Clinical Learning Research Articles

Effect of an online training intervention on evidence-based practice in clinical nurses. #Evidencer Project.

Online learning is becoming increasingly essential for health professionals, and it is necessary to understand how this modality affects clinical nurses' learning of Evidence-Based Practice (EBP). For this reason, the present study sought to assess the effectiveness of an online training program in improving nurses' EBP competence. A quasi-experimental study with a pretest-posttest design was conducted with a control group and without randomization for a period of 6months. The intervention was an online self-learning course based on Melnyk's seven steps of Evidence-Based Practice (EBP). The course was structured into sequential modules requiring 72h of work, with task completions and tests necessary for progression. Participants had three months to complete the course. EBP competence was measured with the EBP-COQ Prof© questionnaire. Data analysis included percentages, means, standard deviations, chi-square tests, student's t-tests, and a two-way repeated measuresanalysis of covariance (ANCOVA). The analysis of the changes observed in each dimension and the overall EBP competence between the intervention group (IG) and the control group (CG) showed a significant group*time interaction in three of the four dimensions of the questionnaire. The results indicated that the online Evidence-Based Practice (EBP) course significantly improved knowledge, skills, and utilization three months after its completion. In the IG, the mean score was 44.04 (standard deviation (SD) = 7), compared to 37.83 (SD = 8.5) in the CG (p < 0.001). Regarding skills, the IG had a mean score of 24.24 (SD = 3.8), while the CG scored 23.01 (SD = 3.1) (p = 0.008). For utilization, the mean score in the IG was 36.77 (SD = 6.8), and the CG was 33.12 (SD = 6.3) (p = 0.005). Overall competence also showed a statistically significant difference, with the IG achieving a mean score of 141.22 (SD = 20.0) compared to the CG with a mean score of 130.34 (SD = 16.7) (p < 0.001). Training through an online education platform for three months (72h) is an effective tool for improving the competence in Evidence-Based Practice (EBP) of clinical nurses. A significant increase was observed in knowledge and moderate improvements in skills and the application of EBP. These online courses, adapted to the needs of professionals, can be an efficient way to prepare nurses and improve their application of EBP in a clinical setting.

Why we should talk about institutional (dis)trustworthiness and medical machine learning.

The principle of trust has been placed at the centre as an attitude for engaging with clinical machine learning systems. However, the notions of trust and distrust remain fiercely debated in the philosophical and ethical literature. In this article, we proceed on a structural level ex negativo as we aim to analyse the concept of "institutional distrustworthiness" to achieve a proper diagnosis of how we should not engage with medical machine learning. First, we begin with several examples that hint at the emergence of a climate of distrust in the context of medical machine learning. Second, we introduce the concept of institutional trustworthiness based on an expansion of Hawley's commitment account. Third, we argue that institutional opacity can undermine the trustworthiness of medical institutions and can lead to new forms of testimonial injustices. Finally, we focus on possible building blocks for repairing institutional distrustworthiness.

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.

Differences in community health nursing learning outcomes based on simulation modality

BackgroundVarious modalities of community health nursing simulation have been useful in improving confidence, communication, and meeting learning objectives. Research focusing on comparing community health nursing learning outcomes in simulation with standardized patients versus mannequins is limited. This study aimed to explore differences in clinical reasoning, clinical learning, knowledge, communication, self-confidence, and learner satisfaction among community health students participating in standardized patient simulation compared to mannequins. MethodsA cross-sectional study was conducted with a convenience sample of 66 prelicensure students in community health nursing. Students completed a pre- and post-knowledge quiz, Satisfaction with Simulation Experience scale, and a simulation evaluation survey. ResultsCompared to simulation with mannequins, clinical reasoning, clinical learning, knowledge, communication, realism, and learner satisfaction scores were significantly higher with standardized patient simulation. ConclusionsSimulation with standardized patients can be useful for increasing community health nursing knowledge while enhancing clinical reasoning and realism. Future research including larger samples and more comprehensive community health topics is needed.

The Clinical Judgment Debriefing Structure: Integrating the Clinical Judgement Measurement Model into debriefing

The transformation of nursing education in the United States, driven by the Next Generation NCLEX (NGN), demands a focus on clinical judgment. However, a gap exists in the literature regarding debriefing structures that center on clinical judgment and integrate the Clinical Judgment Measurement Model (CJMM). This paper introduces the Clinical Judgment Debriefing Structure (CJDS) that was designed to incorporate the CJMM into debriefing to support the development of clinical judgment and enhance NGN preparedness. The CJDS provides clinical judgment practice using reflective questions and tasks by emphasizing each element in Layer 3 of the CJMM. Implementation involves faculty inputting simulation content into the CJDS by preparing answers to the standardized reflection questions and tasks. The CJDS streamlines faculty preparation and ensures standardization of each debriefing session. Presented at the 2023 International Nursing Association for Clinical Simulation and Learning (INACSL) conference, the CJDS received positive feedback, indicating its practicality and applicability in simulation practices. Findings from initial testing of the CJDS using a qualitative/quantitative design, demonstrated increased knowledge and confidence in clinical judgment. While measuring clinical judgment remains challenging, the CJDS stands as a unique tool for centering debriefing on clinical judgment and guiding students through Layer 3 of the CJMM, ultimately contributing to safer nursing practice.

Nurturing clinical teachers' professional learning: A phased approach.

Nurturing clinical teachers' professional learning: A phased approach.

Sociodemographic bias in clinical machine learning models: A scoping review of algorithmic bias instances and mechanisms

BackgroundClinical machine learning (ML) technologies can sometimes be biased and their use could exacerbate health disparities. The extent to which bias is present, the groups who most frequently experience bias, and the mechanism through which bias is introduced in clinical ML applications is not well described. The objective of this study was to examine instances of bias in clinical ML models. We identified the sociodemographic subgroups (using the PROGRESS-Plus framework) that experienced bias and the reported mechanisms of bias introduction MethodsWe searched MEDLINE, EMBASE, PsycINFO and Web of Science for all studies that evaluated bias on sociodemographic factors within ML algorithms created for the purpose of facilitating clinical care. The scoping review was conducted according to the JBI guide and reported using the PRISMA extension for scoping reviews. ResultsWe identified 6448 articles, of which 760 reported on a clinical ML model and 91 (12.0%) completed a bias evaluation and met all inclusion criteria. Most studies evaluated a single sociodemographic factor (n=56, 61.5%). The most frequently evaluated sociodemographic factor was race (n=59, 64.8%), followed by sex/gender (n=41, 45.1%), and age (n=24, 26.4%), with one study (1.1%) evaluating intersectional factors. Of all studies, 74.7% (n=68) reported that bias was present, 18.7% (n=17) reported bias was not present, and 6.6% (n=6) did not state whether bias was present. When present, 87% of studies reported bias against groups with socioeconomic disadvantage. ConclusionMost ML algorithms that were evaluated for bias demonstrated bias on sociodemographic factors. Furthermore, most bias evaluations concentrated on race, sex/gender, and age, while other sociodemographic factors and their intersection were infrequently assessed. Given potential health equity implications, bias assessments should be completed for all clinical ML models.

Implementing a Trauma-Informed Approach in Undergraduate Nursing Student Clinical Education: Strategies for Clinical Nurse Educators

AimTo discuss strategies for clinical nurse educators to integrate a trauma-informed approach while supporting undergraduate nursing students’ learning in the clinical environment. BackgroundUndergraduate nursing students’ risk of exposure to clinical related critical incidents coupled with their higher rates of personal traumas such as adverse childhood experiences, adds to the complexity of experiential learning. Clinical related critical incidents may compromise nursing students’ academic abilities and their well-being. The implications of clinical related critical incidents may extend to future nurse retention and recruitment as students question the perception of the profession’s identity. The cumulative effect from trauma may impact nursing students’ mental health making them vulnerable to trauma-related symptoms and disorders. DesignA discussion paper is used to support the application of a trauma-informed approach throughout clinical learning experiences. MethodWith relevant literature, a trauma-informed approach is emphasized for developing and maintaining safe environments that foster learning and optimize the health and well-being of nursing students. ResultsThe key assumptions and principles of a trauma-informed approach as outlined by the Substance Abuse and Mental Health Services Administration underpinned the proposed strategies that clinical nurse educators may use while preparing for clinical, during and after experiences. ConclusionA trauma-informed approach may encourage undergraduate nursing students to adopt key tenets into their future clinical practices so they can effectively support patients, families and their colleagues.

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.

Development of a Virtual Pediatric Holistic Comfort Care Clinic.

Guided by the tenets of Kolcaba's holistic comfort theory, we developed, implemented, and evaluated a simulated online pediatric advanced practice health center. The Pediatric Comfy Care Clinic (PCCC) was created to enhance person-centered diagnostic reasoning and holistic advanced management skills for family nurse practitioner students. Our interprofessional team used a standardized approach to online design and development while integrating essential holistic comfort theory concepts for student engagement and assessment of learning. We explored outcomes of pre- and postclinic quizzes and student reflection data using mixed methods. Significant differences (P<.001) were noted in all postpractice quizzes in each affiliated PCCC module with variable student outcomes on graded clinic encounters. Important student perspectives on teaching and learning in the virtual clinic were noted. A comfort theory-driven, simulated, and digitally enhanced virtual clinic is feasible and valuable with important implications for holistic advanced practice.

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.

Nurses’ perceptions regarding the establishment of clinical education and training units in public hospitals in the North-West Province: a qualitative study

BackgroundA Clinical Education and Training Unit is defined as a unit in which the clinical orientation, teaching, learning, and assessment, mentoring and support of student nurses are coordinated to achieve the outcomes of their learning programmes in the health establishment. In South Africa, Clinical Education and Training Unit was developed to reconstruct and revitalise nursing education and training. The clinical education is crucial to enable nursing students to put what they learn in the classroom into practice as they direct patient care, practise therapeutic communication, hone technical skills, demonstrate caring behaviours, investigate ethical dilemmas, and take on the roles of nurses. The clinical teaching unit is one of the models that show potential in advancing clinical education. Since the proposed clinical education and teaching model concluded that Clinical Education and Training Units should be established in 2012, to the researcher’s knowledge, no research study has been conducted to explore and describe the nurses’ perceptions regarding the establishment of Clinical Education and Training Units, particularly in the North-West Province. This has resulted in the scarcity of literature on their perceptions. Thus, the researcher believed that it was essential to explore and describe the perceptions of professional nurses regarding the establishment of Clinical Education and Training Units in the North-West Province of South Africa, so that their perceptions may be known and understood.AimThe study aimed to explore and describe the perceptions of professional nurses regarding the establishment of Clinical Education and Training Units in public hospitals in the North-West Province.MethodsA qualitative-exploratory-descriptive and contextual research design was used. This method was used because it is known to unearth a wide range of views, opinions, thoughts, and feelings of the participants thus enabling a deeper understanding concerning perceptions of professional nurses regarding the establishment of Clinical Education and Training Units at the hospitals of interest. Participants were recruited using pamphlets and flyers. A non-probability convenience and purposive sampling techniques were used to select participants based on an inclusion criterion. From 09 September 2023 to 07 December 2023, the researcher used face-to-face group discussions to collect data and it was analysed using six steps of inductive thematic data analysis as outlined by Braun and Clarke.ResultsFour focus groups discussions were conducted with a total of 19 participants who were professional nurses. Responses were categorised into three domains: advantages of the Clinical Education and Training Unit, challenges of the Clinical Education and Training Unit, and recommendations for the Clinical Education and Training Unit. Subsequently, a total of three main themes with eight sub-themes were determined for advantages of the Clinical Education and Training Unit, two themes with six subthemes for challenges of the Clinical Education and Training Unit, and one theme with two sub-themes for recommendations for the Clinical Education and Training Unit respectively.ConclusionThe need to establish functional Clinical Education and Training Units is therefore very important not only to student nurses but also to health care professionals. Most of the participants emphasised that if Clinical Education and Training Units were fully established they would be beneficial in developing health care professionals, especially in terms of in-service training where nursing standards are emphasised as outlined by the South African Nursing Council. The research study results might contribute to the full establishment of CETUs in the hospitals of the North- West Province, South Africa.Trial registrationnot applicable to the study.

RADIOGRAPHY CLINICAL EDUCATION AMIDST THE COVID-19 PANDEMIC: PERSPECTIVE OF RADIOGRAPHY STUDENTS INTERNATIONALLY

Purpose: The COVID-19 pandemic has signifi cantly impacted clinical practice. This study explored the impact of the pandemic on diagnostic radiography clinical education from the perspective of radiography students internationally. Materials and methods: A qualitative approach was used to gain insight into students' experience of clinical placement during the pandemic. A total of sixteen radiography students from six countries were recruited from an international Radiography summer research school. Qualitative data was gathered via three semi-structured focus groups (5-6 students per focus group). Data was analysed using Braun and Clark’s phases of thematic analysis. Results: Five key themes emerged in relation to clinical education during the COVID-19 pandemic, (i) unequal student access to personal protective equipment (PPE) (ii) challenges in achieving clinical learning outcomes (iii) impact of online education on clinical readiness (iv) emotional impact, and (v) coping strategies. Students indicated that they were particularly afraid of transmitting COVID-19 to their family and friends. Some students reported that they felt under pressure to receive COVID-19 vaccinations prior to clinical practice. Others reported confusion with respect to infection control guidelines and application of PPE. Conclusion: Student radiographers identifi ed key challenges which require consideration by educators to ensure students are appropriately prepared for and supported on clinical placement during a pandemic. Implications for practice: • The COVID-19 pandemic has impacted clinical education internationally and this study identifi es the implications for radiography students in terms of clinical readiness and their clinical placement experience. • Simulation-based in-person learning in the X-ray lab and PPE training were perceived by students to be important factors impacting clinical readiness.

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.

Is it worth it? A comparison study of medical students’ aspirations for gaining the Health Care Certificate following employment as Healthcare Assistants

Background Medical students seek early patient contact but their curriculum starts with scientific knowledge. We integrated the Healthcare Assistant (HCA) course into semester one for early patient-facing clinical contact. This study compares students’ aspirations for this learning with the realities of employed work as HCAs. Methods This sequential mixed-methods study used pre-post-scored questionnaire data, followed by post-course focus groups, and interviews a year later. The quantitative data were analysed using SPSS and the qualitative data using thematic analysis. Results The learning was highly valued with early perceptions challenged. The learning both accelerated and advanced their medical skills. Their naivety of nurses’ work within team-based practice quickly eroded; they symbiotically linked their clinical and non-clinical learning; they acclimatised to the hospital environment while future gazing in preparation for clinical learning. Early anxieties for starting employment were overcome, building resilience. Conclusions HCA training offers a practical patient-facing set of competencies on which to build medical capability. Student text-book scientific knowledge was validated through their experiences with recognition of the importance of empathetic patient-centred care. They quickly learnt and absorbed ward function; experienced good and poor teamworking; highly valued the nursing role; and experienced the every-day stresses of being a front-line practitioner.

A change of mind: Error motivation is shaped by error perceptions in different learning environments

Background The medical profession has traditionally had a culture of “blame and shame,” despite the importance errors have for learning, motivation, and improvement of clinical skills. This study aimed to explore how medical students and newly graduated doctors perceive errors across different learning contexts and levels of expertise, and how error perceptions influence motivation and engagement in learning activities. Methods Semi-structured interviews were conducted, and thematic analysis was used to identify themes. Survey questions were developed based on the themes. The final survey included 27 questions divided into three sections. The survey was distributed via RedCap to medical students in year 1, year 4, and year 6 together with newly graduated doctors in Denmark. Results Of the 541 respondents, a majority anticipated making errors in both non-clinical (77.4%) and clinical (61.5%) learning situations, finding them motivating for participation (91.9% and 96.2%, respectively). A psychologically safe learning environment was seen to enhance the perception of errors as learning opportunities (96.9%) and increase risk willingness (96.3% non-clinical, 97.7% clinical). Respondents focused on the specific errors they made (86.0%), and their supervisors were perceived to focus more on correct handling of errors (70.7%). Respondents expected to conduct fewer errors in non-clinical learning situations in PGY-1 compared to medical students in year 1 (F(3529) = 3.0, adjusted p = 0.03). They showed an increase in risk willingness in clinical learning situations from year 6 to PGY-1 (F(3520) = 2.7, adjusted p-value 0.006) as long as the learning situations were considered psychologically safe. Conclusion The study suggests that a psychologically safe learning environment mitigates the “shame and blame culture” associated with errors. Respondents generally embraced errors as valuable learning experiences but noted a lack of specific error-related feedback. These findings underscore the nuanced relationship between errors, explicit learning activities, and supervisor support in medical education.

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.