Dutch Residency Educational Climate Test Research Articles

Ready, Set, Goal: A Mixed Methods Study of a Goal-Setting Intervention on 2 Competency-Based Geriatric Medicine Rotations.

Background More research is required to understand the effects of implementing structured goal-setting on trainee engagement in competency-based clinical learning environments. Objective To explore how residents experienced a rotation-specific goal-setting intervention on geriatric medicine rotations at 2 hospitals. Methods All rotating residents were expected to complete the intervention, consisting of a SMART-based (Specific, Measurable, Achievable, Relevant, and Time-Bound) goal-setting form and feedback sessions with teaching faculty. From November 2019 to June 2021, we recruited a convenience sample of rotating residents. Study participants completed pre- and postrotation 35-item Dutch Residency Educational Climate Test (D-RECT) questionnaires to compare scores from their rotation before the geriatric rotation and a postrotation semistructured interview, which we transcribed and analyzed using principles of constant comparison and reflexive thematic analysis. Results We interviewed 12 of 58 (20.7%) residents participating in the goal-setting intervention, 11 of whom completed both D-RECT questionnaires. Participants' D-RECT scores favored the geriatric medicine rotation versus the immediately preceding clinical rotation (M=4.29±0.37; M=3.84±0.44, P=.002). Analyses of interview transcripts yielded 3 themes on how participants perceived the intervention influenced their learning experience: (1) structured forms and processes mediate, inform, and constrain goal selection; (2) interactions with faculty, patients, and system factors influenced goal enactment; and (3) unstructured assessments led to uncertainty around goal achievement. Challenges included time restrictions and unpredictable clinical opportunities. Conclusions Goal-setting appeared to help many residents direct their learning efforts and engage in collaborative processes with teaching faculty. We identified challenges limiting residents' engagement with the goal-setting intervention, which may inform the practical implementation of goal-setting in other competency-based curricula.

Educational climate of a pathology residency program at a tertiary care hospital.

Evaluating educational climate (EC) is imperative for ensuring postgraduate trainees' competencies and quality in residency training programs. This study assessed the EC experiences of pathology postgraduate residents (PGRs) during their postgraduate training in pathology residency programs-a cross-sectional study design assigned EC scores in the pathology residency program at a prestigious institution in Islamabad, which were measured using the Dutch Residency Educational Climate Test (D-RECT) questionnaire. Scores from the D-RECT were employed to conduct descriptive statistics and comparison of means across groups to evaluate EC scores by years of training and compared to assess where the differences were located. Among FCPS-II pathology residents, most of whom were females (94.4%), the mean age was 28.11±2.91 years. A mean positive score was observed among all pathology residents (M≥3.6) for all D-RECT subscales except for the feedback subscale: the average score for feedback was below the average mean score of 3.6 (M = 3.19). A significant difference p = 0.016 was observed in EC scores across different groups through the Analysis of Variances (ANOVA) test. The most significant difference was between less than two and greater than two groups p = 0.027, followed by the difference between equal to two groups and greater than two groups p = 0.052. Overall, positive scores for EC in the pathology residency program were observed. Thus, targeted interventions are needed to increase feedback scores and address observed differences in EC scores by years of training.

The postgraduate medical educational climate assessed by the Danish Residency Educational Climate Test (DK-RECT): a validation and cross-sectional observational study

BackgroundA good educational climate is essential for delivering high-quality training for medical trainees, professional development, and patient care. The aim of this study was to (1) validate the Dutch Residency Educational Climate Test (D-RECT) in a Danish setting and (2) describe and evaluate the educational climate among medical trainees.MethodsD-RECT was adopted in a three-step process: translation of D-RECT into Danish (DK-RECT), psychometric validation, and evaluation of educational climate. Trainees from 31 medical specialties at Copenhagen University Hospital – Rigshospitalet, Denmark were asked to complete an online survey in a cross-sectional study.ResultsWe performed a forward-backward translation from Dutch to Danish. Confirmatory factor analysis showed that DK-RECT was robust and valid. The reliability analysis showed that only seven trainees from one specialty were needed for a reliable result. With 304 trainees completing DK-RECT, the response rate was 68%. The subsequent analysis indicated a positive overall educational climate, with a median score of 4.0 (interquartile range (IQR): 3.0–5.0) on a five-point Likert scale. Analysis of the subscales showed that the subscale Feedback received the lowest ratings, while Supervision and Peer collaboration were evaluated highest.ConclusionsPsychometric validation of D-RECT in a Danish context demonstrated valid results on the educational climate in specialist training. DK-RECT can be used to evaluate the effectiveness of interventions in the future and can facilitate the conversation on the educational climate.

Learning climate and self-perception of empathy in a teaching hospital’s medical residency programs: a cross-sectional study

In order to explore whether there is a correlation between the learning climate (LC) and the selfperception of empathy by medical residents, we conducted an observational, cross sectional study in a teaching hospital using the D-RECT (Dutch Residency Educational Climate Test) and the Jefferson scale (empathy) in 140 residents from 9 specialties during 2019 and 2020. We documented a low to moderate and statistically significant correlation (Spearman's Rho: 0.34, p<0.0001) between both scores, with an acceptable reliability for both instruments (> 0.7). For every 10-point difference in the D-RECT scale, an average difference of 1.80 points in the Jefferson Scale was observed. This study provides new evidence regarding the correlation between the learning climate and self-perceived medical empathy during the residency program. Our findings suggest a trend that should be further studied in the future.

Bedeutung der Lernumgebung und Reduzierung von Burnout in der stationären Weiterbildung – Analyse des Kompetenzzentrums Weiterbildung Allgemeinmedizin Bayern (KWAB)

BackgroundThe Competence Centre for Residency Training in Family Medicine Bavaria (CCRTB) was established to improve the quality of postgraduate medical training by offering additional seminars and mentoring programmes as well as regular ‘train-the-trainer’ courses for educating physicians. In addition, residents have the opportunity to participate in a regional training network. ObjectiveThe aim was to assess the burden of burnout and the importance of the learning environment in the clinical training phase. MethodsWe conducted a cross-sectional study. Burnout was assessed using the Maslach Burnout Inventory (MBI), which comprises the scales “Emotional Exhaustion”, “Depersonalisation” and “Personal Accomplishment”. The quality of the learning environment was recorded using the German version of the Dutch Residency Educational Climate Test (D-RECT German). In addition, multivariable linear regressions were performed to estimate the impact of learning environment, year of training and participation in a regional network on the level of burnout. Results129 clinical residents enrolled in the CCRTB were invited to participate in the study, 78 (61%) of whom submitted a response. 76 (59%) of these residents were included in the analyses. The present study discloses an increased burden of burnout among residents in the clinical training phase, with approx. 40% reaching a critical burnout score. A higher quality of the learning environment was associated with significantly milder burnout symptoms on the majority of the D-RECT scales. ConclusionFamily medicine residents in the clinical training phase show a high burden of burnout. Therefore, increasing the quality of the learning environment appears to be an effective key element in achieving a reduction of burnout in clinical training. This might contribute to an increase in professional satisfaction, which finally may also prevent migration from the medical profession.

Validation of the French translation of the Dutch residency educational climate test

BackgroundThe learning environment is one of the most influential factors in training of medical residents. The Dutch Residency Educational Climate Test (D-RECT) is one of the strongest instruments for measuring the learning environment. However, it has not been translated in French. The objective of this study is the psychometric validation of the DRECT French version.Material and methodsAfter translation of the D-RECT questionnaire into French, residents of five Moroccan hospitals were invited to complete the questionnaire between July and September 2018. Confirmatory factor analysis was used to evaluate the validity of the construct using the standardized root mean square residual (SRMR), the root mean square error approximation (RMSEA), the Comparative Fit Index (CFI) and the Tucker- Lewis Index (TLI). Reliability analysis was analysed using Internal consistency and Test-retest.ResultsDuring the study period, 211 residents completed the questionnaire. Confirmatory factor analysis showed an adequate model fit with the following indicators: SRMR = 0.058 / RMSEA = 0.07 / CFI = 0.88 / TLI = 0.87. The French translation had a good internal consistency (Cronbach alpha score > 0.7 for all subscales) and a good temporal stability (correlation score between two measurements = 0.89).ConclusionThis French version has an acceptable validity of the construct, a good internal consistency and good temporal reliability, and may be used to evaluate the learning climate. Additional research is necessary in other French-speaking contexts, in order to confirm these results.

Validity and Reliability of the Persian Translation of Dutch Residency Educational Climate Test and Analysis of Residents’ Learning Climate in Four Major Departments of Shiraz Medical School

Background: As one of the most important components of curriculums, the educational environment provides learners with a forum in which they can learn communication skills and other abilities such as critical thinking and clinical problem-solving. To improve this environment and consequently upgrade medical education, the current environment must be evaluated. Objectives: In a quest to adapt a valid and reliable instrument for this purpose, this study aimed to assess the reliability and validity of the Persian translation of Dutch Residency Educational Climate test (D-RECT) to measure the quality of the educational environment in the main clinical wards of Shiraz University of Medical Sciences. Methods: In a cross-sectional study, a forward Persian translation of the D-RECT questionnaire was translated and back-translated by two bilingual expert panels, and its reliability was determined in a pilot study. Then, 100 residents working at internal medicine, surgery, pediatrics, and gynecology wards were selected randomly to fill out the questionnaire. Data were analyzed using SPSS version 21 software. Results: The Persian translation of D-RECT had acceptable validity, reliability, internal consistency, and reproducibility. The reliability of the questionnaire was confirmed by Cronbach’s α of 0.95. Convergent validity was 0.61 to 0.90. Among the wards evaluated in this study, the educational environment was significantly better in the pediatric ward than in the other wards. Conclusions: The Persian translation of D-RECT validated in the studied departments seems to be an effective, valid, and reliable instrument for evaluating and comparing the quality of the current educational environment for residents in Iran. This evaluation can help improve training.

The Dutch residency educational climate test: construct and concurrent validation in Spanish language.

ObjectivesTo translate the 35-item version of the Dutch Residency Educational Climate Test (D-RECT), and assess its reliability, construct validity and concurrent validity in the Spanish language. MethodsFor this validation study, the D-RECT was translated using international recommendations. A total of 220 paper-based resident evaluations covering two Colombian universities were cross-sectionally collected in 2015. A Confirmatory Factor Analysis (CFA) was used to assess the internal validity of the instrument using the Comparative fit index (CFI), Tucker-Lewis index (TLI), Standardized root mean square residual (SRMSR), and Root mean square error of approximation (RMSA). Cronbach’s α was used to assess reliability. The concurrent validity was investigated through Pearson correlations with the Spanish version of the Postgraduate Hospital Educational Environment Measure (PHEEM). ResultsThe original 9-factor structure showed an appropriate fit for the Spanish version of the instrument (CFI = 0.84, TLI = 0.82, SRMSR = 0.06, and RMSA = 0.06). The reliability coefficients were satisfactory (>0.70). The mean total scores of the D-RECT and the PHEEM showed a significant correlation (r = 0.7, p<0.01). ConclusionsThis study confirms the validity and reliability of the Spanish version of the Dutch Residency Educational Climate Test, indicating that the instrument is suitable for the evaluation of departments’ learning climate in the Spanish context. Future research is needed to confirm these findings in other Spanish speaking countries.

Learning climate and quality of Italian training courses in gynecology and obstetrics

ObjectivesTo evaluate the learning climate (LC) and quality of training in postgraduate training courses in gynecology and obstetrics in Italy, as essential element to improve the training quality of future medical specialists. Study DesignWeb-based anonymous survey sent to all Italian trainees in gynecology and obstetrics to assess LC and quality of postgraduate training courses. This included sociodemographic information, details regarding training positions, and a 50-item validated Dutch Residency Educational Climate Test (D-RECT) questionnaire with 11 subscales (1–5 Likert scale). At the same time, the 24-items Fifth Year Training Questionnaire (FYT-Q) was submitted to all trainees at the fifth year of training to assess quality of life (burnout and depression), quality of training and final achieved competency level. Descriptive statistics were used to describe the main characteristics of the study population and for the D-RECT and the FYT-Q results. ResultsOne hundred seventy-eight trainees’ responses were included from 13 departments, yielding a department response rate of 33%. The mean composite score of the D-RECT was 3.185 (SD 0.305). The subscales “Formal education” and “Role of specialty tutor” scored a mean of 2.751 (SD 0.123) and 2.757 (SD 0.130), respectively. Sixty-four FYT-Q evaluations were completed. The 33% of trainees reported more than 56 weekly working hours. At least one burnout episode during the training was reported by 61% of the trainees, and the 45% of them reported one or more episode of depression. More than 50% of trainees reported adequate autonomy for gynecologic ultrasound, obstetrics first level ultrasound, hysteroscopy, and cesarean section. In FYT-Q adequacy of training, teaching, surgical teaching, and tutoring values resulted equal to or less than 3 in a 1–5 Likert scale. ConclusionsD-RECT and FYT-Q questionnaires show a training that requires improvement, although the results do not seem to be completely consistent. D-RECT emphasizes the need for a better formal teaching and specialty tutors to ensure training with better LC. Interventions are needed to improve LC and quality of training in postgraduate training courses in gynecology and obstetrics in Italy.

The Association Between Residency Learning Climate and Inpatient Care Experience in Clinical Teaching Departments in the Netherlands.

To examine the association between residency learning climate and inpatient care experience. The authors analyzed 1,201 evaluations of the residency learning climate (using the Dutch Residency Educational Climate Test questionnaire) and 6,689 evaluations of inpatient care experience (using the Consumer Quality Index Inpatient Hospital Care questionnaire) from 86 departments across 15 specialties in 18 hospitals in the Netherlands between 2013 and 2014. The authors used linear hierarchical panel analyses to study the associations between departments' overall and subscale learning climate scores and inpatient care experience global ratings and subscale scores, controlling for respondent- and department-level characteristics and correcting for multiple testing. Overall learning climate was not associated with global department ratings (b = 0.03; 95% confidence interval -0.17 to 0.23) but was positively associated with specific inpatient care experience domains, including communication with doctors (b = 0.11; 0.02 to 0.20) and feeling of safety (b = 0.09; 0.01 to 0.17). Coaching and assessment was positively associated with communication with doctors (b = 0.22; 0.08 to 0.37) and explanation of treatment (b = 0.22; 0.08 to 0.36). Formal education was negatively associated with pain management (b = -0.16; -0.26 to -0.05), while peer collaboration was positively associated with pain management (b = 0.14; 0.03 to 0.24). Optimizing the clinical learning environment is an important step toward ensuring high-quality residency training and patient care. These findings could help clinical teaching departments address those aspects of the learning environment that directly affect patient care.

Learning climate positively influences residents\u2019 work-related well-being

An optimal learning climate is crucial for the quality of residency training and may also improve residents’ well-being and empathy. We investigated the associations of learning climate with residents’ work-related well-being. A multicenter questionnaire study was performed among 271 surgery and gynaecology residents in 21 training programs from September 2012 to February 2013. Residents were asked to complete work-related well-being measurements: work engagement (Utrecht Work Engagement Scale), job and specialty satisfaction (measures from Physician Worklife Study), and physician empathy (Jefferson Scale of Physician Empathy). The Dutch Residency Educational Climate Test was used to evaluate learning climate. Multivariate adjusted linear regression analyses were used to estimate associations of learning climate with work-related well-being measures. Well-being measures were completed by 144 residents (53.1%). Learning climate was evaluated by 193 residents, yielding 9.2 evaluations per training program on average. Overall learning climate score was positively associated with work engagement [regression coefficient b = 0.58; 95% confidence interval (CI) 0.18–0.98; p = 0.004] and job satisfaction (b = 0.80; 95% CI 0.48–1.13; p < 0.001). No associations were found between learning climate and empathy and specialty satisfaction. Residents’ work engagement and job satisfaction are positively related to the learning climate and may be further enhanced by improved learning climates of training programs.

The Relationship Between the Learning and Patient Safety Climates of Clinical Departments and Residents' Patient Safety Behaviors.

Improving residents' patient safety behavior should be a priority in graduate medical education to ensure the safety of current and future patients. Supportive learning and patient safety climates may foster this behavior. This study examined the extent to which residents' self-reported patient safety behavior can be explained by the learning climate and patient safety climate of their clinical departments. The authors collected learning climate data from clinical departments in the Netherlands that used the web-based Dutch Residency Educational Climate Test between September 2015 and October 2016. They also gathered data on those departments' patient safety climate and on residents' self-reported patient safety behavior. They used generalized linear mixed models and multivariate general linear models to test for associations in the data. In total, 1,006 residents evaluated 143 departments in 31 teaching hospitals. Departments' patient safety climate was associated with residents' overall self-reported patient safety behavior (regression coefficient [b] = 0.33; 95% confidence interval [CI] = 0.14 to 0.52). Departments' learning climate was not associated with residents' patient safety behavior (b = 0.01; 95% CI = -0.17 to 0.19), although it was with their patient safety climate (b = 0.73; 95% CI = 0.69 to 0.77). Departments should focus on establishing a supportive patient safety climate to improve residents' patient safety behavior. Building a supportive learning climate might help to improve the patient safety climate and, in turn, residents' patient safety behavior.

Changes in Perceived Supervision Quality After Introduction of Competency-Based Orthopedic Residency Training: A National 6-Year Follow-Up Study

To evaluate the perceived quality of the learning environment, before and after introduction of competency-based postgraduate orthopedic education. From 2009 to 2014, we conducted annual surveys among Dutch orthopedic residents. The validated Dutch Residency Educational Climate Test (D-RECT, 50 items on 11 subscales) was used to assess the quality of the learning environment. Scores range from 1 (poor) to 5 (excellent). Dynamic cohort follow-up study. All Dutch orthopedic residents were surveyed during annual compulsory courses. Over the 6-year period, 641 responses were obtained (response rate 92%). Scores for "supervision" (95% CI for difference 0.06-0.28, p = 0.002) and "coaching and assessment" (95% CI 0.11-0.35, p < 0.001) improved significantly after introduction of competency-based training. There was no significant change in score on the other subscales of the D-RECT. After the introduction of some of the core components of competency-based postgraduate orthopedic education the perceived quality of "supervision" and "coaching and assessment" improved significantly.

Resident burnout: evaluating the role of the learning environment

BackgroundAlthough burnout is viewed as a syndrome rooted in the working environment and organizational culture, the role of the learning environment in the development of resident burnout remains unclear. We aimed to evaluate the association between burnout and the learning environment in a cohort of Belgian residents.MethodsWe conducted a cross-sectional online survey among residents in a large university hospital in Belgium. We used the Dutch version of the Maslach Burnout Inventory (UBOS-C) to assess burnout and the Dutch Residency Educational Climate Test (D-RECT) to assess the learning environment.ResultsA total of 236 residents (29 specialties) completed the survey (response rate 34.6%), of which 98 (41.5%) met standard criteria for burnout. After multivariate regression analysis adjusting for hours worked per week, quality of life and satisfaction with work-life balance, we found an inverse association between D-RECT scores and the risk of burnout (adjusted odds ratio; 0.47 for each point increase in D-RECT score; 95% CI, 0.23 – 0.95; p = 0.01).ConclusionsResident burnout is highly prevalent in our cohort of Belgian residents. Our results suggest that the learning environment plays an important role in reducing the risk of burnout among residents.

Cross-validation of a learning climate instrument in a non-western postgraduate clinical environment

BackgroundIn postgraduate training, there is a need to continuously assess the learning and working conditions to optimize learning. Students or trainees respond to the learning climate as they perceive it. The Dutch Residency Educational Climate Test (D-RECT) is a learning climate measurement tool with well-substantiated validity. However, it was originally designed for Dutch postgraduate trainees and it remains to be shown whether extrapolation to non-Western settings is viable.The dual objective of this study was to revalidate D-RECT outside of a Western setting and to evaluate the factor structure of a recently revised version of the D-RECT containing 35 items.MethodsWe invited Filipino internal medicine residents from 96 hospitals to complete the revised 35-item D-RECT. Subsequently, we performed a confirmatory factor analysis to check the fit of the 9 scale model of the revised 35-item D-RECT. Inter-rater reliability was assessed using generalizability theory.ResultsConfirmatory factor analysis unveiled that the factor structure of the revised 35-item D-RECT provided a reasonable fit to the Filipino data, after removal of 7 items. Five to seven evaluations of individual residents were needed per scale to obtain a reliable result.ConclusionEven in a non-Western setting, the D-RECT exhibited psychometric validity. This study validated the factor structure of the revised 35-item D-RECT after some modifications. We recommend that its application be extended to other Asian countries and specialties.

Towards healthy learning climates in postgraduate medical education: exploring the role of hospital-wide education committees

BackgroundPostgraduate medical education prepares residents for delivery of high quality patient care during training as well as for later practice, which makes high quality residency training programs crucial to safeguard patient care. Healthy learning climates contribute to high quality postgraduate medical education. In several countries, modernization of postgraduate medical education has resulted in hospital-wide responsibilities for monitoring learning climates. This study investigates the association between the actions undertaken by hospital-wide education committees and learning climates in postgraduate medical education.MethodsResearch conducted in December 2010 invited 57 chairs of hospital-wide education committees to complete a questionnaire on their implemented level of quality improvement policies. We merged the survey data from 21 committees that oversaw training programs and used the Dutch Residency Educational Climate Test (D-RECT) instrument in 2012 to measure their training programs’ learning climate. We used descriptive statistics and linear mixed models to analyse associations between the functioning of hospital-wide education committees and corresponding learning climates.ResultsIn total, 812 resident evaluations for 99 training programs in 21 teaching hospitals were available for analysis. The implementation level of the internal quality management systems as adopted by the hospital-wide education committees varied from 1.6 to 2.6 on a 5 point Likert-scale (ranging from 1 (worst) to 5 (best)). No significant associations were found between the functioning of the committees and corresponding learning climates.ConclusionsThe contribution of hospital-wide committees to creating healthy learning climates is yet to be demonstrated. The absence of such an association could be due to the lack of a Plan-Do-Check-Act cycle guiding the policy as implemented by the committees and the lack of involvement of departmental leadership. Insight into the impact of these strategies on learning climates will benefit the quality of postgraduate medical education and, hopefully, patient care.

From good to excellent: Improving clinical departments’ learning climate in residency training

Introduction: The improvement of clinical departments’ learning climate is central to achieving high-quality residency training and patient care. However, improving the learning climate can be challenging given its complexity as a multi-dimensional construct. Distinct representations of the dimensions might create different learning climate groups across departments and may require varying efforts to achieve improvement. Therefore, this study investigated: (1) whether distinct learning climate groups could be identified and (2) whether contextual factors could explain variation in departments’ learning climate performance.Methods: This study included departments that used the Dutch Residency Educational Climate Test (D-RECT) through a web-based system in 2014–2015. Latent profile analysis was used to identify learning climate groups and multilevel modeling to predict clinical departments’ learning climate performance.Results: The study included 1730 resident evaluations. Departments were classified into one of the four learning climate groups: substandard, adequate, good and excellent performers. The teaching status of the hospital, departments’ average teaching performance and percentage of time spent on educational activities by faculty-predicted departments’ learning climate performance.Discussion: Clinical departments can be successfully classified into informative learning climate groups. Ideally, given informative climate grouping with potential for cross learning, the departments could embark on targeted performance improvement.

Learning environment of the Saudi psychiatry board training program.

Objectives:To assess the learning environment of the Saudi psychiatry board program using the Dutch Residency Educational Climate Test (D-RECT) and to explore residents’ perception of different domains of the learning environment.Methods:This was a descriptive cross-sectional study. The D-RECT instrument was distributed to all residents at all training sites of the Saudi psychiatry training program. It is a reliable and valid instrument to measure educational environment at the postgraduate level. Mean scores are presented, t-tests, analysis of variance, and post hoc analysis were used to compare subgroups and pearson’s correlation was used to assess relationships.Results:Seventy-eight out of 96 residents responded (81.25%), one third of them were female. Overall D-RECT score was 2.76±0.55. The supervision subscale scored 2.83±0.83, coaching and assessment scored 2.60±0.73, feedback scored 2.00±0.85, team work scored 2.81±0.86, peer collaboration scored 3.54±0.84, professional relations between consultants scored 2.71±0.95, work is adapted to residents’ competence scored 2.71±0.86, consultants’ attitudes scored 2.71±0.86, formal education scored 2.68±0.72, and patient handover subscales scored 3.25±1.06. Female residents scored significantly higher than their male counterparts and there were no statistical significant difference between years of residency. Cronbach’s alpha was 0.936.Conclusion:Most of the learning climate domains scored poorly, which necessitates a rigorous plan for reevaluation and improvement. Furthermore, D-RECT proved to be a reliable instrument and could help in evaluation and improvement of postgraduate training programs.

Focus on Quality: Investigating Residents' Learning Climate Perceptions.

BackgroundA department’s learning climate is known to contribute to the quality of postgraduate medical education and, as such, to the quality of patient care provided by residents. However, it is unclear how the learning climate is perceived over time.ObjectivesThis study investigated whether the learning climate perceptions of residents changed over time.MethodsThe context for this study was residency training in the Netherlands. Between January 2012 and December 2014, residents from 223 training programs in 39 hospitals filled out the web-based Dutch Residency Educational Climate Test (D-RECT) to evaluate their clinical department’s learning climate. Residents had to fill out 35 validated questions using a five point Likert-scale. We analyzed data using generalized linear mixed (growth) models.ResultsOverall, 3982 D-RECT evaluations were available to investigate our aim. The overall mean D-RECT score was 3.9 (SD = 0.3). The growth model showed an increase in D-RECT scores over time (b = 0.03; 95% CI: 0.01–0.06; p < 0.05).ConclusionsThe observed increase in D-RECT scores implied that residents perceived an improvement in the learning climate over time. Future research could focus on factors that facilitate or hinder learning climate improvement, and investigate the roles that hospital governing committees play in safeguarding and improving the learning climate.

Revisiting the D-RECT tool: Validation of an instrument measuring residents’ learning climate perceptions

Introduction: Credible evaluation of the learning climate requires valid and reliable instruments in order to inform quality improvement activities. Since its initial validation the Dutch Residency Educational Climate Test (D-RECT) has been increasingly used to evaluate the learning climate, yet it has not been tested in its final form and on the actual level of use – the department.Aim: Our aim was to re-investigate the internal validity and reliability of the D-RECT at the resident and department levels.Methods: D-RECT evaluations collected during 2012–2013 were included. Internal validity was assessed using exploratory and confirmatory factor analyses. Reliability was assessed using generalizability theory.Results: In total, 2306 evaluations and 291 departments were included. Exploratory factor analysis showed a 9-factor structure containing 35 items: teamwork, role of specialty tutor, coaching and assessment, formal education, resident peer collaboration, work is adapted to residents’ competence, patient sign-out, educational atmosphere, and accessibility of supervisors. Confirmatory factor analysis indicated acceptable to good fit. Three resident evaluations were needed to assess the overall learning climate reliably and eight residents to assess the subscales.Conclusion: This study reaffirms the reliability and internal validity of the D-RECT in measuring residency training learning climate. Ongoing evaluation of the instrument remains important.