Clinical Learning Environment Research Articles

Validity and Reliability Study of the Turkish Version of the "Uncivil Behavior in Clinical Nursing Education Scale" for Nursing Students.

Background and Purpose: Nursing undergraduate students may encounter unkind behaviors during their clinical education. This study aimed to test the psychometric properties of the Turkish version of the "Uncivil Behavior in Clinical Nursing Education (UBCNE) Questionnaire," which measures nursing students' perceived levels of uncivil behavior in the clinical learning environment. Methods: The study was conducted in four steps: translation, face and content validity, confirmatory factor analysis, and reliability assessment. Data were collected from 216 nursing students from Turkey. Results: In the exploratory factor analysis (EFA), a unidimensional factor structure with an eigenvalue above 1 was detected, and therefore the scale was analyzed as a single dimension. In the EFA with 13 items, the Kaiser-Meyer-Olkin value was 0.943, and the Barlett test result was 1862.965 (p <05). The fit indices for the class were calculated as χ2/df = 2.218, root-mean-square error of approximation = .075, and comparative fit index = 0.961. Cronbach's coefficient α (alpha) for Turkish culture was .942. Conclusion: The study showed that the Turkish version of the UBCNE scale is a valid and reliable measurement tool for assessing perceived incivil behaviours in nursing students' clinical education.

Exploring clinician perspectives of systems-based practice: A physician training challenge.

Systems-based practice (SBP) has been a competency in US graduate medical education for over 20 years, but it is not well implemented. SBP is loosely defined as physician's responsiveness to the larger system of healthcare. The aim of this study was to describe healthcare professionals' perspectives regarding: (1) their knowledge and beliefs about SBP and (2) their beliefs regarding factors in clinical learning environments (CLE) that facilitate or hinder operationalisation and learning of SBP. Semi-structured interviews were conducted between November 2020 and April 2021 with 42 individuals from four health systems. Participants were healthcare professionals involved in graduate medical education, including physicians and interprofessional clinicians (e.g., nursing staff). Interviews were transcribed and coded using a social constructivist, codebook thematic analysis approach and themes were agreed upon through discussion amongst the research team. Five themes were constructed: (1) SBP remains a challenge to define, (2) SBP may be intuitively understood, particularly when framed at the microsystem level, (3) SBP aligns with the Health Systems Science framework, (4) SBP learning must be intentionally integrated into the CLE, through training such as onboarding and (5) multidisciplinary settings and work processes are critical to engage in SBP. Workload compression is a barrier to SBP implementation. Healthcare professionals highlighted that current CLEs are not designed to prioritise SBP. Graduate medical education programmes may benefit from focusing systems content at the microsystem level and purposefully integrating onboarding procedures, clinical settings and rotations specifically designed to teach SBP into their residencies.

The Effect of Scenario-Based Group Discussion Training on the Nursing Students' Creativity: A Randomized Educational Controlled Trial.

Applying the clinical scenario teaching method using approaches such as group discussion facilitates the possibility of learning and developing creativity in a real clinical learning environment. However, few studies have been done in this field. The present study aimed to evaluate the effect of scenario-based group discussion training on the creativity level of nursing students. This study was a randomized controlled educational trial from January to October 2019 conducted on nursing students at Shiraz University of Medical Sciences. Nursing students were randomly assigned into intervention and control groups (22 per each group). The students in the intervention group participated in a training program consisting of three 60-min sessions per week for two consecutive weeks. In each session, 2-3 scenarios were presented, and the students discussed about it. Each student was asked to submit a practical activity in a written story. In the control group, the training was conducted in the usual way (Students' presentation and discussion of presented content without scenario presentation). Data were collected using a validated creativity questionnaire. Data were analyzed in SPSS software, version 22, using Chi-square and t-test and the significance level was considered p < 0.05. The results showed that immediately after the intervention, a difference was observed between the groups concerning the mean score of fluency (p = 0.02) and originality (p = 0.03), but there was not a significant difference between the groups concerning the overall score of creativity (p = 0.09). It can be concluded that scenario-based group discussion training is effective for improving the dimensions of the fluency and originality creativity of nursing students. It seems that scenario-based education is an appropriate radical method for traditional education methods. Trial Registration: IRCT Registration Number: IRCT20140503017546N13; Registration Date: 09.05.2018.

Shaping minds and hearts in medical education: Embedding and implementing a personal and professional development curriculum

This paper explores personal and professional development (PPD) as a key learning domain for the future of medical education and person-centered care. Guided by existing curriculum development models and lessons learned in practice, scenarios from academic and clinical learning environments will guide a theory-driven discussion of concepts and competencies that humanize the practice of medicine, such as emotional intelligence, professional identity formation, lifelong learning and inclusive practice. Factors contributing to contemporary curriculum implementation will be informed by a case study of a PPD program delivered to post-graduate medical students in Australia and propose an action-focused series of next steps to connect past, current and future directions for medical schools and graduates. Through reflections on iterative stages of program development and the incorporation of emerging concepts in PPD, this paper advocates for the true valuing of personal growth and professional development in medical education. If future doctors are to graduate as compassionate, socially informed, and critically reflective practitioners, they need dedicated PPD learning, opportunities to practice and active encouragement to remain curious towards and beyond their own experience.

From research to resources: developing a case-based learning curriculum for navigating clinical uncertainty

Purpose This study aimed at rethinking ways in which educators from different fields can collaborate to respond to the rapidly evolving demands of health professions education (HPE). The goal was to investigate how a research-to-resources approach can be applied to engage in knowledge translation (KT) of research findings for the benefit of introducing medical students to uncertainty in the clinical learning environment. Design/methodology/approach An interdisciplinary team of medical educators, human resource development (HRD) scholars and emergency medicine fellows engaged in iterative cycles of action research (AR) to develop, pilot and refine case-based learning resources on clinical uncertainty. The team leveraged prior research on physicians’ decision-making during COVID-19, experimented with generative AI tools, and collected feedback from medical students to guide resource development. Findings The findings of this study are twofold. On the one hand, the authors reflect on the lessons learned of developing case-based learning with the help of generative AI. While student feedback indicated that the case helped normalize and process experiences with uncertainty, key challenges included adapting research data to create relevant, sustainable learning resources and designing effective discussion prompts. On the other hand, the authors provide insights into the opportunities and challenges of our interdisciplinary collaboration. The authors show that knowledge utilization is not simple, but complex, and that more work needs to be done to effectively disseminate resources as part of the desired uncertainty curriculum. Practical implications This study attempts to apply a KT framework for bridging the research-practice gap in HPE through interdisciplinary collaboration and AR. It provides lessons learned for developing case-based curricula on complex topics like uncertainty. The findings highlight the need for adaptive KT processes when dealing with rapidly evolving healthcare contexts. Originality/value This paper offers a novel example of research-to-resource KT in medical education, integrating perspectives from HRD and leveraging emerging technologies. It contributes to understanding how interdisciplinary teams can collaborate to create timely, evidence-based educational resources for navigating uncertainty in professional practice. The study also provides insights into the challenges and opportunities of translating complex research findings into practical learning tools to tackle real-world challenges in HPE.

Trainee growth vs. fixed mindset in clinical learning environments: enhancing, hindering and goldilocks factors

BackgroundDoctors in training (trainees) have higher rates of burnout, anxiety and depression than other professionals. An important psychological tool to combat this crisis is promotion of a growth mindset, which increases resilience and improves mental health outcomes. How growth mindset might be promoted within the clinical learning environment is underexplored. This study aimed to explore the factors promoting a growth mindset versus fixed mindset in trainees from the perspective of the trainees.MethodsThis constructivist study employed a novel method of encouraging trainees’ reflections on mindset adoption in the clinical learning environment. Trainees played Mindset, a tabletop simulation board game that included challenges encountered within training. This was followed by a facilitated debriefing, focusing on factors that promoted growth or fixed mindset adoption in the clinical learning environment. Debriefing transcripts were analysed using template analysis.ResultsThree groups of oncology trainees and one group of medical education fellows participated (16 participants in total). Factors promoting growth mindset adoption included passion, collaboration, diverse career and role modelling. Factors promoting fixed mindset adoption included burnout and competition. Some factors, such as grit, previous success experience and singular training location promoted a fixed mindset when too much or too little were present, and promoted a growth mindset when they were in balance (the Goldilocks principle).ConclusionsThe importance of balance versus excess of certain factors, and the ubiquitous competitive culture in medicine promoting a fixed mindset, were compelling reflections. This study may aid invested parties to reflect on what factors they can upregulate and down regulate to optimise trainees’ adoption of a growth mindset.

Psychological safety in students’ clinical learning environment – thematic analysis of open-ended questions and DREEM questionnaire assessment

Introduction: The learning environment impacts students’ motivation, success and fulfilment, and central to this is the psychological safety of students. Psychologically safe environments lead to collaboration, positive learning experiences and effective practitioners. This study assessed the perception of clinical learning environments of medical and nursing students (NSs) using the Dundee Ready Education Measure (DREEM) and with two open-ended questions (OEQs): their memorable learning experience and the effect of being in medical school on their lives. Methods: This was a cross-sectional study using validated DREEM questionnaires and two OEQs: ‘tell us about a memorable learning experience in medical/nursing school’ (MLE) and ‘what impact has your time in medical/nursing school had on your life’ (IoL). Data were collected from fourth- to sixth-year clinical medical, and first- to third-year NSs. Questionnaire data were analysed using the Statistical Package for Social Sciences. For the OEQs, an inductive approach was used for coding and thematic analysis. Coding was both semantic and interpretive. Results: One hundred and ninety-three students completed the validated questionnaires. Fifty-seven (29%) and 59 (30%) answered the OEQs MLE and Impact IoL, respectively. Thirty-four per cent of medical and 7% of NSs had a negative response to one of the two OEQs. Six themes emerged from the memorable learning experience question, three of which centred around student-centred teachings and two around emotional responses and psychological safety. ‘I reviewed my materials over and over, ate well, put on my best clothes and went to present. It was beautiful’, a third-year medical student. ‘The tutor was a great teacher who, when he teaches, students learn’, an NS. There were four themes on the impact on life questions, and these centred around personal development, social awareness, aspirations and psychological safety. ‘It has made me see that broken people break others’, a third-year medical student. The mean total DREEM score was 111 ± 10.2, interpreted as more positive than negative. In only two of the five DREEM domains, perception of the atmosphere and social self-perception were more negative than positive findings. Whilst there was near unanimity about their teachers being knowledgeable, and most students felt teachers were well-prepared for their teaching sessions, complaints about behaviours that adversely affected learning because of their negative impact on psychological safety in the clinical learning environment were very common. Conclusion: Despite the overall positive picture of clinical learning environments, there are significant areas of students’ welfare that need addressing to ensure psychologically safe clinical learning environment. Students’ feedback feeding into annual appraisals, and pedagogic courses are means to achieving students-centred learning environments.

Balancing Honest Assessment and Compassion for Learners Experiencing Burnout: A Workshop and Feedback Tool for Clinical Teachers.

Burnout in medical trainees challenges their work effectiveness and impedes their ability to learn. Teachers in the clinical learning environment (CLE) are well situated to identify burnout and are often responsible for learner assessment. We developed a workshop to improve clinical teachers' identification and understanding of learner burnout while empowering them to provide constructive feedback and support. Building on best-practice feedback techniques and utilizing the Maslach Burnout Inventory (MBI) as a framework, we designed the GetINBurnOUT method to provide feedback and support for learners experiencing burnout. Applying Kern's six-step approach to curriculum development, we created and implemented a workshop for clinical teachers centered on advanced burnout knowledge, application of the MBI to the CLE, and use of the GetINBurnOUT feedback method. Kolb's experiential learning theory informed workshop activities such as group discussion, case practice, and self-reflection. Participants completed surveys immediately after the workshop to assess planned behavior. We delivered the workshop eight times at local, regional, and national faculty development programs/conferences to over 188 participants. Participants rated the workshop favorably, with average scores of 4.5-4.8 out of 5 across all domains and program objectives; all participants planned to make a change to their practice. Positive comments emphasized the topic's importance and the GetINBurnOUT tool's practicality. This workshop can enhance clinical teachers' understanding of burnout and provide them with the tools to address it in the CLE. The GetINBurnOUT method offers a practical approach for providing honest assessments while supporting learners in the CLE.

Fostering Inclusivity in the Clinical Learning Environment.

Despite the Supreme Court's decision on race-based admissions, academic medical centers, medical societies, and accreditation bodies remain committed to recruiting a diverse workforce. Many medical schools and graduate medical education programs created initiatives to expand their census of underrepresented in medicine (UIM) as the key to addressing health care disparities. As a result, an influx of an UIM physician workforce has entered clinical learning environments, often without consideration of the inclusivity of these settings. To create inclusive, safe, and comfortable CLEs, we must first recognize the challenges faced by UIM trainees, students, and faculty and the complex ways in which discrimination manifests. Ultimately, having inclusive CLEs allows all learners, especially those from historically excluded identities, to thrive in their training and working environment, making it essential to retain the diverse workforce necessary. Using case examples, we discuss strategies of inclusivity and ways in which we can maintain clinical learning environments where learners feel safe and supported through their training.

The challenging reality of the clinical learning environment at Damascus University Faculty of Dental Medicine in Syria: A qualitative study

Introduction In Syria, specialist dentists undergo five years of undergraduate education and four years of postgraduate education. In the latter, students engage in treating complex cases as part of their professional training. This study aimed to obtain in-depth qualitative understanding of the clinical learning environment at Damascus University Faculty of Dental Medicine, Syria. Methods Semi-structured interviews were held with eight postgraduate dental students at Damascus University Faculty of Dental Medicine. The faculty has eight clinical departments; therefore, a single participant was purposively sampled from each department. The male-female ratio of the eight interviewed participants was 1:1. All interviews were conducted between 26th April 2020 and 8th January 2021. Data were analyzed inductively using reflective thematic analysis. Pragmatic saturation was discussed during the analysis and the authors made an interpretative judgement to stop data collection at the eighth interview. Results Major themes which emerged covered different aspects of the clinical learning environment such as clinical training, social interaction and assessment procedures. Faculty’s negligence of their teaching duties was one of the most recurrent themes. In clinical training and due to faculty inaccessibility, students had to rely on themselves or their senior peers in training. The social climate was perceived negatively and assessment was described as unfair and biased. Discussion The findings of this study were framed within Gruppen et al. (2019) theory of the learning environment wherein four dimensions emerge: the personal, the social, the organizational and the material. The findings of this study showcased the continuing deterioration of the clinical learning environment at Damascus University. It is hoped that these findings will encourage decision makers to introduce a comprehensive reform that addresses the curriculum, teaching practices and assessment procedures in clinical professional training.

Digital supervision in the clinical learning environment: Characterizing teamwork in the electronic health record.

Attending physicians in academic hospitals work in supervisory team structures with medical residents to provide patient care. How attendings utilize the electronic health record (EHR) to support learning through supervision is not well understood. To compare EHR behavior on teaching versus direct care, including evidence of supervisory calibration to learners. Cross-sectional study analysis of EHR metadata from 1721 shifts of hospital medicine faculty at a large, urban academic medical center, January to June 2022. Measures included total EHR time per shift, EHR time outside shift, and time spent on: note-writing, note review/attestation, order entry, and other clinical review. We assessed within physician differences across these service types and used multilevel modeling to determine whether these behaviors varied with resident physicians' experience, accounting for physician-specific signature behavior patterns. Attendings spent substantially less time in the EHR while on teaching service than on direct service (129 vs. 240 min; p < .001) and apportioned their work differently throughout the day. Physicians were less behaviorally consistent and varied more than their peers when on teaching service. Attendings calibrated their supervision to learners. Attendings logged 12.7% less EHR time when paired with more senior residents than postgraduate year 2 (PGY2) residents (137 vs. 120 min, p = .002). PGY1 presence was also associated with reduced EHR time, suggesting some delegation of supervision to senior trainees. EHR behaviors on teaching service are highly variable and differ substantially from direct care; a lack of consistency suggests important opportunities to establish best practices for EHR-based supervision and create an effective clinical learning environment.

Provision of early clinical experience in UK medical schools: a cross-sectional survey

ABSTRACT Background There is an established evidence base to support early clinical experience (ECE) within medical degree programmes. However, increasingly crowded clinical learning environments can make provision challenging. The aim of this research was to develop understanding about how ECE is provided within UK medical schools. Methods We conducted a cross-sectional study on ECE provision by UK medical schools using an electronic survey containing a mix of question styles. We gathered data on the stage at which ECE featured within curricula, the amount of ECE provided, the setting for ECE, the learning outcomes covered during ECE and whether such content was formally assessed. Support for survey dissemination was obtained from the UK Medical Schools Council (MSC) Education Leads Advisory Group (ELAG). Responses were collected between 10/05/23 and 11/10/23. Findings Of the 43 eligible UK medical schools, responses were received from 28 (65%). The provision of ECE amongst respondent medical schools was ubiquitous. The majority of ECE was provided within general practice and hospital settings, but community and voluntary sector settings were increasingly employed, as was technology enhanced ECE. A significant shift in the nature of the content addressed during ECE, with less focus on implementation of basic science was seen within learning outcomes. The extent to which ECE learning outcomes were formally assessed was variable. Conclusion The amount of ECE provided by UK medical schools has fallen. We encourage institutions to reflect on their provision of ECE and to consider how greater diversity of community settings and technology-enhanced learning could be harnessed.

Level of clinical competency and associated factors of nursing students in Ethiopia: systematic review and meta-analysis

BackgroundAssessing the clinical level of competency in nursing students is crucial as it represents the ultimate goal of nursing education. Poor competency result in low performance and can be affected by various factors. Thus, the aim of this study was to identify level of clinical competency and associated factors of nursing students in Ethiopia.Methodssystematic review and meta-analysis was employed. Searching strategy was conducted from January up to march 2024 from Web of Science, PubMed and Google Scholar. The quality of studies was assessed using PRISMA checklist. A meta-analysis was performed using R Studio with the meta package Version 1.4.1106.Resultsin total, 145 studies were identified through database search, and only 7 studies were included in the meta-analysis representing 1937 nursing students. The pooled effect size of clinical competency of nursing students was 28%. Three factors were found to be associated with clinical competency: a positive clinical learning environment, student confidence in performing procedures, and effective staff-student interaction. The effect sizes of these factors were 6.30, 2.23, and 7.76, respectively.Conclusion and recommendationThe clinical competency of nursing students was 28%, and it was associated with clinical learning environment, student confidence in performing procedures, and staff-student interaction. Nursing education programs should focus on enhancing students’ competency levels by addressing specific factors.(PROSPERO) International prospective register of systematic reviewsCRD42022367057.

Satisfaction of medical and health science students with their clinical learning environment and its determinant factors at Debre Markos University, northwest Ethiopia

BackgroundUnderstanding the student’s perspective of their clinical learning environment (CLE) might assist to discover solutions to improve the learning process and increase engagement. However, there is a lack of information on this issue, particularly in Ethiopia. The purpose of this study was to assess the satisfaction of undergraduate medical and health science students with their clinical learning environment, as well as to identify the factors that affect it.MethodsInstitutional-based cross-sectional study was conducted using a self-administered questionnaire among 412 medical and health science students from Debre Markos University in 2023 through a simple random sampling technique. Mean, median, frequencies, and percentages were used to describe the data. A multivariate logistic regression model was fitted to test the association of dependent and independent variables. The Hosmer-Lemeshow goodness-of-fit test was used to check the fitness of the model. Variables with a p-value < 0.05 with a 95% confidence interval were considered statistically significant.ResultsThe questionnaire was completed by 394 individuals in total, generating a response rate of 95.63%. Approximately half (49.7%) of the participants were satisfied with their CLE. Age (AOR = 1.12; 95%CI = 1.02, 1.22), university positive perceptions (AOR = 1.60; 95%CI = 1.04, 2.43) and curriculum positive perception (AOR = 2.70; 95%CI = 1.73, 4.10) were all positively associated with CLE satisfaction.ConclusionIn this study, approximately half of the respondents were satisfied with their CLE. Age, positive perceptions of the university and positive perceptions of the curriculum were all positively associated with CLE satisfaction. The university and clinical facilitators should work together to improve infrastructure, and the facilities at the university, build dormitories at the clinical placement sites, as well as the curriculum review should involve students to increase their academic performance, self-esteem, and satisfaction with CLE.

Ugandan optometry students’ experiences of their clinical training: a qualitative study

BackgroundThere is a gradual increase in the number of optometry education programs in Africa yet there is limited knowledge on optometry students’ experiences of their clinical training. Therefore, the purpose of this study was to explore the optometry students’ experiences of their clinical learning environment at a national referral and teaching hospital in Uganda.MethodsBetween April 2023 and May 2023, face to face in-depth interviews were conducted to explore the experiences of the participants. All 16 optometry students in fourth-year at university were purposefully recruited into the study. Data was collected at the end of the students’ clinical training at the eye clinic of a national referral and teaching hospital. Interviews were audio recorded and transcribed for analysis using an inductive thematic approach.ResultsTwo themes, learning at the eye clinic and organization of the eye clinic, were identified to represent participants’ experiences. Each theme had three sub themes.ConclusionTraining optometry students at an eye clinic enhances their clinical skills and knowledge of diagnosing and managing various eye conditions. Future studies should compare optometry students’ experiences in lower-level health units to those in national referral hospitals.

Bibliometric Analysis of Research Trends in Clinical Learning Environment for Nursing and Midwifery Education.

The clinical learning environment is central to nursing and midwifery education, providing critical contexts for student training and professional development. This study fills a gap by offering a comprehensive bibliometric analysis of trends in The clinical learning environment research within nursing and midwifery education. A descriptive bibliometric study was conducted on June 7, 2024, using the Scopus database to retrieve research articles related to The clinical learning environment from 1957 until June 2024. VOSviewer software was used to analyze scientific collaborations and map co-occurrence networks of key terms. The United States and Australia led in publications and citations. Key journals included Nurse Education Today, Nurse Education in Practice, Journal of Advanced Nursing, and Journal of Clinical Nursing. Prominent authors like Saarikoski M. Levett-Jones T. and Henderson A. significantly contributed. Co-occurrence analysis highlighted themes such as student experiences, clinical competence, psychological factors, and teaching methodologies. This study highlights key trends in The clinical learning environment research and the significant contributions of specific countries, journals, and authors. The collaboration networks provide insights into the interrelated nature of various factors influencing the clinical learning environment. Limitations of the study include the reliance on a single database, which may not capture all relevant articles, particularly those in less prominent journals or non-English languages. Additionally, citation metrics may be influenced by factors such as self-citations or field-specific citation practices. These insights highlight areas for future research, including the role of virtual learning environments and cultural competency in The clinical learning environment. The findings contribute to shaping future research and practice in nursing and midwifery education.

Pimping in the clinical learning environment: representation of women in surgery.

Pimping in the clinical learning environment: representation of women in surgery.

Factors affecting clinical experience of nursing students in Malaysia: A cross-sectional study

BACKGROUND: Nursing education covers pathophysiology, nursing procedures, and compassionate care. Nursing students can apply theory and develop skills in the real world by participating in a supportive learning environment. For nursing students to effectively apply what they have learned in the classroom, they need a supportive clinical learning environment. However, some difficulties and impediments may prevent them from learning and having excellent clinical placement experiences. This study aims to identify factors affecting nursing students’ clinical experience during clinical placement. MATERIALS AND METHODS: The respondents in this descriptive cross-sectional study were at Universiti Kuala Lumpur (RCMP) Diploma in Nursing students in Ipoh, Perak, who had more than two clinical placements at a public hospital. The time frame of the study was 6 months. Sociodemographic information and elements affecting clinical practice, such as perceptions of clinical experience, hospital settings, and clinical instructor aspects, were obtained by a self-administered questionnaire. A descriptive analysis and the Kruskal–Wallis test were used to obtain the study’s outcome. RESULTS: Although the clinical placement demonstrated possibilities for learning, research has shown that the absence of instructors, equipment, and nursing staff has a negative impact on students’ experiences. The study also discovered a substantial correlation between a student’s semester and their clinical experience and between the clinical environment and the contributions of clinical instructors with P &lt; 0.05. CONCLUSION: In conclusion, the study semester, clinical experience, clinical ambient characteristics, and instructors’ contributions are strongly correlated. It suggests boosting academic-clinical collaboration, interprofessional collaboration, and student clinical experiences.

Pearls of Wisdom from Teaching Rounds: Reconceptualizing “See One, Do One” as Social Learning

Abstract Background Experiential education is paramount to clinical instruction in medicine. During teaching rounds, faculty can assess medical knowledge and clinical reasoning while modeling evidence-based patient care and effective communication. This study aimed to describe observed traits common across faculty who contribute to favorable learning environments. Design Students completed an Internal Medicine (IM) Student Chief elective at a midwestern United States Academic Tertiary Care Center in which M4s aided Clerkship leadership in near-peer teaching and communicating with students. Chiefs participated in rounds for experiential learning in clinical teaching. For this qualitative, descriptive study, M4s were asked to provide at least three “pearls of wisdom,” on observations about teaching and learning in reflective essays during two consecutive academic years. Twenty-nine M4s participated in the elective and submitted 238 pearls. The research team undertook document review and qualitatively analyzed content of Chiefs’ reflective essays. Detailed codes were organized into primary and secondary themes by each author, and then re-evaluated until they reached consensus. Through thematic analysis, we identified faculty traits students found conducive to learning. Results Three primary themes emerged: Attributes, Autonomy, and Achieving Engagement. Conclusion Experiential educational encounters are transformative to developing new physicians. Chiefs highlighted positive aspects of teaching rounds described previously including providing clear expectations, promoting goal setting, engagement, and instilling confidence. They also valued humor, recognizing cognitive overload, displaying humility, listening skills, and mentorship. While one attending cannot replicate all described effective techniques simultaneously, faculty development that promotes refining these approaches may improve the clinical learning environment for all learners.

Advancing Value-Based Academic-Clinical Partnership Evaluation in Physical Therapy Education: Multiattribute Utility Analysis as a Contextual Methodological Approach.

There is a need to investigate the application of systematic, scholarly methods to develop and implement a sustainable, flexible process for evaluating academic-clinical partnership effectiveness. The purpose of this study was to explore the potential for multiattribute utility analysis (MAUA) methodology to be applied in the context of academic-clinical partnership evaluation. Persistent systemic challenges related to academic-clinical partnership volume and quality require intentional strategies addressing the inherent complexities of the clinical learning environment and contextual differences between academic institutions. Multiattribute utility analysis appears to be a viable existing methodological framework based on its successful application in a wide variety of fields. Directors and Co-Directors of Clinical Education in accredited Doctor of Physical Therapy programs. The MAUA methodological framework was used to identify and quantify weighted priorities in factors contributing to partnership effectiveness as perceived by academic-clinical education programs across the United States. Survey participants were invited to share their perspectives regarding priority characteristics and assessment approaches to advance value-based partnership evaluation in physical therapy education. The products resulting from this contemporary analysis, coupled with the previous applied MAUA simulation, offer a methodology and flexible framework that may be utilized by academic-clinical education faculty to perform a value-based partnership evaluation and make decisions within the context of their institution. Clinical educator survey results also provide a new depth of insight regarding trends in the collective degree of attribute prioritization and the complexity and intersectionality across partnership priorities. The proposed processes may allow academic programs to narrow the large number of possible partnership criteria to a manageable subset, offering a way forward for those interested in pursuing a quantitative method for practical decision making. The ability to assess partnership quality using an evidence-based framework such as MAUA may allow partners to maintain, enhance, or discontinue partnerships based on a shared understanding of attribute alignment, rather than reactively coming together in practice to address challenges needing resolution.