We aim to assist educators and institutions with these important monitoring and evaluation functions by reviewing various clinical learning environment instruments and identifying what aspects of the learning environment they do and do not cover.Ĭlinical environments serve as the primary setting for learning in medicine, especially in clerkships and graduate medical education. 1–4 Accreditation agencies have placed more emphasis on clinical learning environments in recent years, which further encourages educators and institutions to find ways to monitor these environments. The interactions between environments and learners enable learners to thrive, learn, and provide excellent patient care and also contribute to burnout, depression, diminished learning, and poorer quality patient care. How will they define the learning environment and which theoretical lens is most applicable (e.g., personal vitality, sociocultural learning theory)? What aspects or domains of the learning environment do they most wish to capture (e.g., personal support, social interactions, organizational culture, access to resources)? How comprehensive do they want the instrument to be (and correspondingly how much time do they expect people to devote to completing the instrument and how frequently)? Whose perspective do they wish to evaluate (e.g., student, resident, fellow, attending, team, patient)? Each of these considerations is addressed.Ĭlinical learning environments play a key role in students’ and residents’ educational experiences. The variations in these instruments suggest that educators might consider several guiding questions. Most instruments focused heavily on the organizational and social domains and less on the personal and material domains (half omitted the material domain entirely). The 6 instruments varied in number of items, underlying constructs, subscales, definitions of clinical learning environment, and domain coverage. They collected key information about each instrument (e.g., number of items and subscales, conceptual frameworks, operational definitions of the learning environment) and coded items from each instrument according to the 4 domains. Building on 3 prior literature reviews as well as a literature search, the authors identified 6 clinically oriented learning environment instruments designed for medical education. To assist educators with these decisions, the authors compared clinical learning environment instruments based on their characteristics, underlying constructs, and degree to which items reflect 4 domains (personal, social, organizational, material) from a recently developed model for conceptualizing learning environments in the health professions. However, educators find it challenging to decide whether to measure clinical learning environments with existing instruments or to design their own new instrument and, if using an existing instrument, which to choose. Learning environments shape the experiences of learners and practitioners, making them an important component of program evaluation.

Irby, Center for Faculty Educators, University of California, San Francisco, 533 Parnassus Ave., Room U-80, San Francisco, CA 94143-0410 email. O’Brien was a participant in the conference.Įthical approval: Reported as not applicable.Ĭorrespondence should be addressed to David M. Palmgren’s work helped inform the conference and the model.

Foundation Conference on Improving the Learning Environment in the Health Professions held in April 15–18, 2018, in Atlanta, Georgia. Irby coauthored the Gruppen articles and the model of the learning environment and chaired the Josiah Macy Jr. Palmgren is university lecturer and educational scientist, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden ORCID. Stenfors is associate professor, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden ORCID. O’Brien is professor of medicine and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California ORCID.

Irby is professor emeritus of medicine and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California, and affiliate faculty member, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden ORCID.

Clinical learning center monitor