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 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 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 Restructuring Graduate Medical Education to Meet the Health Care Needs of Emirati Citizens

2013 ◽  
Vol 5 (2) ◽  
pp. 195-200 ◽  
Author(s):  
Sawsan Abdel-Razig ◽  
Hatem Alameri
Keyword(s):  
Health Care ◽  
Medical Education ◽  
United Arab Emirates ◽  
Graduate Medical Education ◽  
Health Care Systems ◽  
Abu Dhabi ◽  
Care Needs ◽  
Graduate Medical ◽  
Comprehensive Health ◽  
The Government

Abstract Many nations are struggling with the design, implementation, and ongoing improvement of health care systems to meet the needs of their citizens. In the United Arab Emirates, a small nation with vast wealth, the lives of average citizens have evolved from a harsh, nomadic existence to enjoyment of the comforts of modern life. Substantial progress has been made in the provision of education, housing, health, employment, and other forms of social advancement. Having covered these basic needs, the government of Abu Dhabi, United Arab Emirates, is responding to the challenge of developing a comprehensive health system to serve the needs of its citizens, including restructuring the nation's graduate medical education (GME) system. We describe how Abu Dhabi is establishing GME policies and infrastructure to develop and support a comprehensive health care system, while also being responsive to population health needs. We review recent progress in developing a systematic approach for developing GME infrastructure in this small emirate, and discuss how the process of designing a GME system to meet the needs of Emirati citizens has benefited from the experience of “Western” nations. We also examine the challenges we encountered in this process and the solutions adopted, adapted, or specifically developed to meet local needs. We conclude by highlighting how our experience “at the GME drawing board” reflects the challenges encountered by scholars, administrators, and policymakers in nations around the world as they seek to coordinate health care and GME resources to ensure care for populations.

scholarly journals Plug the Leak: Align Public Spending With Public Need

2012 ◽  
Vol 4 (3) ◽  
pp. 293-295 ◽  
Author(s):  
Donald E. Girard ◽  
Patrick Brunett ◽  
Andrea Cedfeldt ◽  
Elizabeth A. Bower ◽  
Christine Flores ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Medical Education ◽  
Graduate Medical Education ◽  
Public Spending ◽  
Education Spending ◽  
Graduate Medical ◽  
Workforce Needs ◽  
Training Physicians ◽  
And Training

Abstract We explore the history behind the current structure of graduate medical education funding and the problems with continuing along the current funding path. We then offer suggestions for change that could potentially manage this health care spill. Some of these changes include attracting more students into primary care, aligning federal graduate medical education spending with future workforce needs, and training physicians with skills they will require to practice in systems of the future.

scholarly journals Graduate Medical Education on the Frontlines during the COVID-19 Pandemic in New York City- A Response to Promote Well-being

2021 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Medical Education ◽  
Graduate Medical Education ◽  
Health Program ◽  
Mental Health Program ◽  
Well Being ◽  
The United States ◽  
Personal Factors ◽  
Graduate Medical

Introduction: The COVID-19 pandemic has driven many health care institutions in the United States beyond their capacity. Physicians-in-training in graduate medical education programs have suffered the strain of providing patient care during this unprecedented time of crisis. The significant prevalence of pre-existing resident and fellow burnout and depression makes the need for action by institutions to support the well-being of residents and fellows even more urgent. We aim to describe innovative adaptations our Office of Graduate Medical Education implemented with the support of institutional leadership as responses to promote the well-being of residents and fellows on the frontlines during the COVID-19 pandemic. Methods: The Office of Graduate Medical Education (GME), in collaboration with the Office of Well-being and Resilience, developed a set of resources and interventions to support trainees during the pandemic based on four major categories: workplace culture, personal factors and health, mental health support, and workplace efficiency and function. Examination of the capacity of existing services and gaps that needed to be filled in the rapidly evolving early days of the COVID pandemic led to a robust growth in resources. For example, the already established Student and Trainee Mental Health program was able to expand and adapt its role to serve trainee needs more effectively. Results: We expanded resources to target trainee well-being across a broad array of domains within a short time frame. With investment in access to the Student and Trainee Mental Health program, utilization increased by 25.7%, with 1,231 more visits in 2020 compared to the number of visits in 2019, prior to the COVID-19 pandemic. The creation of Recharge Rooms had a positive impact on the well-being of health care workers. After a single fifteen-minute experience in the Recharge Room, an average 59.6% reduction in self-reported stress levels was noted by users. Other interventions were noted to be helpful in regular town hall meetings with trainees. Conclusion: Addressing trainee well-being is an essential aspect of a crisis response. The Mount Sinai Health System was able to care for the physical, mental, psychosocial, and safety needs of our trainees thanks to the collaborative effort of a pre-existing institutional well-being program and the GME Office. The ability to implement such a response was enabled by our well-being foundation, which allowed leadership at the highest institutional level and the Office of GME to provide support in response to this unprecedented crisis.

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 See No Evil, Hear No Evil, Stop No Evil: Institutional-Level Tracking to Combat Mistreatment of Residents and Fellows

2019 ◽  
Vol 11 (5) ◽  
pp. 601-605 ◽  
Author(s):  
Taj Mustapha ◽  
Yedam Ho ◽  
John S. Andrews ◽  
Michael J. Cullen
Keyword(s):  
Medical Education ◽  
Graduate Medical Education ◽  
Primary Source ◽  
University Of Minnesota ◽  
Multiple Sources ◽  
Team Members ◽  
Institutional Level ◽  
Graduate Medical ◽  
Program Evaluations ◽  
New Information

ABSTRACT Background Mistreatment of trainees, including discrimination and harassment, is a problem in graduate medical education. Current tools to assess the prevalence of mistreatment often are not administered institutionally and may not account for multiple sources of mistreatment, limiting an institution's ability to respond and intervene. Objective We describe the utility of a brief questionnaire, embedded within longer institutional program evaluations, measuring the prevalence of different types of trainee mistreatment from multiple sources, including supervisors, team members, colleagues, and patients. Methods In 2018, we administered a modified version of the mistreatment questions in the Association of American Medical Colleges Graduation Questionnaire to investigate the prevalence and sources of mistreatment in graduating residents and fellows. We conducted analyses to determine the prevalence, types, and sources of mistreatment of trainees at the institutional level across graduate medical education programs. Results A total of 234 graduating trainees (77%) from the University of Minnesota—Twin Cities completed the questions. Patients were cited as the primary source of mistreatment in 5 of 6 categories, including both direct and indirect offensive remarks, microaggressions, sexual harassment, and physical threats (paired t test comparisons from t = 3.92 to t = 9.71, all P < .001). The only category of mistreatment in which patients were not the most significant source was humiliation and shaming. Conclusions Six questions concerning types and sources of trainee mistreatment, embedded within an institutional survey, generated new information for institutional-, departmental- and program-based future interventions. Patients were the greatest source for all types of mistreatment except humiliation and shaming.

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