the objective of this study was to determine emergency medicine (EM) internal evaluations of perceived organizational support and psychological safety and compare to the results from the Accreditation Council for Graduate Medical Education (ACGME) Resident Survey for the purpose of program improvement and to explore factors affecting residents' perception of their learning environment.Results: Institutional response rates were 63% for the internal learning environment survey and 96% for ACGME Resident Safety Survey. EM residents responded positively on the SPOS and PSS compared to other programs (ranked second highest scores on both scales). One-hundred percent of respondents agreed or strongly agreed on SPOS items: "Help is available from my department when I have a problem." "My department really cares about my well-being." "My department values my contribution to its well-being." Furthermore, EM had the highest overall training experience score (mean = 4.83) on the ACGME survey compared to the 18 other training programs. Qualitative responses suggest program strengths included supportive program leadership, positive working relationships with faculty, and emphasis on trainee wellness.Conclusions: Compared to other programs, EM has created a positive environment of safety and support as perceived by their residents. Internal surveys of the learning environment can help programs understand their culture for purposes of improvement and align with the ACGME survey.From the

Psychological safety and perceived organizational support in emergency medicine residencies

“…The primary aim of this study was to evaluate the perception of EM residents as it relates to psychological safety and organizational support in their CLEs. Data from our multisite analysis are consistent with the single-site results of Feeser et al, 20 indicating that the CLE within EM residencies is perceived as generally psychologically safe and supportive across multiple sites. This is indicated by aggregate PSS and SPOS scores.…”

“…The PSS includes seven questions and the SPOS includes 16 questions, both utilizing Likert‐type scales from “strongly disagree” to “strongly agree.” The PSS is on a 5‐point scale and the SPOS is on a 7‐point scale. Both the PSS and SPOS have previous validity evidence when examining resident perceptions of the CLE 19,20 . Like in the studies by Appelbaum et al 19 .…”

“…Both the PSS and SPOS have previous validity evidence when examining resident perceptions of the CLE. 19,20 Like in the studies by Appelbaum et al 19 and Feeser et al 20 studies, the words "organization" and "team" were replaced by "department." Three open-ended questions were added to the survey to identify threats, supporting factors, and opportunities for improvement to the CLE.…”

“…[16][17][18] A study by Appelbaum et al 19 established validity evidence for the PSS and SPOS in comparison to annual ACGME survey results at a single site. An additional study by Feeser et al 20 reported that emergency medicine (EM) residents had a favorable perception of their CLE compared to residents from other specialties within that single institution using the PSS and…”

Psychological safety in European medical students’ last supervised patient encounter: A cross-sectional survey

“…Respondents were asked which country they studied in, and place of study was categorised according to the United Nations (UN) M49 classification of geographic regions [ 15 ]. They were also asked to report on the speciality in which supervision took place as research in post-graduate medical education has found differences in psychological safety between specialities [ 14 , 16 ].…”