Abstract
BackgroundMeasuring clinical learning environment is crucial for the quality improvement of medical education, especially for medical trainees at transition stages. Medical education in Taiwan is shaped by multiple socio-cultural influences. The aims of this study were to construct an instrument for measuring clinical learning environment in alignment with the local socio-cultural factors and medical training settings, and further investigate the relationship between the quality of the clinical learning environment and the status of mental distress among medical trainees.MethodsParticipants consisted of 189 medical trainees (62 interns, 52 postgraduate year one (PGY1) residents, and 75 senior residents). Instruments included a designed 40-item Clinical Learning Environment Questionnaire (CLENQ) and a five-item Brief Symptoms Rating Scale (BSRS-5) for evaluating mental distress. Constructs of CLENQ were examined using factor analysis. Correlations were calculated between BSRS-5 and CLENQ across the three levels of medical trainees.ResultsFactor analysis of CLENQ yielded five factors- I: Teaching (13 items), II: Workload (7 items), III: Relationship pressure (9 items), IV: Organisational support (4 items) and V: Mutual trust (6 items). Intern trainees reported the lower total CLENQ scores in comparison to PGY1 and senior resident trainees. Mental distress using BSRS-5 was negatively correlated with total CLENQ scores and several key factors in all three groups.ConclusionsOur study using CLENQ has identified five major factors of clinical learning environment that are closely linked with our local socio-cultural factors and medical training settings. Medical trainee’s mental distress status was negatively correlated with the quality of CLENQ. These findings have socio-cultural relevance and medical contextual significance and might be applicable to other countries. It warrants further study to investigate the impact of clinical learning environment improvement on the medical trainee’s mental distress and performance.
Highlights
Measuring clinical learning environment is crucial for the quality improvement of medical education, especially for medical trainees at transition stages
Medical trainees consisted of 145 interns, 87 postgraduate year one (PGY1) residents, and 218 senior residents above the second year (Rs), considered to be at the transitions stages of medical education
In total, 189 of 450 medical trainees completed the questionnaires with a response rate of 42%
Summary
Measuring clinical learning environment is crucial for the quality improvement of medical education, especially for medical trainees at transition stages. The aims of this study were to construct an instrument for measuring clinical learning environment in alignment with the local socio-cultural factors and medical training settings, and further investigate the relationship between the quality of the clinical learning environment and the status of mental distress among medical trainees. Measuring an educational or learning environment has become an essential approach for evaluating the quality of the medical curriculum and training programmes by identifying the strengths, weaknesses, and priority areas for improvement [1,2,3]. A systemic review has reported the validity and usefulness of several instruments to measure the clinical educational environment [3].
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