-A cross-sectional study of clinical learning environments across four undergraduate programs using the undergraduate clinical education environment measure

Validation of the Polish version of the Johns Hopkins Learning Environment Scale-a confirmatory factor analysis

The Johns Hopkins Learning Environment Scale (JHLES) was developed by Robert B. Shochet, Jorie M. Colbert and Scott M. Wright of the Johns hopkins university school of medicine and consists of 28 items used to evaluate perception of the academic environment. The objective was to translate and adapt the JHLES to Polish cultural conditions and to validate the Polish version of the tool. The JHLES questionnaire was completed by students of all years (first-fifth) of the faculties of dental medicine at the Medical University of Lublin and the Medical University of Gdańsk. The total surveyed population consisted of 597 students. The overall reliability of the tool was excellent. Confirmatory factor analysis was performed in order to confirm structural consistency with the original JHLES tool. Consequently, all indices had acceptable values (close to 1 or 0, depending on the case), and there was consistency in the results, which shows that the JHLES model is supported by the data. In the present study, the JHLES has been validated in a sample of dental students for the first time in Poland and Europe. Our study provided good evidence for the reliability and validity of the Polish version of the JHLES. In conclusion, the Polish-language version of the JHLES questionnaire is a reliable and valid instrument for analysing the learning environment for students, and its factor structure is supported by the data.

Nursing students' stressors and coping strategies during their first clinical training: a qualitative study in the United Arab Emirates

BACKGROUND

Understanding the stressors and coping strategies of nursing students in their first clinical training is important for improving student performance, helping students develop a professional identity and problem-solving skills, and improving the clinical teaching aspects of the curriculum in nursing programmes. While previous research have examined nurses' sources of stress and coping styles in the Arab region, there is limited understanding of these stressors and coping strategies of nursing students within the UAE context thereby, highlighting the novelty and significance of the study.

METHODS

A qualitative study was conducted using semi-structured interviews. Overall 30 students who were undergoing their first clinical placement in Year 2 at the University of Sharjah between May and June 2022 were recruited. All interviews were recorded and transcribed verbatim and analyzed for themes.

RESULTS

During their first clinical training, nursing students are exposed to stress from different sources, including the clinical environment, unfriendly clinical tutors, feelings of disconnection, multiple expectations of clinical staff and patients, and gaps between the curriculum of theory classes and labatories skills and students' clinical experiences. We extracted three main themes that described students' stress and use of coping strategies during clinical training: (1) managing expectations; (2) theory-practice gap; and (3) learning to cope. Learning to cope, included two subthemes: positive coping strategies and negative coping strategies.

CONCLUSIONS

This qualitative study sheds light from the students viewpoint about the intricate interplay between managing expectations, theory practice gap and learning to cope. Therefore, it is imperative for nursing faculty, clinical agencies and curriculum planners to ensure maximum learning in the clinical by recognizing the significance of the stressors encountered and help students develop positive coping strategies to manage the clinical stressors encountered. Further research is required look at the perspective of clinical stressors from clinical tutors who supervise students during their first clinical practicum.

Self-directed learning and clinical competence: The mediating role of the clinical learning environment

Introduction

Recognizing the factors affecting clinical competence among internship nursing students is crucial. This study was aimed at determining the effects of self-directed learning on internship nursing students' clinical competence under the mediating role of the clinical learning environment.

Methods

This cross-sectional research was performed on 300 internship nursing students selected by convenience sampling with a structural equation modeling (SEM) approach. Data were collected in one stage with three tools: the Self-Directed Learning Readiness Scale for Nursing Education, Education Environment Measure, and Clinical Competence Questionnaire. Data analysis was performed in SPSS version 21 and Smart-PLS version 3 with partial least squares-SEM. Measurement and structural model data were assessed with a significance threshold of p < 0.05.

Results

A total of 20.5 % of the variance in clinical competence was explained by self-directed and clinical learning environments. Self-directed learning had a significant positive effect on clinical competence (path coefficient = 0.14, 95 % CI: 0.02, 0.26; p = 0.027), and on the clinical learning environment (path coefficient = 0.41, 95 % CI: 0.31, 0.52; p < 0.001). A relationship was observed between the clinical learning environment and clinical competence (path coefficient = 0.38, 95 % CI: 0.25, 0.50; p < 0.001). The indirect effect of self-directed learning on clinical competence was positive and significant (path coefficient = 0.11, 95 % CI: 0.07, 0.17; p < 0.001). Self-directed learning had a significant total effect on clinical competence (path coefficient = 0.30, 95 % CI: 0.19, 0.40; p < 0.001).

Conclusions

According to the results, we recommend that nursing education managers and instructors consider plans to enhance self-directed learning among nursing students and improve the clinical learning environment.

Evaluation of a new concept to improve and organize clinical practice in nursing education: a pilot-study

BACKGROUND

Nursing students may experience clinical practice as unsafe due to the interactions with patients, fear of making mistakes, lack of clinical experience and supervision, which results in anxiety and stress. Thus, interventions to improve and organize the learning environment in clinical practice for nursing students are warranted, and the aim of this pilot-study was to evaluate a new concept of clinical practice in order to get insight on the different initiatives and gain knowledge for further developing.

METHODS

The new concept consisted of nursing students being affiliated to the same department during their clinical practices, reflective supervision, and participation in a self-compassion course. Data was collected using questionnaires and focus group interviews of 17 nursing students, 17 clinical supervisors, and 14 head nurses. A mixed-methods strategy was employed to give the study a pragmatic approach. Finding from the questionnaires and focus group interviews were analyzed separately and then weaved together into themes.

RESULTS

The results generated four themes: Information and involvement before and during the new concept, Learning outcomes, safety, and well-being, Impact of reflective supervision and self-compassion course, and Transition from study life to working life. In general, the participating nursing students, clinical supervisors, and head nurses had positives experiences regarding the new concept. They felt well-informed, and they experienced that it contributed to a safe learning environment, increased well-being, strengthened the relationship between nursing students and clinical supervisors and healthcare staff at the department, and prepared the nursing students to working life.

CONCLUSION

Our results complement the suggestion that improved quality of clinical practice for nursing students is an effective strategy to establish a safe and supportive learning environment that contribute with satisfaction, successful experiences, and attraction of future nurses. However, further intervention studies are needed to compare the effect of the new concept with traditional clinical practice.

Assessment of clinical competence of graduating medical students and associated factors in Ethiopia

BACKGROUND

Ethiopia has scaled up medical education to improve access to healthcare which presented challenges to maintaining training quality. We conducted a study to assess the clinical competence of graduating medical students and the associated factors.

METHODS AND MATERIALS

A pretest assessment of a quasi-experimental study was conducted in 10 medical schools with a sample size of 240 students. We randomly selected 24 students per school. Clinical competence was assessed in a 12-station objective structured clinical examination. The clinical learning environment (CLE), simulation training, and practice exposure were self-rated. Mean scores for clinical competence, and satisfaction in the CLE and simulation training were calculated. Proportions of students with practice exposure, and who agreed on CLE and simulation items were done. Independent t-tests were used to look at competence differences among subgroups. Bivariate and multiple linear regression models were fitted for the outcome variable: competence score. A 95% statistical confidence interval and p-value < 0.05 were used for making statistical decisions. A 75% cut-off score was used to compare competence scores.

RESULTS

Graduating medical students had a mean competence score of 72%. Low scores were reported in performing manual vacuum aspiration (62%), lumbar puncture (64%), and managing childbirth (66%). Female students (73%) had a significantly higher competence score than males (70%). Higher cumulative grade point average (CGPA), positive appraisal of the CLE, and conducting more clinical procedures were associated with greater competence scores. Nearly half of the students were not satisfied with the clinical practice particularly due to the large student number and issues affecting the performance assessment. About two-thirds of the students were not satisfied with the sufficiency of models and equipment, and the quality of feedback during simulation training. Nearly one-third of the students never performed lumbar puncture, manual vacuum aspiration, and venipuncture.

CONCLUSIONS

Medical students had suboptimal clinical competence. A better clinical learning environment, higher cumulative GPA, and more practice exposure are associated with higher scores. There is a need to improve student clinical practice and simulation training. Strengthening school accreditation and graduates' licensing examinations is also a way forward.

Clinical learning environments across two different healthcare settings using the undergraduate clinical education environment measure

BACKGROUND

The clinical placements of our medical students are almost equally distributed across private and public sectors. This study aims to assess medical students' perceptions of their Clinical learning Environment (CLE) across these two different healthcare settings, using the Undergraduate Clinical Education Environment Measure (UCEEM).

METHODS

76 undergraduate medical students (Year 5 and 6), were invited to participate. Data were collected using an online UCEEM with additional questions related to demographics and case load exposure. The UCEEM consists of two overarching domains of experiential learning and social participation, with four subdomains of learning opportunities, preparedness, workplace interaction, and inclusion.

RESULTS

38 questionnaires were received. Of 225 responses to the individual UCEEM items, 51 (22.6%) scored a mean of ≥ 4 (range 4-4.5, representing strong areas), 31 (13.7%) scored a mean of ≤ 3 (range 2.1-3, needing attention) and 143 (63.6%) scored a mean of 3.1-3.9 (areas that could be improved). The majority (63%) of the case load exposure responses scored a mean of ≥ 4 (range 4-4.5). Compared to the private sittings, there is a significant reduction in total UCEEM (p = 0.008), preparedness for student entry (p = 0.003), and overarching dimension of social participation (p = 0.000) scores for the public sector. Similarly, both workplace interaction patterns and student inclusion and equal treatment scored significantly lower for the public sector (p = 0.000 and p = 0.011 respectively). Two out of three case load exposure items scored significantly higher for the public sector (p = 0.000).

DISCUSSION

The students' CLE perceptions were generally positive. The lower UCEEM ratings in the public sector items were related to student entry preparedness, workplace interactions, student inclusiveness and workforce equity of treatment. In contrast the students were exposed to more variety and larger number of patients in the public sector. These differences indicated some significantly different learning environments between the two sectors.

Perceptions of Physiotherapy students about their teaching environment at Kamuzu University of Health Sciences in Malawi

Introduction

The learning environment is defined as an environment where teaching is taking place, as perceived by both students and teachers. A conducive learning environment is critical for successful curriculum implementation, which also affects students' academic performance. There have been initiatives introduced to improve the learning environment at Kamuzu University of Health Sciences (KUHeS). The purpose of this study was to ascertain physiotherapy final year students' perceptions of their learning environment at KUHeS in Malawi.

Methodology

This study was conducted at KUHeS among final-year physiotherapy students. A retrospective, quantitative cross-sectional design was used. The study utilised secondary data on education environment which had already been collected using Dundee Ready Education Environment Measure (DREEM) forms. There were 26 completed DREEM forms for 2019/2020 academic year. Demographic data were captured. Mean and standard deviation were used to analyse the DREEM scores. Inferential analysis was conducted with p-value set at ≤ 0.05.

Results

The total DREEM mean score was 120/200 which represented a positive perception of students learning environment. Students' academic self-perception scored the highest (69.13%), followed by students' perception of learning (61.94%), students' social self-perception (59.46%), students' perception of atmosphere (56.25), and students' perception of teachers (55.50%). Married students had negative perceptions (p-value = 0.05) of their teachers and students with previous college experience had positive perceptions of their academic performance (p-value = 0.02). Many statements under items of perception of teachers (mean score = 24) and social self-perceptions (mean score = 16) were considered negatively.

Conclusion

Students in their final year of physiotherapy had positive perceptions of their learning environment. However, students' perceptions of their teachers and social life were low. The learning environment had a significant impact on married students and those who had no prior experience with college life. Faculty development initiatives should aim to improve these critical areas.

Validity of the UCEEM in use: How Does it Triangulate with Qualitative Data in Measuring the Effect of an Educational Intervention?

Objectives

Improving medical student placements relies on being able to reliably evaluate how students experience clinical learning environments. The Undergraduate Clinical Education Environment Measure (UCEEM) is an increasingly used validated tool designed to allow such evaluations. This study aims to further characterize how the UCEEM relates to qualitative evaluation.

methods

Students on placement at one hospital were invited to complete the UCEEM before and after the implementation of an innovative new placement structure. Additionally, focus groups were employed to collect qualitative data on their experiences. a novel protocol to triangulate the output of the UCEEM with the qualitative data was developed.

Results

The UCEEM showed good internal consistency (Cronbach's Alpha 0.79-0.91) and internal correlation. Implementation of the intervention created significant improvements in the overall UCEEM scores (P = .008) and in the "Learning in and through work and quality of supervision" (P = .048), "Preparedness for student entry" (P = .033) and "Workplace interaction patterns and student inclusion" (P = .039) domains. The triangulation of qualitative data with UCEEM output showed that the UCEEM allowed evaluation of some perceptions not reached through open questioning. However, mixed interpretations of UCEEM items by students led to the conflation of themes and challenges in deriving the meaning behind the score. This appeared to be the case for 14 of the 24 UCEEM items.

Conclusion

This investigation adds to the literature supporting the UCEEM as a validated tool. It also elucidates the limitations and relationships to qualitative data that investigators need to be aware of in its use.

Key tips to providing a psychologically safe learning environment in the clinical setting

Having psychological safety embedded in preceptorship relationships facilitates positive interpersonal and educational experiences for students. Psychological safety refers to a student's belief as to whether or not it is safe for them to take interpersonal risks, such as asking questions, sharing an idea for improvement or speaking up to maintain patient safety. Having psychological safety leads to collaboration, positive student learning experiences and effective patient care. This article presents key guidelines for preceptors to provide a psychologically safe learning environment for their students. Guidelines fall under four categories 1) before meeting students, 2) first meeting students, 3) continued relationship with students, and 4) general rules. These guidelines are informed by current literature on psychological safety and preceptorship and the author's clinical expertise in nursing preceptorship. We conceptualise psychological safety in a nursing preceptorship for preceptors to denote the experience of inclusivity, empowerment, and well-being of students within the social, cultural and physical clinical learning environment. A crucial attribute to cultivating a psychologically safe environment involves being an accessible and approachable preceptor.

Nursing students' perceived stress and clinical learning experience

BACKGROUND

Stressors among nursing students arise from both academic activities and clinical placement. Understanding how nursing students perceive academic and clinical stressors and the clinical learning environment could help develop useful approaches to reducing levels of stress and contribute to the maintenance of a good learning environment. There is a paucity of studies that investigated associations between the clinical learning environment and the stress of nursing students.

OBJECTIVES

To investigate the relationship between the perception of the clinical learning environment and stress in nursing students; to compare the perception of the clinical learning environment and stress in terms of the year and terms of the organization of supervision.

DESIGN

Cross-sectional correlation study SETTINGS: University PARTICIPANTS: The sample consisted of 155 nursing students in the bachelor's degree program. During the four academic years, students of individual years of the bachelor's study program were included in the study after completing all clinical placements in a given academic year.

METHODS

The following instruments were used for the data collection: Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale, Perceived Stress Scale; Physio-Psycho-Social Response Scale and Coping Behaviour Inventory. Correlation analysis and multiple linear regression analysis using stepwise methods were used to determine the relationships between the variables.

RESULTS

The clinical learning environment is a strong predictor of students' perceptions of stress related to teachers and nursing staff. Types and degrees of stressful events during clinical practice varied between years of study. The experience with supervision was related to the overall perception of the clinical learning environment, but not to the students' physio-psychosocial status, types of stressful events during clinical practice and coping behaviors. Also, the differences in the students' physio-psychosocial status were not significant in terms of individual years of study and method of supervision.

CONCLUSIONS

There is a significant relationship between the clinical learning environment and the perception of academic stress. The attitude of the teacher and the medical staff can thus be important in influencing the level of stress in nursing students.

Psychometric Properties of Clinical Learning Environment Comparison Survey Questionnaire in Nursing Students

INTRODUCTION

Continuous evaluations of clinical education and learning in nursing require the use of valid and reliable instruments. The present study aimed to evaluate the validity and reliability of the CLECS questionnaire (a questionnaire for assessing the clinical learning environment) in nursing students.

METHODS

This is a psychometric study conducted on 118 nursing students. Through email correspondence with the corresponding author, permission was obtained from the developer to translate, validate, and use the CLECS. The CLECS was translated into Persian. The psychometric process was performed after the translation and cultural adaptation steps. Cronbach's alpha was used to assess the reliability. The instrument validity was assessed through convergent, discriminant, and confirmatory factor analysis. We used AMOS 18 for confirmatory factor analysis and SPSS-20 for reliability, convergent, and discriminant validity.

RESULTS

A total of 118 nursing students participated in the study. The Cronbach's alpha value of the questionnaire was 0.942. Convergent validity was obtained in all dimensions above 0.4. The confirmatory factor analysis results confirmed the fit of the final model and showed that the present questionnaire was 6-dimensional. Most of the questions in the questionnaire did not have a good differential validity. The highest and lowest means were related to the nursing process and holism dimensions, respectively.

CONCLUSION

Based on the findings of this study, CLECS, except in the discriminant validity, has good validity and reliability, which can be considered to examine the learning environment of undergraduate nursing students.

Balancing acting and adapting: a qualitative study of medical students' experiences of early clinical placement

BACKGROUND

Clinical learning experience is an important part of medical education. In the clinical learning environment, students are exposed to various aspects of medical care and may train their skills under supervision. Supervision, in which students' learning needs and the outcomes of placements are met, is essential. The aim of this study was to explore medical students' experiences of the early stages of clinical training.

METHODS

In 2021, 18 individual semi-structured interviews were conducted with medical students after their first clinical placements in semester 5. The interviews were transcribed verbatim and analyzed using qualitative content analysis according to Graneim and Lundman.

RESULTS

The findings resulted in an overall theme: balancing acting and adapting. Three categories described that the clinical learning environment was a big leap from campus, that personal relationships influenced learning, and that the organization of clinical placements was suboptimal. The students were encouraged to push themselves forward to practice clinical skills. This, however, did not suit all the students; the cautious ones risked becoming passive spectators. The intended learning outcomes were not frequently used; rather, the supervisors asked the students what they had learned, or the students focused on what seemed to be important on the ward. The students tried to adapt to their supervisors' working situation and not to be a burden to them.

CONCLUSIONS

Our findings show that the transition from learning on campus was sometimes abrupt, as the students had to switch to a more active learning role. Ad hoc solutions in supervision occurred, which contributed to the experience that educational responsibilities were downgraded and the opportunities for clinical training varied. Rather than trying to change the circumstances, the students opted to adapt to the busy clinical learning environment.