Psychology and learning: The role of the clinical learning environment

Clinical learning environments: Updates

Academic exploration of the Clinical Learning Environment (CLE) has evolved over time. In 2009, Asch et al. drew a direct connection between the CLE, training outcomes, and patient care, highlighting the importance of the CLE and inspiring further research in this domain. With a growing body of evidence articulating its significance, several organizations were prompted to publish conceptualizations of the CLE as a discrete concept, such that its components may be measured and thus improved upon. Since then, it has become increasingly clear that the CLE is not an isolated entity; it is continuously molded by external pressures including the intensifying polarizations within our global society and the political ramifications of these divides. And yet, the nuances of how these external forces influence our CLE, including how we should, or should not, adapt to accommodate them, has not yet been explicitly captured. In this commentary we will summarize the academic history of CLE, review how the shifting global landscape has influenced the CLE, and propose a way forward. As a professional community, we must understand the impact of these external factors such that we may proactively adapt and ensure quality training outcomes and positive outcomes for our patients.

How Do Trainees Use EPAs to Regulate Their Learning in the Clinical Environment? A Grounded Theory Study

Introduction

Entrustable Professional Activities (EPAs) can potentially support self-regulated learning in the clinical environment. However, critics of EPAs express doubts as they see potential harms, like checkbox behaviour. This study explores how GP-trainees use EPAs in the clinical environment through the lens of self-regulated learning theory and addresses the question of whether EPAs help or hinder trainees' learning in a clinical environment.

Methods

Using constructivist grounded theory methodology, a purposive and theoretical sample of GP-trainees across different years of training were interviewed. Two PICTOR interviews were added to refine and confirm constructed theory. Data collection and analysis followed principles of constant comparative analysis.

Results and Discussion

Trainees experience both hindering and helping influences of EPAs and self-regulate their learning by balancing these influences throughout GP-placements. Three consecutive stages were constructed each with different use of EPAs: adaptation, taking control, and checking the boxes. EPAs were most helpful in the 'taking control' stage. EPAs hindered self-regulated learning most during the final stage of training as trainees had other learning goals and experienced assessment of EPAs as bureaucratic and demotivating. Regularly discussing EPAs with supervisors helped to focus on specific learning goals, create opportunities for learning, and generate task-oriented feedback.

Conclusion

EPAs can both help and hinder self-regulated learning. How trainees balance both influences changes over time. Therefore, placements need to be at least long enough to enable trainees to gain and maintain control of learning. Supervisors and teachers should assist trainees in balancing the hindering and helping influences of EPAs.

A model for improving the learning environment in high-stress and emotion-bound clinical settings

INTRODUCTION

In clinical settings, it is necessary to create a clinical learning environment that provides the ground for the learners to acquire competencies especially in high-stress and emotion-bound clinical settings.

METHODS

In the present study, a model for improving the learning environment in high-stress and emotion-bound clinical settings was designed by conducting a multi-method study in the form of three sub-studies.

RESULTS

This model was designed with 3 pivotal concepts; organizing learning opportunities around safe care, fair participation in learning opportunities and creating a positive emotional climate and 6 peripheral concepts; designing physical space and appropriate equipment for education and care, preparing learners to attend the clinical setting, preparing learners to participate in learning opportunities, balancing the learner role and the care provided by the learners, the presence of a competent educator and providing education to all learners, and acquiring the ability to manage emotions by learners, faculty and staff.

CONCLUSIONS

The implementation of the model obtained from this study provides the basis for solving the challenges of clinical learning environments, especially in high-stress and emotion-bound clinical settings, and improves clinical education and the realization of educational and care outcomes.

Psychological safety and perceived organizational support in emergency medicine residencies

Background

The clinical learning environment (CLE) is a key focus of the Accreditation Council of Graduate Medical Education. It impacts knowledge acquisition and professional development. A previous single-center study evaluated the psychological safety and perceived organizational support of the CLE across different specialties. Building on this work, we explored and evaluated psychological safety and perceived organizational support across multiple heterogeneous emergency medicine (EM) residencies to identify trends and factors affecting perceptions of the CLE.

Methods

Using the Psychological Safety Scale (PSS) and Survey of Perceived Organizational Support (SPOS), residents from seven U.S. EM residencies were surveyed using REDCap software from September through November 2021, with 300 potential respondents. As an adjunct to these surveys, three open-ended questions were included regarding features of their learning environments.

Results

A total of 137 out of 300 residents completed the survey. The overall response rate was 45.7%. There was a variable response rate across programs (26.0%-96.7%). Pooled results demonstrate an overall positive perception of CLEs, based on positive mean responses (i.e., "Members of my department are able to bring up problems and tough issue" had a mean of 4.2 on a 5-point Likert scale). Open responses identified teaching, collegiality, and support from program leadership as supportive features of the CLE. Confrontational interdisciplinary communication, a sense of being devalued, and off-service rotations were identified as threats or areas for improvement to the CLE.

Conclusions

PSS and SPOS scores were generally positive in this multi-institution study, consistent with the prior single-institution study indicating that EM is often considered psychologically safe and supportive. EM training programs can consider using the PSS/SPOS to audit their own programs to identify areas for improvement and foster supportive features already in place.

The effects of clinical learning environment and career adaptability on resilience: A mediating analysis based on a survey of nursing interns

BACKGROUND

The resilience education of intern nursing students has significant implications for the development and improvement of the nursing workforce. The clinical internship period is a critical time for enhancing resilience.

AIMS

To evaluate the resilience level of Chinese nursing interns and explore the effects of factors affecting resilience early in their careers, focusing on the mediating roles of career adaptability between clinical learning environment and resilience.

METHODS

The cross-sectional study design was adopted. From March 2022 to May 2023, 512 nursing interns in tertiary care hospitals were surveyed online with the Connor-Davidson Resilience Scale, the Clinical Learning Environment Scale for Nurse and the Career Adapt-Abilities Scale. Structural equation modelling was used to clarify the relationships among these factors. Indirect effects were tested using bootstrapped confidence intervals.

RESULTS

The nursing interns showed a moderately high level of resilience [M (SD) = 70.15 (19.90)]. Gender, scholastic attainment, scholarship, career adaptability and clinical learning environment were influencing factors of nursing interns' resilience. Male interns with good academic performance showed higher levels of resilience. Career adaptability and clinical learning environment positively and directly affected their resilience level (β = 0.62, 0.18, respectively, p < .01). Career adaptability was also positively affected by the clinical learning environment (β = 0.36, p < .01), and mediated the effect of clinical learning environment on resilience (β = 0.22, p < .01).

CONCLUSION

Clinical learning environment can positively affect the resilience level of nursing interns. Career adaptability can affect resilience directly and also play a mediating role between clinical learning environment and resilience. Thus, promotion of career adaptability and clinical teaching environment should be the potential strategies for nursing interns to improve their resilience, especially for female nursing interns with low academic performance.

Development of a Competency Framework Defining Effective Surgical Educators

OBJECTIVE

The objective of this study is to develop a practical framework of competencies and behaviors which define an effective surgical educator.

DESIGN

A modified Delphi approach was used. A literature review and series of discussions with surgical education experts led to creation of a survey instrument which was sent to surgical faculty and trainees from a single academic institution. The results from this initial survey informed the creation of the subsequent survey instrument which was also sent to surgical faculty and trainees. Focus groups with surgical faculty and residents were conducted separately, transcribed, deidentified, and then evaluated for recurring themes. A competency framework was developed.

SETTING

The surveys were administered and focus groups were conducted at the University Hospitals Cleveland Medical Center, a tertiary care academic institution.

PARTICIPANTS

Residents, fellows, and faculty surgeons from the fields of general surgery, plastic surgery, vascular surgery, orthopedic surgery, otolaryngology, neurosurgery, and urology.

RESULTS

There were 115 responses (31.3%) from 367 faculty surgeons, residents, and fellows invited to complete the initial survey examining 50 competencies. Eighteen competencies received a mean Likert score of at least 4 by both faculty and residents and were included in the subsequent survey instrument which was completed by 72 participants (19.6%). Focus groups were held separately with 6 faculty surgeons and 6 residents. Analysis of the survey results and focus group discussions identified several themes which informed the development of a competency framework consisting of 5 overarching competencies as well as 16 specific behaviors.

CONCLUSIONS

A practical framework was developed consisting of 5 competencies and 16 behaviors which define an effective surgical educator. The 5 competencies are: 1) fosters psychological safety, 2) displays exemplary medical knowledge and patient care, 3) diagnoses the learner and adjusts teaching, 4) communicates thought process to trainee, and 5) displays learner-centeredness. Based on the competency framework, residency leadership may specifically tailor faculty development initiatives to improve surgical education programming.

Psychological safety in medical education: A scoping review and synthesis of the literature

PURPOSE

Psychological safety (PS) is the belief that the environment is safe for risk taking. Available data point to a lack of PS in medical education. Based on literature in other fields, PS in clinical learning environments (CLEs) could support trainee well-being, belonging, and learning. However, the literature on PS in medical education has not been broadly assessed.

MATERIALS AND METHODS

In 2020, authors searched PubMed, Web of Science, CINAHL, Scopus, ERIC, PsycInfo, and JSTOR for articles published prior to January 2020. Authors screened all search results for eligibility using specific criteria. Data were extracted and thematic analysis performed.

RESULTS

Fifty-two articles met criteria. The majority focused on graduate medical education (45%), and 42% of studies took place within a CLE. Articles addressed organizational and team level constructs (58%), with fewer descriptions of specific behaviors of team members that promote or hinder safety. The impacts of safe environments for trainees and patients are areas in need of more exploration.

DISCUSSION

Future research should focus on defining specific organizational and interpersonal leader behaviors that promote PS, seek to understand how PS is determined by individual trainees, and measure the impact of PS on learners, learning, and patient care outcomes.

Endured and prevailed: a phenomenological study of doctors' first year of clinical practice

CONTEXT

The challenging nature of the transition from medical student to doctor is highlighted by the associated negative consequences to new doctors' mental health and wellbeing. Enhanced understanding of the lived experience of recent medical graduates as they move through the stages of transition over the first year of practice can inform interventions to ease the difficulties encountered.

METHODS

Using interpretative phenomenological analysis (IPA), a novel approach to this topic, we explored the lived experience of transition from student to doctor over the first year of practice after graduation. Twelve new graduates were purposively recruited. We conducted semi-structured interviews at the end of their first year of practice with respect to their experience over the first year.

RESULTS

The experience of transition was characterised by overlapping temporal stages. Participants' initial adjustment period was characterised by shock, coping and stabilisation. A phase of development followed, with growth in confidence and a focus on self-care. Adversity was experienced in the form of interprofessional tensions, overwork, isolation and mistreatment. Finally, a period of reflection and rationalisation marked the end of the first year.

DISCUSSION

Following initial anxiety regarding competence and performance, participants' experience of transition was predominantly influenced by cultural, relational and contextual aspects of clinical practice. Solutions to ease this challenging time include stage-specific transitional interventions, curricular change at both undergraduate and postgraduate levels and a re-evaluation of the clinical learning environment to mitigate the difficulties endured.

Utilising Immersive Video Technology to improve Medical Student Education in an Operating Theatre Environment

Background

Educational opportunities in operating theatres are finite resources, therefore utilising them effectively is essential. Immersive video technology (IVT) may achieve this by exposing students to high-fidelity scenarios. In this study, we describe impact of IVT on student understanding of an orthopaedic procedure, barriers to surgical education, appreciation of theatre logistics and its effect on career aspirations.

Methods

Purposive sampling was used to recruit UK medical undergraduates. An electronic questionnaire was developed using previous studies in the field. Half of the questionnaire was completed prior to a three-minute video describing a surgical procedure, and the second half of the questionnaire was completed after. The study design allowed researchers to collect paired qualitative data on the impact of IVT on students' subjective understanding of carpal tunnel decompression surgery and interest in surgical careers.

Results

Out of 980 contacted, 207 respondents completed the 'pre' and 'post' video questionnaires. Following the video intervention, understanding of operative principles increased from 3.3 ± 0.16 (95% CI:1-7) to 6.1 ± 0.16 (95% CI:3-10, p < 0.0001). 81% of respondents reported they would feel more confident attending a carpal tunnel decompression in theatre post-video, with 60% feeling less apprehensive and 72% stating they would feel more engaged if they were shown a short educational video beforehand. Interest in pursuing a career in surgery increased from 3.9 ± 0.30 (95% CI:1-10) before watching the video to 4.2 ± 0.28 (95% CI:1-10, p < 0.0001), post-video.

Conclusions

This study supports the use of immersive multimedia to enhance medical education in surgery which may stimulate student interest in surgical careers.

"I never should have been a doctor": a qualitative study of imposter phenomenon among internal medicine residents

INTRODUCTION

Imposter phenomenon is common among medical trainees and may influence learning and professional development. The authors sought to describe imposter phenomenon among internal medicine residents.

METHODS

In 2020, using emailed invites we recruited a convenience sample of 28 internal medicine residents from a teaching hospital in Baltimore, Maryland to participate in an exploratory qualitative study. In one-on-one interviews, informants described experiences of imposter phenomenon during residency training. Using thematic analysis to identify meaningful segments of text, the authors developed a coding framework and iteratively identified and refined themes. Informants completed the Clance Imposter Phenomenon Scale.

RESULTS

Informants described feelings and thoughts related to imposter phenomenon, the contexts in which they developed and the impact on learning. Imposter phenomenon has profound effects on residents including: powerful and persistent feelings of inadequacy and habitual comparisons with others. Distinct contexts shaping imposter phenomenon included: changing roles with increasing responsibilities; constant scrutiny; and rigid medical hierarchy. Learning was impacted by inappropriate expectations, difficulty processing feedback, and mental energy diverted to impression management.

DISCUSSION

Internal medicine residents routinely experience imposter phenomenon; these feelings distort residents' sense of self confidence and competence and may impact learning. Modifiable aspects of the clinical learning environment exacerbate imposter phenomenon and thus can be acted upon to mitigate imposter phenomenon and promote learning among medical trainees.

The ward round: friend or foe in postgraduate training? A grounded theory study of residents' perspectives

The ward round has traditionally been a learning activity in medical education. Apart from education, ward rounds have multiple roles including patient care and communication. Some studies have described the ward round as an ideal place to learn patient management while others reported that little learning happens on rounds due to lack of time and patient volume. This study aimed to develop a deeper understanding of ward round learning from the perspective of postgraduate trainees. A constructivist grounded theory approach was used and data was collected during focus group discussions. Data were analyzed by initial coding, then grouped into focused codes and development of a theoretical framework by the process of constant comparison. Six categories evolved which contributed to the framework. Postgraduate trainees perceive the ward round as an important space where they use different learning activities to acquire knowledge, attitude and skills required of a specialist doctor. They progress from novices to experts under supervision of faculty who lead ward rounds. The round can achieve its full learning potential if planned and organized well but can become a missed opportunity if the learning environment is unfriendly. Patient- and learner-related barriers exist that hinder ward round learning. The framework explains how ward round learning occurs in postgraduate medical education from a trainee perspective. The findings can guide interventions to improve the learning experience. Studies comparing perspectives of teachers to those of learners are needed to further understand the complex learning milieu of the ward round.

Lessons From a Near-Peer Junior Doctor Teaching Program in Trauma and Orthopedics

INTRODUCTION

 A junior doctor teaching program delivered by near-peers can foster collaboration in a less-pressured and conducive learning environment. The aim of this study was to provide an analysis of an orthopedic teaching program in a high-resource environment utilizing readily available tools and resources that are potentially available in most hospitals globally.  Methods: This study involved the utilization of an outcome-based learning approach with regular formal feedback. An anonymized Google Forms survey using a 10-point Likert scale was conducted after a 30-week period. The survey tool was sent out to 28 doctors and two senior nurse practitioners who participated in the program either as tutors, learners, or both. A total of 19 out of 30 respondents completed the survey giving a 63% survey completion rate. The setting for this study was the trauma and orthopedics department in a United Kingdom district general hospital.

RESULTS

 Learners' confidence in their orthopedic knowledge and skills pre-program had a median response of eight with a mode of seven whereas confidence following engagement on the program improved with a median response of nine and a mode of 10. At an alpha level of 0.05, this observed improvement was statistically significant using the Mann-Whitney U test (p=0.466). Tutors' perception of the usefulness of the teaching feedback had a median response of nine with a mode of 10. Relevance of the selected topics had a median response of nine and a mode of 10. Inclusion in the teaching program to cater to learner diversity had a median response of nine and a mode of 10. The effectiveness of a blended approach for learning had a median response of nine and a mode of 10.  Conclusion: This study has provided evidence of the benefits of a near-peer teaching program. This is especially important in the post-coronavirus disease (COVID) pandemic recovery period where easily accessible and well-grounded educational programs will be useful to complement the deanery teachings for trainees. This is important as this may be the main source of formal teaching for non-trainee junior doctors in many hospital settings. Additional research will be needed to further explore the pros and cons of such programs within a surgical specialty like orthopedics with an emphasis on the various pedagogical approaches to teaching and learning for junior doctors working in a busy clinical setting.

Faculty motivations for leading clinical clerkship electives: A qualitative study

PURPOSE

Faculty are motivated to pursue clinician-educator careers out of a sense of purpose, duty, connectedness, satisfaction, and mastery. Yet, many suffer from burnout due to a lack of funding, resources, and competing clinical demands. Reasons for clinician-educator participation in unfunded educational leadership positions are underexplored. This study examined faculty members' reasons for volunteering and remaining as clerkship elective directors, an unfunded leadership position.

METHODS

In this qualitative study, the authors conducted 17 semi-structured interviews with clerkship elective directors in March 2021. The authors conducted a thematic analysis of deidentified transcripts using motivation theories as a lens.

RESULTS

Directors' motivations to engage in this unfunded educational leadership position stemmed from their existing clinician-educator identity and a sense of purpose and duty. Directors are sustained by the satisfaction derived from witnessing the positive impact they have on learners' career development and skills building, the impact of learners on the clinical environment, as well as personal benefits in the mastery of educator skills and enhanced visibility as educators.

CONCLUSIONS

Unfunded educational leadership positions can advance clinician-educators' commitment to learners and alter the learning environment. Strategies for faculty recruitment and retention in unfunded leadership positions include ensuring meaningful contact with learners, as well as opportunities for personal career development through skills building and enhanced visibility through recognition.

Learning clinical skills: an ecological perspective

The pedagogy underpinning clinical psychology training is often reliant upon the acquisition and transmission of knowledge and the practice of skills. The dominant paradigm in the training of clinical psychologists emphasises competence-based training drawing upon a scientist practitioner model of practice, often underpinned by knowledge of evidence-based interventions. Little has changed over the past 40 years. Training is predicated upon the assumption that effective therapy is attributed to the therapist's skills to implement specific therapeutic processes and her or his capacity to form an effective working alliance with the client or patient. We provide an argument for an alternative paradigm in which ecological principles are privileged with a view to enhancing clinical training of psychologists in health settings responsive to the trainee as well as the broader societal context in which they practice, by adopting a pedagogy which prioritizes the relationship between the person and the environment. The proposed approach brings an ecological set of assumptions to the learning experience in clinical contexts. Key principles, drawn from an ecological perspective includes: affordances, the emergence of self-organisation in clinical learning, constraints and rate limiters. The approach is supported by examples applied to clinical learning contexts. Implications for clinical training are discussed. The ways in which an ecological approach may contribute to more effective learning outcomes through the use of representative learning contexts may inform learning design, how learning is actioned in clinical psychology as well as future research on the pedagogy of clinical training.

Growth, Engagement, and Belonging in the Clinical Learning Environment: the Role of Psychological Safety and the Work Ahead

Psychological safety is the perception that an environment is safe for interpersonal risk taking, exposing vulnerability, and contributing perspectives without fear of being shamed, blamed, or ignored. The presence of psychological safety has been associated with improved team learning and innovation, leader inclusivity, and team members' sense of belonging. In medical education, psychological safety has additional benefits: it allows learners to be present in the moment and to focus on the tasks at hand, and reduces trainee focus on image. Several key features of psychologically safe environments have already been described, including the presence of high-quality relationships, the absence of social positioning, a learner-driven and flexible learning agenda, the lack of formal assessment, and time for debriefing. However, many of the structures and cultural traditions in medical education are in clear opposition to these features. This paper describes the current barriers to psychological safety in medical education, and sets out an agenda for change. In accordance with benefits seen in other sectors, we anticipate that an emphasis on relationships and psychological safety will support the learning, inclusion, and success of medical trainees.

Twelve tips for mindful teaching and learning in medical education

Mindfulness practice has been shown to have many positive benefits for patients, clinicians, and trainees. Mindfulness fosters compassion, connection, and enhanced clinical reasoning and can reduce burnout among clinicians. A primary focus of mindfulness is present-moment awareness and may be achieved through openness, curiosity, perspective-taking, and letting go of judgment. We propose that the core principles of mindfulness can be harnessed by educators to enhance their teaching skills specifically around creating a supportive and safe learning environment, using questions effectively, providing feedback, and serving as role models. Mindful teaching promotes mindful learning, which focuses on context, openness to new possibilities, reflection, and critical thinking, as opposed to rote repetition and memorization. This article describes core mindfulness principles and strategies that can be used to become a more mindful teacher.

Self-efficacy beliefs and expectations during an Emergency Medicine Clerkship

Background

Undergraduate emergency medicine (EM) training is important because all medical graduates are expected to have basic emergency knowledge and skills regardless of their future speciality. EM clerkship should provide opportunities to improve not only knowledge and skills but also the self-efficacy of learners. This study aims to evaluate the expectations, opinions, and self-efficacy beliefs of medical students during a 4-week mandatory EM clerkship.

Methods

This study used a prospective longitudinal design with quantitative and qualitative survey methods. It includes final year medical students of the 2015–2016 academic year. Voluntary de-identified pre- and post-clerkship surveys included 25 statements. The post-clerkship survey included two open-ended questions asking participants to identify the best and worst three aspects of EM clerkship. Responses were analysed to determine themes or commonalities in participant comments indicative of the EM clerkship learning experiences and environment.

Results

Sixty-seven out of seventy-nine (85%) students responded to both pre- and post-clerkship surveys. Medical students’ expectations of EM clerkships’ effect on knowledge and skill acquisition were high, and a 4-week mandatory EM clerkship was able to meet their expectations. Medical students had very high expectations of EM clerkships’ educational environment. In most aspects, their experiences significantly exceeded their expectations (p value < 0.001). The only exception was the duration of clerkship, which was deemed insufficient both at the beginning and at the end (p value: 0.92). The students perceived that their self-efficacy improved significantly in the majority of basic EM skills and procedures (p value < 0.001). Emergent qualitative themes in the study also supported these results.

Conclusion

This study showed that a 4-week mandatory EM clerkship increased medical students' perceived self-efficacy in basic emergency management skills. The EM clerkship met students' expectations on knowledge and skill acquisition, and exceeded students’ expectations on educational environment.

The Future Comes Early for Medical Educators

Many experts have foretold of a digital transformation in medical education. Yet, until recently, day-to-day practices for frontline clinician-educators, who cherish close physical and intellectual contact between the patient, learner, and teacher, have remained largely unchanged. The COVID-19 pandemic disrupted that model and is forcing teachers to pursue new ways to reach learners. We provide a roadmap for educators to start their transformation from an analog to a digital approach by harnessing existing tools including podcasts, social media, and videoconferencing. Teachers will need to enhance the same pedagogical and interpersonal practices that underpin effective in-person education while they learn new skills as they become curators, creators, and moderators in the digital space. This adaptation is essential, as many of the changes in medical education spurred by COVID-19 will likely far outlast the pandemic.

NeuroQ: A neurophobia screening tool assesses how roleplay challenges neurophobia

BACKGROUND

Neurophobia is a chronic disease of medical students and junior doctors. Early detection is needed to facilitate prevention and management as this fear can negatively impact patient care.

METHODS

We conducted a two-part mono-centric study at the faculty of Medicine, Sorbonne University, in Paris. Part one: a cross-sectional study to validate a newly constructed neurophobia scale, NeuroQ. Part two: a prospective longitudinal study to assess the impact of The Move on student neurophobia using NeuroQ. A population-based sample of second-year medical students of the 2019 and 2020 class of the Faculty of Medicine of Sorbonne University were invited to participate.

RESULTS

NeuroQ incorporates the main themes of the neurophobia definition and demonstrates uni-dimensionality. Three hundred and ninety-five medical students participated in the study (mean age was 20.0 years, SD: 2.1 years) assessing the effect of The Move teaching on neurophobia. Two hundred and eighty-eight (72.9%) students were female. After the Move teaching the mean NeuroQ score was significantly lower compared to the baseline NeuroQ score (mean [SD] variation, -1.1 [2.6], p < 0.001). There was a 22.3% relative reduction in the number of neurophobic students after The Move teaching.

CONCLUSION

Our results highlight the utility of NeuroQ in assessing (i) baseline neurophobia and (ii) the impact of pre-clinical educational interventions on neurophobia. Furthermore, we have shown the importance of pre-clinical educational interventions, such as The Move, in tackling neurophobia.

The Effect of the Educational Environment on the rate of Burnout among Postgraduate Medical Trainees - A Narrative Literature Review

BACKGROUND

Burnout among postgraduate medical trainees is common. It is a syndrome characterised by emotional exhaustion, depersonalisation and reduced personal accomplishment. Burnout is seen as an organisational problem rather than the result of an individual's ability to cope with the stress at work. The educational environment can play a pivotal role in the prevention of burnout among postgraduate medical trainees. This narrative literature review is aimed at assessing the effect of the educational environment on burnout in postgraduate doctors-in-training.

METHODS

A search of the databases Medline and PscyInfo for articles published between 2015 and 2020 was performed with the key words 'burnout' and 'educational environment' or 'clinical learning environment' or 'postgraduate medical education' or 'learning environment'.

RESULTS

A total of 27 studies were identified and reviewed by the author. The prevalence of burnout reported varied widely between studies, ranging from 10% to 62%. Many of the factors that contribute to burnout form part of the educational environment, for example, hours worked, mistreatment, harassment and perceptions of injustice. Residency itself is a stressful period wherein trainees have to balance their responsibilities towards their patients with their responsibilities at home, all while furthering their studies and taking on new responsibilities. Interventions to prevent burnout and tackle existing burnout are multiple but very little solid evidence exists to attest to their efficacy. More research is needed to identify the most effective ways to deal with burnout in postgraduate medical trainees.

Examining the effect of non-specialised clinical rotations upon medical students' Thanatophobia and Self-efficacy in Palliative Care: a prospective observational study in two medical schools

INTRODUCTION

Including palliative care (PC) in overloaded medical curricula is a challenge, especially where there is a lack of PC specialists. We hypothesised that non-specialised rotations could provide meaningful PC learning when there are enough clinical experiences, with adequate feedback.

OBJECTIVE

Observe the effects of including PC topics in non-specialised placements for undergraduate medical students in two different medical schools.

DESIGN

Observational prospective study.

SETTING

Medical schools in Brazil.

PARTICIPANTS

134 sixth-year medical students of two medical schools.

METHODS

This was a longitudinal study that observed the development of Self-efficacy in Palliative Care (SEPC) and Thanatophobia (TS) in sixth-year medical students in different non-specialised clinical rotations in two Brazilian medical schools (MS1 and MS2). We enrolled 78 students in MS1 during the Emergency and Critical Care rotation and 56 students in MS2 during the rotation in Anaesthesiology. Both schools provide PC discussions with different learning environment and approaches.

PRIMARY OUTCOMES

SEPC and TS Scales were used to assess students at the beginning and the end of the rotations.

RESULTS

In both schools' students had an increase in SEPC and a decrease in TS scores.

CONCLUSION

Non-specialised rotations that consider PC competencies as core aspects of being a doctor can be effective to develop SEPC and decrease TS levels.

They Don't See a Lot of People My Color: A Mixed Methods Study of Racial/Ethnic Stereotype Threat Among Medical Students on Core Clerkships

PURPOSE

Stereotype threat is an important psychological phenomenon in which fear of fulfilling negative stereotypes about one's group impairs performance. The effects of stereotype threat in medical education are poorly characterized. This study examined the prevalence of racial/ethnic stereotype threat amongst fourth-year medical students and explored its impact on students' clinical experience.

METHOD

This was an explanatory sequential mixed methods study at 2 institutions in 2019. First, the authors administered the quantitative Stereotype Vulnerability Scale (SVS) to fourth-year medical students. The authors then conducted semistructured interviews among a purposive sample of students with high SVS scores, using a qualitative phenomenographic approach to analyze experiences of stereotype threat. The research team considered reflexivity through group discussion and journaling.

RESULTS

Overall, 52% (184/353) of students responded to the survey. Collectively, 28% of students had high vulnerability to stereotype threat: 82% of Black, 45% of Asian, 43% of Latinx, and 4% of White students. Eighteen students participated in interviews. Stereotype threat was a dynamic, 3-stage process triggered when students experienced the workplace through the colored lens of race/ethnicity by standing out, reliving past experiences, and witnessing microaggressions. Next, students engaged in internal dialogue to navigate racially charged events and workplace power dynamics. These efforts depleted cognitive resources and interfered with learning. Finally, students responded and coped to withstand threats. Immediate and deferred interventions from allies reduced stereotype threat.

CONCLUSIONS

Stereotype threat is common, particularly among non-White students, and interferes with learning. Increased minority representation and developing evidence-based strategies for allyship around microaggressions could mitigate effects of stereotype threat.

Are We Making an Impact? A Qualitative Program Assessment of the Resident Leadership, Well-being, and Resiliency Program for General Surgery Residents

OBJECTIVE

After implementing a formal resident well-being and resiliency program in our surgery residency, we performed in-depth qualitative interviews to understand residents' perceptions of: (1) the impact and benefits, (2) the essential elements for success, and (3) the desired changes to the well-being program.

DESIGN

The well-being program is structured to address mental, physical, and social aspects of resident well-being through monthly experiential sessions. All General Surgery residents participated in the program; content is delivered during residents' protected educational time. For this study, we conducted individual semistructured interviews: residents were asked for their feedback to understand the value, benefits, and drawbacks of program.

SETTING

Accreditation Council for Graduate Medical Education-accredited General Surgery residency program PARTICIPANTS: We used purposeful selection to maximize diversity in recruiting residents who had participated in program for at least 1 year. Recruitment continued until themes were saturated. Eleven residents were interviewed including 2 from each residency year.

RESULTS

Residents reported benefits in 3 thematic spheres: (1) Culture/Community, (2) Communication/Emotional Intelligence, and (3) Work-Life Integration Skills. Key structural elements of success for a well-being program included a committed leader, a receptive department culture, occurrence during protected time, and interactive sessions that taught applicable life skills. In discussing opportunities for improvement, residents desired more faculty-level involvement. Some residents were skeptical of the benefit of time spent learning nontechnical skills; some wanted more emphasis placed on accountability to patients and work.

CONCLUSIONS

Our qualitative assessment of a novel resident well-being program demonstrates reported benefits that reflect the intent of the program. Residents most benefited from sessions that were interactive, introduced readily applicable skills for their day-to-day lives, and included reinforcement of principles through experiential learning. Engagement of the department leadership is essential to the success of the program, as is ongoing feedback and modification to ensure that program is tailored to the needs of residents.