The Clinic is The Curriculum: Can Attention to the Clinical Learning Environment Enhance Improvement in Health Care Delivery and Outcomes?

Abstract

Actualization of knowledge and skills learned in medical education is required for medical students and residents to adopt effective clinical patterns and behaviors into their lives as practicing physicians. In addition, the imprinting of clinical behaviors that these trainees incorporate from the observations they make in the clinical learning environment in which they train has been well established to have a substantial and long-lasting impact on their approaches to care in subsequent practice settings. While much attention is paid to the formal curriculum for students and residents, supported by the need to meet requirements for accreditation, it is less common to witness explicit discussions and planning about the role that the clinical learning environment plays in the ultimate outcomes of educational efforts.Despite being 3 decades into a national focus on the need to improve patient safety and quality of care delivered in the United States, substantive progress toward meeting Quadruple Aim goals remains elusive. In this commentary, the impact of the clinical learning environment on the production of graduates who are both knowledgeable about health system science competencies and incorporate them into the ways in which they view themselves and their work is posited to be one of the reasons contributing to the lack of consistent application of effective approaches to improving care. Recommendations for further training of faculty, alongside residents and students, are explored. Finally, models of medical education and curriculum must make the clinical learning environment "visible" in their planning, lest the outcomes they desire, and the nation needs, may never come to fruition.