Get a “CLEW”: Using Clinical Learning Environment Walks (CLEWs) to Optimize Clinical Learning Environments

Background: Needs of health workers, especially general practitioners, relatively high in Indonesia. Career choices among medical students are various, such as general practitioner, specialist, medical researcher, etc. Many factors affect medical students’ career choices, one of them is learning environments. This study aims to prove the correlation between clerkship students’ perceptions of clinical learning environments and their career choices.Methods: This research was an analytical observational research with cross sectional approach. The subjects were clerkship students who underwent clinical rotation. The samples were 178 clerkship students from all departments. They were chosen by probability proportional to size sampling. Every respondent was given career choices questionnaire and PHEEM questionnaire which has analyzed for its validity and reliability with α≥0,6 (α=0,826) and r≥0,30 (r=0,442). The result of this study was analyzed by Chi-square test and followed by Contingency Coefficient with 95% confidence level (α = 0,05). Result: The result showed that students’ perception of clinical learning environment “good but still need improvement” category was nearly the same as “plenty of problems” category. The result on the students’ career choices, most students choose clinical career. There was significant correlation between perception of clinical learning environment and career choices on clerkship students of medical faculty, Sebelas Maret University with p <0,05 (p= 0,018), x2 count (x2=5,625) > x2 table (x2=3,841) and also very weak correlation (C= 0,189).Conclusion: There was very weak correlation between perception of clinical learning environments and career choice on clerkship students.

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Using the CLER Pathways to Excellence to Evaluate the Learning Environments at a Multi-Site Institution

Journal of Graduate Medical Education ◽

10.4300/jgme-d-18-00507.1 ◽

2018 ◽

Vol 10 (6) ◽

pp. 683-687

Author(s):

Maria Aaron ◽

Philip Shayne ◽

Erica Brownfield ◽

Nathan O. Spell ◽

Jaffar Khan ◽

...

Keyword(s):

Learning Environment ◽

Learning Environments ◽

Clinical Training ◽

Clinical Care ◽

Evaluation Process ◽

Audience Response ◽

Clinical Learning ◽

Clinical Learning Environment ◽

Supportive Culture ◽

Effective Supervision

ABSTRACT Background The Accreditation Council for Graduate Medical Education Clinical Learning Environment Review (CLER) program visits 1 participating site per sponsoring institution. While valuable, feedback on that site does not necessarily generalize to all learning environments where trainees and faculty provide clinical care, and institutions may be missing significant insight and feedback on other clinical learning sites. Objective We explored how the Emory Learning Environment Evaluation process—modeled after CLER—could be used to improve the learning environments at 5 major clinical training sites. Methods Participants were recruited via e-mail. Sites hosted separate 60-minute sessions for medical students, residents and fellows, and faculty. We used the CLER Pathways to Excellence to develop a combination of fixed choice and opened-ended questions deployed via an audience response system and verbal queries. Data were analyzed primarily through descriptive statistics and graphs. Results Across sites, per session, medical student participants ranged from 9–16, residents and fellows ranged 21–30, and faculty ranged 15–29. Learners agreed that sites: (1) provided a supportive culture for requesting supervision (students 100%; residents and fellows 70%–100%), and (2) provided a supportive culture for reporting patient safety events (students 94%–100%; residents and fellows 91%–95%). Only a minority of residents and fellows and faculty agreed that they were educated on how to provide effective supervision (residents and fellows 21%–52%; faculty 45%–64%). Conclusions Data from this process have helped standardize improvement efforts across multiple clinical learning environments within our sponsoring institution.

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Role of the clinical learning environment in preparing new clinicians to engage in quality improvement efforts to eliminate health care disparities

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz251 ◽

2019 ◽

Author(s):

Baretta R Casey ◽

Marie Chisholm-Burns ◽

Morgan Passiment ◽

Robin Wagner ◽

Laura Riordan ◽

...

Keyword(s):

Health Care ◽

Learning Environment ◽

Learning Environments ◽

Health Care System ◽

Health Care Disparities ◽

Care Delivery ◽

The United States ◽

Clinical Learning ◽

Clinical Learning Environment ◽

Care System

Abstract Purpose The National Collaborative for Improving the Clinical Learning Environment offers guidance to health care leaders for engaging new clinicians in efforts to eliminate health care disparities. Summary To address health care disparities that are pervasive across the United States, individuals at all levels of the health care system need to commit to ensuring equity in care. Engaging new clinicians is a key element of any systems-based approach, as new clinicians will shape the future of health care delivery. Clinical learning environments, or the hospitals, medical centers, and ambulatory care clinics where new clinicians train, have an important role in this process. Efforts may include training in cultural humility and cultural competency, education about the organization’s vulnerable populations, and continuous interprofessional experiential learning through comprehensive, systems-based QI efforts focused on eliminating health care disparities. Conclusion By preparing and supporting new clinicians to engage in systems-based QI efforts to eliminate health care disparities, clinical learning environments are instilling skills and supporting behaviors that clinicians can build throughout their careers—and helping pave the road towards equity throughout the US health care system.

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“Back to Bedside”: Residents' and Fellows' Perspectives on Finding Meaning in Work

Journal of Graduate Medical Education ◽

10.4300/jgme-d-17-00136.1 ◽

2017 ◽

Vol 9 (2) ◽

pp. 269-273 ◽

Cited By ~ 25

Author(s):

Dustin M. Hipp ◽

Kristy L. Rialon ◽

Kathryn Nevel ◽

Anai N. Kothari ◽

LCDR Dinchen A. Jardine

Keyword(s):

Learning Environment ◽

Learning Environments ◽

Clinical Teaching ◽

Direct Patient Care ◽

Clinical Learning ◽

Physician Burnout ◽

Clinical Learning Environment ◽

Daily Work ◽

Meaning In Work ◽

Multispecialty Group

ABSTRACT Background Physician burnout is common and associated with significant consequences for physicians and patients. One mechanism to combat burnout is to enhance meaning in work. Objective To provide a trainee perspective on how meaning in work can be enhanced in the clinical learning environment through individual, program, and institutional efforts. Methods “Back to Bedside” resulted from an appreciative inquiry exercise by 37 resident and fellow members of the ACGME's Council of Review Committee Residents (CRCR), which was guided by the memoir When Breath Becomes Air by Paul Kalanithi. The exercise was designed to (1) discover current best practices in existing learning environments; (2) dream of ideal ways to enhance meaning in work; (3) design solutions that move toward this optimal environment; and (4) support trainees in operationalizing innovative solutions. Results Back to Bedside consists of 5 themes for how the learning environment can enhance meaning in daily work: (1) more time at the bedside, engaged in direct patient care, dialogue with patients and families, and bedside clinical teaching; (2) a shared sense of teamwork and respect among multidisciplinary health professionals and trainees; (3) decreasing the time spent on nonclinical and administrative responsibilities; (4) a supportive, collegial work environment; and (5) a learning environment conducive to developing clinical mastery and progressive autonomy. Participants identified actions to achieve these goals. Conclusions A national, multispecialty group of trainees developed actionable recommendations for how clinical learning environments can be improved to combat physician burnout by fostering meaning in work. These improvements can be championed by trainees.

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A Framework to Guide the Implementation of Best Practice Clinical Learning Environments in Community General Practice: Australia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041482 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1482

Author(s):

Belinda O'Sullivan ◽

Helen Hickson ◽

Rebecca Kippen ◽

Donna Cohen ◽

Phil Cohen ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Learning Environment ◽

Learning Environments ◽

Best Practice ◽

Clinical Learning ◽

Limited Information ◽

Clinical Learning Environment ◽

Liaison Officer ◽

Starting Point

Clinical education/training is increasingly being expanded to community general practice settings (primary care clinics led by doctors). This plays an important role in developing a skilled “primary-care ready” workforce. However, there is limited information to guide the implementation of high-quality learning environments suitable for the range of general practices and clinical learners they oversee. We aimed to develop a consensus-based framework to address this. A co-design participatory action research method involved working with stakeholders to agree a project plan, collect and interpret data and endorse a final framework. As a starting point, an initial draft framework was adapted from an existing framework, the Best Practice Clinical Learning Environment (BPCLE) Framework. We gathered feedback about this from a national GP Supervisor Liaison Officer Network (SLON) (experienced GP clinical supervisors) during a 90-minute face-to-face focus group. They rated their agreement with the relevance of objectives and elements, advising on clear terminology and rationale for including/excluding various components. The resulting framework was refined and re-tested with the SLON and wider GP educational stakeholders until a final graphically designed version was endorsed. The resulting “GP Clinical Learning Environment” (GPCLE) Framework is applicable for planning and benchmarking best practice learning environments in general practice.

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The Mismatch Between Perceived and Preferred Expectations of Undergraduate Paramedic Students

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2012.1422 ◽

2011 ◽

Author(s):

Brett Williams ◽

Ted Brown ◽

Christian Winship

Keyword(s):

Learning Environment ◽

Learning Environments ◽

Clinical Education ◽

Response Rate ◽

Cross Sectional Study ◽

Clinical Learning ◽

Practical Skills ◽

Clinical Learning Environment ◽

Cross Sectional ◽

Clinical Placements

Background: Clinical education placements provide the opportunity for students to gain practical skills and apply theoretical knowledge not otherwise available in many instances. Objectives: This research explored how undergraduate paramedic students perceive their clinical placement learning environments. Methods: A prospective cross-sectional study using a paper-based survey, the Clinical Learning Environment Inventory (CLEI), was conducted on undergraduate paramedic students studying at a large Australian university in semester 1, 2010. A total of 190 students were invited to participate in the survey. The CLEI is a standardised tool that contains 84-items and six subscales. Findings: Sixty students completed the CLEI (31% response rate). It was found that on both the actual and preferred CLEI forms, Satisfaction was found to be the most important domain having a mean score of 29.68 (SD+3.81) and 31.37 (SD+4.35) respectively.Individualisation was found to be the least important domain in both the actual and preferred form, with mean scores of 20.93 (SD+3.80) and 24.03 (SD+3.82) respectively. This indicated that paramedic students as a group sensed that theSatisfaction aspect of clinical placements are an integral aspect of their preferred clinical learning environment. Results also indicated that all six subscales were statistically different at the p<0.001 level. Conclusion: There were significant differences in the perceptions of paramedic students actual and preferred clinical learning environments. This provides educators with strategies in promoting positive learning experiences for students.

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Exploratory Factor Analysis of the Clinical Learning Environment, Supervision and Nurse Teacher Scale (CLES+T)

Journal of Nursing Measurement ◽

10.1891/1061-3749.22.1.164 ◽

2014 ◽

Vol 22 (1) ◽

pp. 164-180 ◽

Cited By ~ 9

Author(s):

Paul Barry Watson ◽

Philippa Seaton ◽

Deborah Sims ◽

Isabel Jamieson ◽

Jane Mountier ◽

...

Keyword(s):

Factor Analysis ◽

New Zealand ◽

Learning Environment ◽

Construct Validity ◽

Learning Environments ◽

Exploratory Factor Analysis ◽

Clinical Learning ◽

Clinical Learning Environment ◽

Internal Reliability ◽

Cronbach's Alpha

Background and Purpose: The Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) scale measures student nurses’ perceptions of clinical learning environments. This study evaluates the construct validity and internal reliability of the CLES+T in hospital settings in New Zealand. Comparisons are made between New Zealand and Finnish data. Methods: The CLES+T scale was completed by 416 Bachelor of Nursing students following hospital clinical placements between October 2008 and December 2009. Construct validity and internal reliability were assessed using exploratory factor analysis and Cronbach’s alpha. Results: Exploratory factor analysis supports 4 factors. Cronbach’s alpha ranged from .82 to .93. All items except 1 loaded on the same factors found in unpublished Finnish data. The first factor combined 2 previous components from the published Finnish component analysis and was renamed: connecting with, and learning in, communities of clinical practice. The remaining 3 factors (Nurse teacher, Supervisory relationship, and Leadership style of the manager) corresponded to previous components and their conceptualizations. Conclusion: The CLES+T has good internal reliability and a consistent factor structure across samples. The consistency across international samples supports faculties and hospitals using the CLES+T to benchmark the quality of clinical learning environments provided to students.

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