Nested Domains: A Global Conceptual Model for Optimizing the Clinical Learning Environment

Jaffe, Rebecca; Bergin, Christina R.; Loo, Lawrence K.; Singh, Simran; Uthlaut, Brian; Glod, Susan A.; Fondhan, Emily; McManamon, Alyssa; Wallach, Sara; Hamad, Karen; Walsh, Katherine; Gentilesco, Bethany

doi:10.1016/j.amjmed.2019.03.019

Cited by 13 publications

(10 citation statements)

References 16 publications

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“…Multiple outcomes of interest-clinical and educationalcompete for priority. While frameworks characterizing the clinical learning environment exist to describe its interrelated personal, social, organizational, physical, and virtual workplace components, each of which directly links to the broader health system, 13,14 the clinical environment is challenged by role clarity, the changing nature of teams, adequacy of learner supervision, and learner mistrust. It is often difficult for clinical teams immersed in the clinical learning environment (CLE) to make informed decisions during instances of heightened complexity, when the relationship between cause and effect is blurred, and when there are minimal causal loops to guide teams through the uncertainty.…”

Section: The Clinical Environmentmentioning

confidence: 99%

Highlighting a curricular need: Uncertainty, COVID‐19, and health systems science

Papanagnou

Jaffe

Ziring

2021

Health Science Reports

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The coronavirus disease 2019 (COVID-19) pandemic has illuminated the gap in training students in the health professions to function in environments of both certainty and uncertainty. Medical students are typically presented with facts, associations, and algorithms, and are later assessed through methods that either has a single correct answer or a series of acceptable answers with a single meaning (eg, multiple-choice examinations and objective structured clinical examinations). 1 The transition from the classroom to the clinical learning environment poses medical students with significant struggles. These may include struggles with diagnosis, management, communication, patient care, and care coordination. To date, formal training and assessment to enhance comfort with and management of uncertainty in clinical practice are lacking in many training programs. 1 A curriculum in Health Systems Science (HSS) can specifically acknowledge and address the uncertainty intrinsic to modern medical care and, in doing so, better prepare students for the transition to the clinical environment, the intrinsic complexity of the healthcare system, and the uncertainty of professional clinical practice.

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Section: The Clinical Environmentmentioning

confidence: 99%

Highlighting a curricular need: Uncertainty, COVID‐19, and health systems science

Papanagnou

Jaffe

Ziring

2021

Health Science Reports

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“…The initial screening will be performed by database filter according to the proposed inclusion and exclusion criteria. The inclusion criteria will include the following: studies published in the latest six years (between January 2015 and December 2020) to reflect the current clinical learning environment (Okoli, 2015 ; Xiao & Watson, 2017 ), which changes rapidly with the advancement in medical technologies; the decrease in the duration of patient's hospital stay; and learner's different needs within the clinical learning environment (Jaffe et al., 2019 ). Furthermore, only articles published in peer‐reviewed journals will be included to ensure the quality of the studies (Mohamed Shaffril, Ahmad, et al., 2020 ).…”

Section: The Reviewmentioning

confidence: 99%

Protocol for a mixed‐method systematic review on challenges perceived by final‐year undergraduate nursing students in a clinical learning environment

Ali

Rahman

Shariff

et al. 2021

Journal of Advanced Nursing

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Aims To determine the challenges perceived by final‐year nursing students in the clinical learning environment. Design Data‐based convergent mixed‐method systematic review. Methods Three electronic databases (Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature) will be used in the identification stage. The first search will use the search string for each database to identify relevant studies. The articles retrieved will be screened by year of publication, article type and language. Abstracts and full‐text of selected studies will be screened for eligibility independently by a minimum of two reviewers. The reference lists will be manually screened to identify additional publications. The quality assessment will be conducted by two reviewers using the Mixed Methods Appraisal Tools. Quantitative and mixed‐method studies will be transformed into qualitative. A thematic approach will be used to synthesize and report the data. Ethics approval and funding have been approved in April 2020. Discussion This study will synthesize the types of challenges perceived by final‐year undergraduate nursing students in different clinical learning environments across the country. Impact The proposed study findings will help nursing education stakeholders and faculty provide assistance to final‐year nursing students in their transition year to become registered nurses.

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“…To safely and constructively engage in a clinical learning environment (CLE), health professions learners navigate complex interactions between patient care, learning from real patients, and practice improvement [ 1 ]. In contrast to the classroom, learning within the CLE is more opportunistic and dependent on the setting, patients, supervisors, and leaner needs [ 2 ]. The variability of CLEs challenges clinical learners to recurrently acculturate to new roles, relationships, expectations, and processes [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Resources for clinical learning environment orientation

Gifford

Choi

Kieffer

2021

Medical Education Online

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Introduction Each clinical learning environment (CLE) requires learners to navigate a different set of complex interactions to engage in safe patient care while learning from real patients. Orientation forms the foundation for learning, yet CLE models in the literature are primarily written for an educator audience and practical advice for orienting learners to a new CLE is limited. To address this gap, we designed resources to support both supervisors and learners in the orientation process. Materials/Methods We reviewed the CLE literature to select critical content for orientation and interviewed high performing residents to identify their best practices. We synthesized the literature and resident interviews into a visually appealing and easy to digest infographic designed to simultaneously remind teachers of the critical areas to cover in orientation and empower learners to ask about them. We integrated these principles into an online module for Graduate Medical Education onboarding and surveyed users about how well they could meet the module learning objectives. Results We organized the literature review and resident advice regarding questions learners should ask about a new CLE into the typical question categories (why, who, what, when, where, and how) and described strategies for orientation to each category. Our infographic has been incorporated into CLE orientation for multiple types of learners at our institution. After completing the orientation module, 112/124(90%) residents indicated that they could, ‘Orient yourself or a learner to a clinical learning environment using orientation questions’ moderately to extremely well. Discussion We developed resources that can be used by educators to create orientation materials and by learners to ensure they understand important features, resources, and expectations in a new CLE. Because the foundational principles of CLE apply to a variety of clinical settings and learner types, the resources may be broadly applicable.

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Nested Domains: A Global Conceptual Model for Optimizing the Clinical Learning Environment

Cited by 13 publications

References 16 publications

Highlighting a curricular need: Uncertainty, COVID‐19, and health systems science

Highlighting a curricular need: Uncertainty, COVID‐19, and health systems science

Protocol for a mixed‐method systematic review on challenges perceived by final‐year undergraduate nursing students in a clinical learning environment

Resources for clinical learning environment orientation

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