scholarly journals Psychological Safety and Support: Assessing Resident Perceptions of the Clinical Learning Environment

2018 ◽  
Vol 10 (6) ◽  
pp. 651-656 ◽  
Author(s):  
Nital P. Appelbaum ◽  
Sally A. Santen ◽  
Brian M. Aboff ◽  
Ryan Vega ◽  
Jose L. Munoz ◽  
...  
Keyword(s):  
Medical Education ◽  
Program Evaluation ◽  
Learning Environment ◽  
Graduate Medical Education ◽  
Organizational Support ◽  
Perceived Organizational Support ◽  
Psychological Safety ◽  
Clinical Learning ◽  
Clinical Learning Environment ◽  
Graduate Medical

ABSTRACT Background Assessments of the clinical learning environment could allow early interventions to improve graduate medical education. To date, measurement tools for this have not been identified. Objective We established the concurrent validity of 2 instruments that assess cultural facets of the clinical learning environment by correlating them with external program evaluation data. Methods In 2017 we surveyed residents across 19 training programs on their perceptions of organizational support by using the Short Survey of Perceived Organizational Support (SPOS), and psychological safety by using the Psychological Safety Scale (PSS). Data were aggregated to the program level and correlated with results from the Accreditation Council for Graduate Medical Education (ACGME) Resident Survey. Results Of 511 residents, 322 (63%) completed the survey, and 496 of 516 residents (96%) completed the ACGME Resident Survey. Perceived organizational support correlated positively with overall program evaluation score (r = 0.75, P < .001); faculty (r = 0.72, P < .001); evaluation (r = 0.73, P < .001); educational content (r = 0.52, P = .022); and resources domains (r = 0.55, P =  .014). Psychological safety had a positive correlation with overall program evaluation (r = 0.57, P = .011); faculty (r = 0.50, P = .028); and evaluation (r = 0.62, P < .005). Conclusions The SPOS and PSS correlated with key ACGME Resident Survey domains. Programs showing greater support of residents were likely to show more positive ratings on program evaluation metrics. Teaching institutions may benefit from actively monitoring and improving aspects of their learning environment through internal assessments.

scholarly journals Preliminary Evidence Supporting a Novel 10-Item Clinical Learning Environment Quick Survey (CLEQS)

2021 ◽  
Vol 13 (4) ◽  
pp. 553-560
Author(s):  
Deborah Simpson ◽  
Matthew McDiarmid ◽  
Tricia La Fratta ◽  
Nicole Salvo ◽  
Jacob L. Bidwell ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Education ◽  
Learning Environment ◽  
Graduate Medical Education ◽  
Validity Evidence ◽  
Clinical Learning ◽  
Clinical Learning Environment ◽  
Good Reliability ◽  
Team Members ◽  
Graduate Medical

ABSTRACT Background The clinical learning environment (CLE) is a priority focus in medical education. The Accreditation Council for Graduate Medical Education Clinical Learning Environment Review's (CLER) recent addition of teaming and health care systems obligates educators to monitor these areas. Tools to evaluate the CLE would ideally be: (1) appropriate for all health care team members on a specific unit/project; (2) informed by contemporary learning environment frameworks; and (3) feasible/quick to complete. No existing CLE evaluation tool meets these criteria. Objective This report describes the creation and preliminary validity evidence for a Clinical Learning Environment Quick Survey (CLEQS). Methods Survey items were identified from the literature and other data sources, sorted into 1 of 4 learning environment domains (personal, social, organizational, material) and reviewed by multiple stakeholders and experts. Leaders from 6 interprofessional graduate medical education quality improvement/patient safety teams distributed this voluntary survey to their clinical team members (November 2019–mid-January 2021) using electronic or paper formats. Validity evidence for this instrument was based on the content, response process, internal structure, reliability, relations to other variables, and consequences. Results Two hundred one CLEQS responses were obtained, taking 1.5 minutes on average to complete with good reliability (Cronbach's α ≥ 0.83). The Cronbach alpha for each CE domain with the overall item ranged from 0.50 for personal to 0.79 for social. There were strong associations with other measures and clarity about improvement targets. Conclusions CLEQS meets the 3 criteria for evaluating CLEs. Reliability data supports its internal consistency, and initial validity evidence is promising.

scholarly journals Evaluating the Clinical Learning Environment: Resident and Fellow Perceptions of Patient Safety Culture

2015 ◽  
Vol 7 (1) ◽  
pp. 109-112 ◽  
Author(s):  
Gregory M. Bump ◽  
Jaclyn Calabria ◽  
Gabriella Gosman ◽  
Catherine Eckart ◽  
David G. Metro ◽  
...  
Keyword(s):  
Medical Education ◽  
Patient Safety ◽  
Learning Environment ◽  
Health System ◽  
Graduate Medical Education ◽  
Safety Culture ◽  
Patient Safety Culture ◽  
Clinical Learning ◽  
Clinical Learning Environment ◽  
National Norms

Abstract Background The Accreditation Council for Graduate Medical Education has begun to evaluate teaching institutions' learning environments with Clinical Learning Environment Review visits, including trainee involvement in institutions' patient safety and quality improvement efforts. Objective We sought to address the dearth of metrics that assess trainee patient safety perceptions of the clinical environment. Methods Using the Hospital Survey on Patient Safety Culture (HSOPSC), we measured resident and fellow perceptions of patient safety culture in 50 graduate medical education programs at 10 hospitals within an integrated health system. As institution-specific physician scores were not available, resident and fellow scores on the HSOPSC were compared with national data from 29 162 practicing providers at 543 hospitals. Results Of the 1337 residents and fellows surveyed, 955 (71.4%) responded. Compared with national practicing providers, trainees had lower perceptions of patient safety culture in 6 of 12 domains, including teamwork within units, organizational learning, management support for patient safety, overall perceptions of patient safety, feedback and communication about error, and communication openness. Higher perceptions were observed for manager/supervisor actions promoting patient safety and for staffing. Perceptions equaled national norms in 4 domains. Perceptions of patient safety culture did not improve with advancing postgraduate year. Conclusions Trainees in a large integrated health system have variable perceptions of patient safety culture, as compared with national norms for some practicing providers. Administration of the HSOPSC was feasible and acceptable to trainees, and may be used to track perceptions over time.

scholarly journals Success of a Resident-Led Safety Council: A Model for Satisfying CLER Pathways to Excellence Patient Safety Goals

2019 ◽  
Vol 11 (2) ◽  
pp. 226-230 ◽  
Author(s):  
Sarah P. Cohen ◽  
Jonathan H. Pelletier ◽  
Jennifer M. Ladd ◽  
Colby Feeney ◽  
Victoria Parente ◽  
...  
Keyword(s):  
Medical Education ◽  
Patient Safety ◽  
Learning Environment ◽  
Graduate Medical Education ◽  
Safety Data ◽  
Clinical Learning Environment ◽  
Safety Attitudes ◽  
Graduate Medical ◽  
Safety Report ◽  
Safety Event

ABSTRACT Background  The Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review (CLER) program focuses on aspects of the graduate medical education learning environment, such as patient safety. Data from CLER site visits reveal that many resident physicians do not receive adequate training on patient safety. Objective  We evaluated a pediatric resident-led safety council as a method to meet CLER Pathways to Excellence patient safety objectives. Methods  The Duke Pediatric Residency Safety Council (PRSC) created an infrastructure for residents to participate in department safety efforts, review safety events, and act as leaders for safety initiatives. Annual surveys were distributed to graduate medical education trainees through the institution's patient safety center and the PRSC. Survey results of safety attitudes were compared over time within the pediatrics program and between pediatrics and nonpediatrics trainees at the institution. Resident-submitted safety reports were tracked through an institutional safety event repository. Results  From 2013 to 2017, the percentage of residents who strongly agreed that they could submit a safety report doubled (from 35% [6 of 17] to 73% [22 of 30], P = .011). The average number of safety reports submitted by a pediatrics resident per year did not significantly change during this period (from 3.0 to 3.8, P = .11). In 2017, 90% of pediatrics residents (27 of 30) agreed or strongly agreed that their concerns would be addressed if they entered a safety report. Conclusions  The council addressed 5 of the 7 CLER Pathways to Excellence in patient safety.

scholarly journals A Systematic Review of the Use of Google Glass in Graduate Medical Education

2019 ◽  
Vol 11 (6) ◽  
pp. 637-648
Author(s):  
Joseph F. Carrera ◽  
Connor C. Wang ◽  
William Clark ◽  
Andrew M. Southerland
Keyword(s):  
Systematic Review ◽  
Medical Education ◽  
Graduate Medical Education ◽  
Skills Training ◽  
Small Sample ◽  
Point Of View ◽  
Battery Life ◽  
Google Glass ◽  
Clinical Learning Environment ◽  
Graduate Medical

ABSTRACT Background Graduate medical education (GME) has emphasized the assessment of trainee competencies and milestones; however, sufficient in-person assessment is often constrained. Using mobile hands-free devices, such as Google Glass (GG) for telemedicine, allows for remote supervision, education, and assessment of residents. Objective We reviewed available literature on the use of GG in GME in the clinical learning environment, its use for resident supervision and education, and its clinical utility and technical limitations. Methods We conducted a systematic review in accordance with 2009 PRISMA guidelines. Applicable studies were identified through a review of PubMed, MEDLINE, and Web of Science databases for articles published from January 2013 to August 2018. Two reviewers independently screened titles, abstracts, and full-text articles that reported using GG in GME and assessed the quality of the studies. A systematic review of these studies appraised the literature for descriptions of its utility in GME. Results Following our search and review process, 37 studies were included. The majority evaluated GG in surgical specialties (n = 23) for the purpose of surgical/procedural skills training or supervision. GG was predominantly used for video teleconferencing, and photo and video capture. Highlighted positive aspects of GG use included point-of-view broadcasting and capacity for 2-way communication. Most studies cited drawbacks that included suboptimal battery life and HIPAA concerns. Conclusions GG shows some promise as a device capable of enhancing GME. Studies evaluating GG in GME are limited by small sample sizes and few quantitative data. Overall experience with use of GG in GME is generally positive.

scholarly journals Use of an Institutional Template for Annual Program Evaluation and Improvement: Benefits for Program Participation and Performance

2010 ◽  
Vol 2 (2) ◽  
pp. 160-164 ◽  
Author(s):  
Kathryn M. Andolsek ◽  
Alisa Nagler ◽  
John L. Weinerth
Keyword(s):  
Medical Education ◽  
Program Evaluation ◽  
Graduate Medical Education ◽  
Tracking System ◽  
University Hospital ◽  
Improvement Strategy ◽  
Meaningful Improvement ◽  
Graduate Medical ◽  
Program Adherence ◽  
Duke University

Abstract Purpose The Accreditation Council for Graduate Medical Education (ACGME) expects programs to engage in ongoing, meaningful improvement, facilitated in part through an annual process of program assessment and improvement. The Duke University Hospital Office of Graduate Medical Education (OGME) used an institutional practice-based learning and improvement strategy to improve the annual evaluation and improvement of its programs. Methods The OGME implemented several strategies including the development and dissemination of a template for the report, program director and coordinator development, a reminder and tracking system, incorporation of the document into internal reviews, and use of incentives to promote program adherence. Results In the first year of implementation (summer 2005), 27 programs (37%) submitted documentation of their annual program evaluation and improvement to the OGME; this increased to 100% of programs by 2009. A growing number of programs elected to use the template in lieu of written minutes. The number of citations related to required program review and improvement decreased from 12 in a single academic year to 3 over the last 5 years. Conclusion Duke University Hospital's institutional initiative to incorporate practice-based learning and improvement resulted in increased documentation, greater use of a standardized template, fewer ACGME-related citations, and enhanced consistency in preparing for ACGME site visits.

scholarly journals Residentsʼ Perspectives on the Learning Environment: Data From the Accreditation Council for Graduate Medical Education Resident Survey

2010 ◽  
Vol 85 (3) ◽  
pp. 512-518 ◽  
Author(s):  
Kathleen D. Holt ◽  
Rebecca S. Miller ◽  
Ingrid Philibert ◽  
Jeanne K. Heard ◽  
Thomas J. Nasca
Keyword(s):  
Medical Education ◽  
Learning Environment ◽  
Graduate Medical Education ◽  
Accreditation Council ◽  
Graduate Medical

scholarly journals Otolaryngology Resident Well-Being and Perceptions of the Clinical Learning Environment

2019 ◽  
Vol 98 (7) ◽  
pp. 409-415 ◽  
Author(s):  
Kelley M. Dodson ◽  
Nital P. Appelbaum ◽  
Nathaniel Lee ◽  
Michael Amendola ◽  
Brian Kaplan
Keyword(s):  
Learning Environment ◽  
Organizational Support ◽  
Well Being ◽  
Program Directors ◽  
The United States ◽  
Work Life ◽  
Clinical Learning ◽  
Clinical Learning Environment ◽  
South Central ◽  
Life Strain

Objective: To measure the current state of organizational and well-being factors in otolaryngology residency programs and associate these perceptions with demographics, pursuit of subspecialty fellowships, and performance on the Otolaryngology Training Examination (OTE). Materials and Methods: Anonymous mail and online survey study of otolaryngology residents from the Southern, Mid-Atlantic, and East South-Central Regions of the United States. Summary of Results: A total of 46 otolaryngology residents across 14 residency training programs (22% resident response rate) completed our survey. Residents who scored above the 80th percentile on the OTE perceived greater organizational support (median = 3.84) than residents who scored below the 40th percentile (median = 3.31), U = 48.00, P = .047, η2 = 0.14. Residents interested in fellowship reported less burnout (median = 2.44) compared to those who did not plan to pursue fellowship (median = 3.56), U = 105.00, P = .010, η2 = 0.05. Residents pursuing fellowship also reported less work–life strain (median = 2.56) than those forgoing fellowship (median = 2.89), U = 126.00, P = .044, η2 = 0.10. Residents with children reported greater work–life strain (median = 3.11) compared to those without (median = 2.56), U = 60.50, P = .008, η2 = 0.15. Conclusion: For otolaryngology residents in this survey sample, the perception of organizational support and well-being may influence resident performance (on OTE examinations) and ultimate career goals (fellowship applications). Program directors and coordinators can use this information to strengthen the perceptions of organizational support as well as improve the clinical learning environment to optimize training conditions for their residents. Residency program directors can also use the identified study measures to assess resident perceptions of the clinical learning environment and well-being for annual evaluation and improvement purposes.

scholarly journals Promotion of Wellness and Mental Health Awareness Among Physicians in Training: Perspective of a National, Multispecialty Panel of Residents and Fellows

2015 ◽  
Vol 7 (1) ◽  
pp. 143-147 ◽  
Author(s):  
Timothy J. Daskivich ◽  
Dinchen A. Jardine ◽  
Jennifer Tseng ◽  
Ricardo Correa ◽  
Brian C. Stagg ◽  
...  
Keyword(s):  
Mental Health ◽  
Medical Education ◽  
Learning Environment ◽  
Graduate Medical Education ◽  
Health Awareness ◽  
Graduate Medical ◽  
Mental Health Awareness ◽  
Education Community ◽  
Resident Wellness ◽  
The Ideal

Abstract Background Physicians in training are at high risk for depression, and physicians in practice have a substantially elevated risk of suicide compared to the general population. The graduate medical education community is currently mobilizing efforts to improve resident wellness. Objective We sought to provide a trainee perspective on current resources to support resident wellness and resources that need to be developed to ensure an optimal learning environment. Methods The ACGME Council of Review Committee Residents, a 29-member multispecialty group of residents and fellows, conducted an appreciative inquiry exercise to (1) identify existing resources to address resident wellness; (2) envision the ideal learning environment to promote wellness; and (3) determine how the existing infrastructure could be modified to approach the ideal. The information was aggregated to identify consensus themes from group discussion. Results National policy on resident wellness should (1) increase awareness of the stress of residency and destigmatize depression in trainees; (2) develop systems to identify and treat depression in trainees in a confidential way to reduce barriers to accessing help; (3) enhance mentoring by senior peers and faculty; (4) promote a supportive culture; and (5) encourage additional study of the problem to deepen our understanding of the issue. Conclusions A multispecialty, national panel of trainees identified actionable goals to broaden efforts in programs and sponsoring institutions to promote resident wellness and mental health awareness. Engagement of all stakeholders within the graduate medical education community will be critical to developing a comprehensive solution to this important issue.

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