Exploring the Experiences of Undergraduate Medical Students on Surgical Placement - A Qualitative Study

OBJECTIVE

Multiple elements in the clinical learning environment have been found to influence medical students' learning experiences. A rich area of research, many factors are already known to influence students' experiences of learning which go on to impact later training choices. However, there is a knowledge gap specifically related to undergraduate medical students' experiences of surgical placement. This study aims to explore the lived experiences of medical students in their surgery rotation(s).

DESIGN

A phenomenological study using semistructured interviews was conducted. Transcribed interview recordings were thematically analyzed using an iterative approach.

SETTING

Participants were studying in a large medical school in the north of England.

PARTICIPANTS

Fitting with the method, 6 undergraduate medical students, with at least 1 surgery placement took part in the study.

RESULTS

Participants described issues including knowing the details of clinical opportunities, the clinical environment, and the portfolio; having a sense of involvement and previous surgical experiences; teaching and assessments; observation; and interactions. These experiences were also found to influence later career aspirations.

CONCLUSIONS

The findings suggest that undergraduate surgical learning experiences can be influenced by various themes: knowing the details of progression, the clinical environment, having a sense of involvement and previous experiences, constructive alignment of teaching and assessment, and professional identity formation. Future studies can explore methods such as personalized learning outcomes to enhance the overall learning experience of medical students.

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.

Exploring the sociocultural experiences of student veterinary nurses in the clinical learning environment through the lens of situated learning theory

BACKGROUND

Student veterinary nurses (SVNs) complete significant time in clinical placements and this training can have a positive or negative impact on the development of professional skills and identity.

METHODS

A cross-sectional design, using semi-structured interviews, explored 12 SVNs' experiences of clinical placements. Interpretative phenomenological analysis was used to explore each individual participant's experience, prior to the identification of themes across participants' experiences.

RESULTS

Most students reported a sense of belonging within the practice team, which fostered engagement. Clinical supervisors were considered key role models and vital support for student progress. Students reported conflict between the demands of the practice and the requirements of their student status. Some poor interpersonal interactions led to reduced confidence.

LIMITATIONS

The results may not reflect experiences of the diversity of student demographics, such as those students with protected characteristics, as described in the Equality Act 2010, who may encounter specific workplace challenges.

CONCLUSION

To ensure parity and positive experiences, accredited educational institutes can plan regular engagement with student feedback and support of the training practice. Training practice teams can ensure they are meeting the student's needs and fostering a positive learning environment by adhering to the RCVS Framework for Veterinary Nurse Education and Training, which will, in turn, benefit the whole team. Clinical supervisors can play a convening role in increasing belonging and participation within the clinical learning environment.

Teaming in Graduate Medical Education: Ward Rounds and Beyond

Teamwork in graduate medical education (GME) is often hindered in clinical learning environments where discontinuity among residents, supervisors, and other health care professionals is typical. Teaming is a conceptual approach to teamwork in dynamic environments with constantly changing team members and goals. Teaming is built on principles of project management and team leadership, which together provide an attractive strategy for addressing teamwork challenges in GME. Indeed, teaming is now a requirement of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program. However, many clinician-educators and leaders may be unfamiliar with teaming and how to integrate it into their GME programs. In this article, the teaming framework is described with a specific example of how it can be applied to improve hospital ward rounds, a common setting of teamwork breakdown. The goal of this article is to educate and encourage GME leaders as they learn new ways to implement teaming to improve patient care and education in their programs.

Exploring Undergraduate Nursing Students' Perceptions on Clinical Learning Environment in the UAE: A Focus on Perceived Benefits and Challenges

Introduction

Establishing a supportive clinical environment is paramount for enhancing nursing students' engagement in clinical practice, their clinical proficiencies, and satisfaction. The increase in nursing student enrollment at the Nursing College, driven by the collaborative efforts between Abu Dhabi Health Services Company (SEHA) and universities, has given rise to concerns regarding the quality of education and clinical instruction. These concerns are primarily due to the increased student-to-instructor ratio. Furthermore, the unsupportive clinical settings and learning tensions underscore the need to understand students' learning experiences and address research gaps within the field of clinical learning in the United Arab Emirates (UAE).

Objectives

The purpose of this study is to investigate the undergraduate nursing students' perceptions of their clinical learning environment, with a focus on perceived benefits and challenges.

Methods

This study used a cross-sectional survey design. The researchers administered a five-point Likert scale questionnaire, which had been adapted and contextualized, to a convenience sample of 217 third and fourth-year nursing students who willingly participated in this study.

Results

Despite the presence of positive aspects, such as diverse clinical experiences and strong support from both clinical instructors and peers, several challenges affect the students' clinical learning. These challenges encompass disparate perceptions of supervision among staff nurses, learning tensions related to student academic workload, insufficient clinical supervision, and difficulties in finding assistance when needed.

Conclusion

There is a clear need to enhance the overall ward learning environment to optimize students' academic motivation and clinical skills. Several measures can be taken to achieve this goal, including incentivizing and reducing the workload of staff nurses, investing in the professional development of clinical instructors, promoting peer interactions and group learning, and adopting a block pattern of education in years three and four for better clinical knowledge assimilation and reduced theoretical workload.

Enhancing Medical Education: A Pathway to Nurturing Future Healthcare Professionals

Introduction As medical knowledge, technology, and healthcare delivery continue to evolve, it is critical that upcoming healthcare workers possess the skills and information needed to ensure optimal patient care. Numerous studies indicate that students achieve better learning outcomes through active practice rather than solely relying on theoretical knowledge. The average human attention span is only 8.25 seconds, so an effective teaching program should employ various modes and techniques to ensure that students remain involved and interested. Aims and objectives The aim is to identify the primary areas where medical students need teaching and guidance and form the basis of a new teaching program to meet those needs. Materials and methods An anonymous online questionnaire, designed by the author was distributed to medical students who came for their clinical rotations at Basildon University Hospital, Mid and South Essex NHS Foundation Trust, United Kingdom, and that laid the foundations for introducing a new teaching program at the education department of the hospital in April 2023. The progress of the teaching program was evaluated by a second questionnaire-based survey conducted after six months, in October 2023. The teaching program we designed employed various modes and techniques including simulation, flip classroom, graded quizzes, and constructive feedback. The technique we used for giving feedback to students was the "star star wish" to encourage growth and further participation. The teaching program also made use of Lev Vygotsky's "Learning zone model" to ensure optimum learning. Results and discussion The program received immensely positive feedback from the students, and they felt that it catered perfectly to their requirements. Twenty-three students took part in this study and the results showed that 39% of the students felt adequately prepared for ward rounds in October 2023 in contrast to only 17% in April 2023. The mean score, on a scale of 1-10 on how comfortable the students felt in discussing patient care plans and management with the rest of the team rose from 2.78 in April 2023 to 4.26 in October 2023. When asked to score how confident the students felt in performing bedside examinations in wards, 26% scored 5 or above (on a scale of 1-10) in April 2023 as compared to 62% scoring 5 or above in October 2023. The students were then asked how confident they felt in using their theoretical knowledge in practical situations and the majority scored 2 or 3 (on a scale of 1-10) in April 2023 whereas in October, the majority scored 4 or above. Conclusions A significant number of medical students were satisfied with the teaching program and demanded more frequent sessions. The results of this study showed that in order to foster increased student engagement and effective participation, it is essential for teaching to incorporate diverse techniques and approaches.

Development of TOEKAN, a 360° evaluation tool for the clinical learning environment in General Practice postgraduate training

BACKGROUND

The General Practice (GP) postgraduate program exists for 80% out of workplace learning. The quality of the clinical learning environment (CLE) has a direct effect on the quality of training and the professional development of GP trainees.

METHODOLOGY

Participatory research was used to involve all stakeholders in the development process of a 360° evaluation tool that should improve the average quality of GP training practices, guide GP trainees towards the best training practices and detect and remediate GP trainers of lower quality.

RESULTS

TOEKAN (Tool for Communication and Evaluation of Quality Standards) was developed, which consists of a 72-item questionnaire for GP trainees and GP trainers and an 18-item questionnaire for those who coach and remediate GP trainers. The outcomes of the TOEKAN questionnaires are visualized in an online dashboard.

DISCUSSION

TOEKAN is the first 360° evaluation tool for CLE in GP education. All stakeholders will complete the survey on a regular basis and have access to the results. By creating intrinsic and extrinsic motivation as well as mediation measures, the quality of CLE will improve. Continuous monitoring of the use and outcomes of TOEKAN will allow to critically review and improve this new evaluation tool as well as support the broader implementation.

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.

Making decisions "in the dark": Learning through uncertainty in clinical practice during Covid-19

Purpose

The purpose of this study was to explore how decision making and informal and incidental learning (IIL) emerged in the clinical learning environment (CLE) during the height of the Covid-19 pandemic. The authors' specific interest was to better understand the IIL that took place among frontline physicians who had to navigate a CLE replete with uncertainty and complexity with the future goal of creating experiences for medical students that would simulate IIL and use uncertainty as a catalyst for learning.

Method

Using a modified constructivist, grounded theory approach, we describe physicians' IIL while working during times of heightened uncertainty. Using the critical incident technique, we conducted 45-min virtual interviews with seven emergency department (ED) and five intensive care unit (ICU) physicians, who worked during the height of the pandemic. The authors transcribed and restoried each interview before applying inductive, comparative analysis to identify patterns, assertions, and organizing themes.

Results

Findings showed that the burden of decision making for physicians was influenced by the physical, emotional, relational, and situational context of the CLE. The themes that emerged for decision making and IIL were interdependent. Prominent among the patterns for decision making were ways to simplify the problem by applying prior knowledge, using pattern recognition, and cross-checking with team members. Patterns for IIL emerged through trial and error, which included thoughtful experimentation, consulting alternative sources of information, accumulating knowledge, and "poking at the periphery" of clinical practice.

Conclusions

Complexity and uncertainty are rife in clinical practice and this study made visible decision-making patterns and IIL approaches that can be built into formal curricula. Making implicit uncertainty explicit by recognizing it, naming it, and practicing navigating it may better prepare learners for the uncertainty posed by the clinical practice environment.

Implementation and Maturity of Clinical Learning Environment Components Across Pediatric Residency Programs

OBJECTIVE

Pediatric residency programs prioritize clinical learning environment components depending on resource availability, institutional constraints and culture, and accreditation requirements. However, there is limited literature on the landscape of implementation and maturity of clinical learning environment components across programs nationally.

METHODS

We used Nordquist's clinical learning environment conceptual framework to craft a survey around the implementation and maturity of learning environment components. We performed a cross-sectional survey of all pediatric program directors enrolled in the Pediatric Resident Burnout-Resiliency Study Consortium.

RESULTS

Components with the highest implementation rates were resident retreats, in-person social events, and career development, while components least likely to be implemented were scribes, onsite childcare, and hidden curriculum topics. The most mature components were resident retreats, anonymous systems for reporting patient safety events, and faculty-resident mentoring programs, while the least mature components were use of scribes and formalized mentorship for trainees underrepresented in medicine. Learning environment components included in the Accreditation Council of Graduate Medical Education Program Requirements were significantly more likely to be implemented and mature than nonrequired components.

CONCLUSIONS

To our knowledge, this is the first study to use an iterative and expert process to provide extensive and granular data about learning environment components for pediatric residencies.

Undergraduate Students' and Interns' Perception towards Learning Environment at Dental Clinics, Qassim University, Saudi Arabia

Background

Dental clinical educational environment plays a critical part in the inculcation of skills and enhancement of knowledge for the dental students. The objective was to assess undergraduate dental students' and interns' perceptions towards the clinical learning environment.

Methods

Current cross-sectional study was conducted from December 2020 to February 2021, using the 24-item dental clinical learning environment inventory (DECLEI) on a six point Likert scale. The possible range of cumulative score for DECLEI was from 0 to 100 (interpretation poor to excellent). The inventory was emailed to 111 students and interns at College of Dentistry, Qassim University. The relationship between the independent variables and DECLEI scores was determined by using Pearson correlation test. SPSS version-23 was used for statistical analysis.

Results

Overall response rate was 78.37%. The mean DECLEI score was noted as 67.5 ± 17.98. Among the factors, the highest mean score was documented for the systematic self-evaluation and the lowest mean score was observed for the item related to patients' punctuality for appointments. A factor-wise analysis of three subscales of DECLEI demonstrated the respondents had good perception towards all subscales with the highest mean score (72.3 ± 18.06) for Factor III and lowest mean score (61.3 ± 19.81) for Factor II. Overall, the DECELI was found to be reliable with the Cronbach's Alpha value of 0.94. The Pearson's correlation test showed the weak positive insignificant correlation of mean DECLEI score with gender and categories.

Conclusions

Present study indicated more positive than negative perceptions of the dental students related to their clinical learning environment. The DECLEI helped in recognizing both strengths and shortcomings of the dental clinical learning environment.

Trainee Autonomy and Supervision in the Modern Clinical Learning Environment: A Mixed-Methods Study of Faculty and Trainee Perspectives

Background

Balancing autonomy and supervision during medical residency is important for trainee development while ensuring patient safety. In the modern clinical learning environment, tension exists when this balance is skewed. This study aimed to understand the current and ideal states of autonomy and supervision, then describe the factors that contribute to imbalance from both trainee and attending perspectives.

Methods

A mixed-methods design included surveys and focus groups of trainees and attendings at three institutionally affiliated hospitals between May 2019-June 2020. Survey responses were compared using chi-square tests or Fisher's exact tests. Open-ended survey and focus group questions were analyzed using thematic analysis.

Results

Surveys were sent to 182 trainees and 208 attendings; 76 trainees (42%) and 101 attendings (49%) completed the survey. Fourteen trainees (8%) and 32 attendings (32%) participated in focus groups. Trainees perceived the current culture to be significantly more autonomous than attendings; both groups described an "ideal" culture as more autonomous than the current state. Focus group analysis revealed five core contributors to the balance of autonomy and supervision: attending-, trainee-, patient-, interpersonal-, and institutional-related factors. These factors were found to be dynamic and interactive with each other. Additionally, we identified a cultural shift in how the modern inpatient environment is impacted by increased hospitalist attending supervision and emphasis on patient safety and health system improvement initiatives.

Conclusions

Trainees and attendings agree that the clinical learning environment should favor resident autonomy and that the current environment does not achieve the ideal balance. There are several factors contributing to autonomy and supervision, including attending-, resident-, patient-, interpersonal-, and institutional-related. These factors are complex, multifaceted, and dynamic. Cultural shifts towards supervision by primarily hospitalist attendings and increased attending accountability for patient safety and systems improvement outcomes further impacts trainee autonomy.

Veterinary Nursing Students' Experience in the Clinical Learning Environment and Factors Affecting their Perception

Student veterinary nurses (SVNs) spend a significant proportion of their training time within the clinical learning environment (CLE) of a veterinary practice. These clinical experiences are vital for building practical and professional skills. To evaluate the current satisfaction of SVNs in the CLE, a cross-sectional survey design was used incorporating a previously validated instrument. To provide understanding of factors that may affect the SVN satisfaction, additional validated tools were added across factors, including resilience, wellbeing, personality, and work place belonging. A total of 171 SVNs completed the survey. In addition, two open questions were included to provide greater depth of understanding of the SVN experiences. Results showed that 70.76% of respondents were satisfied/very satisfied with the CLE. Significant factors that affected the satisfaction scores included, depression, anxiety, and stress (p ≤ .001), psychological sense of organizational membership (p ≤ .001), agreeableness (p = .022), and emotional stability (p = .012). The qualitative data demonstrated shared SVN factors that are considered to contribute to clinical learning and those that detract from clinical learning. Educational facilities and training veterinary practices can support the SVN within the CLE by creating a greater sense of belonging, considering the SVN individual personality and wellbeing, and including the SVN in discussions around learning support needs.

Appraisal and Evaluation of the Learning Environment Instruments of the Student Nurse: A Systematic Review Using COSMIN Methodology

BACKGROUND

Nursing education consists of theory and practice, and student nurses' perception of the learning environment, both educational and clinical, is one of the elements that determines the success or failure of their university study path. This study aimed to identify the currently available tools for measuring the clinical and educational learning environments of student nurses and to evaluate their measurement properties in order to provide solid evidence for researchers, educators, and clinical tutors to use in the selection of tools.

METHODS

We conducted a systematic review to evaluate the psychometric properties of self-reported learning environment tools in accordance with the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Guidelines of 2018. The research was conducted on the following databases: PubMed, CINAHL, APA PsycInfo, and ERIC.

RESULTS

In the literature, 14 instruments were found that evaluate both the traditional and simulated clinical learning environments and the educational learning environments of student nurses. These tools can be ideally divided into first-generation tools developed from different learning theories and second-generation tools developed by mixing, reviewing, and integrating different already-validated tools.

CONCLUSION

Not all the relevant psychometric properties of the instruments were evaluated, and the methodological approaches used were often doubtful or inadequate, thus threatening the instruments' external validity. Further research is needed to complete the validation processes undertaken for both new and already developed instruments, using higher-quality methods and evaluating all psychometric properties.

Comparing Preferred and Actual Clinical Learning Environments and Perceptions of First-Year Nursing Students in Long-Term Care: A Cross-Sectional Study

The clinical learning environment, which includes the culture of clinical units, the mentoring process, and the different health organizations, influences the learning process of nursing students. However, scarce literature has been published on the impact of the clinical learning environment on first-year nursing students in long-term care. We aimed to assess first-year nursing students 'preferred' and 'actual' clinical learning environments when conducting their first placements in nursing homes within an innovative placement model that comprised the active participation of academic mentors. The validated Spanish version of the Clinical Learning Environment Inventory (CLEI) instrument was used in our study, and 99 first-year nursing students participated. The highest mean scores for the CLEI-Actual were found for the Satisfaction (22.7) and Involvement scales (19.09). The lowest mean scores were found for the Personalization (17) and Individualization (17.27) scales. The multiple correlation (R) between the Satisfaction and the other CLEI scales was 0.61 (p > 0.001), which means that in this study the association between student satisfaction and their perception of the clinical learning environment was strong. First-year students conducting their first clinical placements in nursing homes can have a positive learning experience considering a well-designed and organized pedagogical strategy, including constant support and feedback from academic and clinical mentors.

STUDENT EVALUATION OF THE CLINICAL EDUCATION: ENVIRONMENT: DEVELOPMENT AND TESTING OF THE SECEE VERSION 4

Background and Purpose: Nursing education programs must ensure the quality of student clinical learning experiences. The purpose of this paper is to present psychometric data on the revised digital version of the Student Evaluation of Clinical Education Environment (SECEE) v.4 instrument. Methods: Data were extracted retrospectively from student SECEE evaluations completed between 2016 and 2019. Results: Reliability coefficients for each of the three SECEE subscales were .92 and above. Exploratory factor analysis indicated strong loadings of all selected items on the pre-identified subscales, explaining 71.8% of total score variance. The inventory scale scores were able to discriminate differences between individual clinical sites, between clinical faculty, and between student level in the program. Conclusion: Analysis supports the reliability and validity of the revised instrument and a sizable improvement in total variance accounted for by the contained subscales compared to previous SECEE versions.

Lived Experiences of Mistreatment in a General Surgery Residency

OBJECTIVE

Explore the lived experiences of General Surgery residents to identify how they perceive, define mistreatment, and which factors can contribute to or mitigate mistreatment within the Clinical Learning Environment.

DESIGN

This is a phenomenological study conducted during 2019-2020 using Giorgi's psychological descriptive phenomenology methodology. Researcher bias, trustworthiness, and triangulation were addressed using bracketing, check-ins with program leadership, comparisons to resident survey, and team consensus based on Consensual Qualitative Research.

SETTING

General Surgery Residency program at Long School of Medicine, UT Health San Antonio, Texas.

PARTICIPANTS

All residents in the general surgery program were invited to participate (n= 66, 43% female and 63% non-Hispanic). Specific demographic and identifying data for each participant was not collected. Approximately 50 (76% of program) residents from General Surgery participated.

RESULTS

We were able to identify four themes that helped to delineate the lived experience of residents including program cultural factors, resident internal processing, and perceived effects of mistreatment by the residents. The resulting psychological structure and conceptual framework help clarify the interrelations between the themes and the Clinical Learning Environment. The scenarios discussed were adapted and depersonalized to use as prompts for the Forum Theater intervention. This project set out to explore resident's lived experiences and allow the data to reveal the main outcomes. The data was coded and analyzed following strict guidelines from descriptive psychological phenomenology and Consensual Qualitative Research with the aim of informing a later experiential intervention based on Forum Theater.

CONCLUSIONS

The lived experience of general surgery residents helped identify cultural factors and behaviors that contribute to and/or mitigate mistreatment providing information to plan interventions at the resident and faculty level. Mitigating or stopping mistreatment can improve the Clinical Learning Environment and hence, the quality of training.

Psychometric properties of Clinical Learning Environment Inventory and its association with Moroccan nursing students' satisfaction: A PLS-SEM approach

Background

The Clinical Learning Environment (CLE) is integral to pre-registration nursing curricula. Assessing the student's perceptions of their CLE is essential to adjust clinical placement to trainees' needs. Clinical Learning Environment Inventory (CLEI) appears to be widely used in measuring CLE, but no previous study has reported a full structural validity and its association with students' satisfaction in the Moroccan context.

Objectives

This study investigated the psychometric properties of the CLEI and its subscales association with Moroccan nursing students' satisfaction.

Methods

The research design was descriptive, cross-sectional, and conducted from March and June 2022 using convenience sampling in three nursing institutes of the Fez-Meknes region of Morocco. The selected sample involved Moroccan nursing students undertaking clinical practice. First, exploratory factor analysis (EFA) was used to determine the factor structure of the pilot sample (N = 143). The second sample (N = 206) was then used to confirm this structure using partial least squares structural equation modeling (PLS-SEM) confirmatory composite analysis (CCA). Finally, using a bootstrapping method, the significance of the structural path was evaluated.

Results

The CLEI scale depicted convergent validity (AVE = 0.56 - 0.71), discriminant validity, estimated by the square roots of AVE and bootstrapped HTMT confidence interval, and significant reliability (rhoC = 0.83 - 0.92). Using a bootstrapping approach, structural path significance displayed a substantial association between task orientation and students' satisfaction (β = 0.29, p <0.001). This ascertains that nurse students need well-planned guidelines from their facilitators in clinical wards.

Conclusions

The CLEI instrument revealed adequate psychometric properties and supported its original structure. As a result, the instrument might be used to measure students' perceptions of their CLE. Task orientation appeared to be the most important factor influencing the students' satisfaction in CLE.

Developing the SVN CLEI: A Novel Psychometric Instrument for Evaluating the Clinical Learning Environment of Student Veterinary Nurses in the UK

Student veterinary nurses (SVNs) in the United Kingdom can spend over half their training time within the clinical learning environment (CLE) of a training veterinary practice before achieving clinical competency. Sociocultural complexities and poor management within the CLE may have a significant impact on the learning experiences of SVNs, as has been found in studies involving student human nurses. The aim of this research was to develop and validate the SVN CLE Inventory (CLEI) using principal component analysis (PCA), via a cross-sectional design, based on inventories already established in human nursing CLEs. The SVN CLEI was distributed to SVNs via an online survey over a 3-month period, generating 271 responses. PCA resulted in a valid and reliable SVN CLEI with 25 items across three factors with a total variance explained of 61.004% and an overall Cronbach's alpha (α) of .953 (factor 1: clinical supervisor support of learning [α = .935]; factor 2: pedagogical atmosphere of the practice [α = .924]; factor 3: opportunities for engagement [α = .698]). Gaining student feedback is a requirement set out by the Royal College of Veterinary Surgeons Standards Framework for Student Veterinary Nurse Education and Training, and the SVN CLEI can be used to complement the current evaluation of the training veterinary practice CLE. This will facilitate development of a more comparable, consistent, and positive experience for SVNs during clinical training in the UK.

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.

Preceptor support during the COVID-19 pandemic: Recommendations for continuing development

Background

Mentally fit preceptors may be more capable and flexible in providing students with system, emotional and cognitive support in the clinical learning environment (CLE) in the face of any life-threatening outbreaks. Existing professional development programmes for preceptors emphasise the development of preceptor competence in a normal CLE with minimal focus on their ability to engage with adverse events that challenge their mental health.

Objective

The study sought insight from preceptors’ experiences during the coronavirus disease 2019 (COVID-19) pandemic to identify their professional development programme needs while providing support to students during accompaniment.

Method

A mixed methods convergent parallel design was used to collect data from 24 preceptors at a nursing education institution (NEI). Eleven preceptors responded to the survey that included the coronavirus disease 2019 (COVID-19) Stress Scale (CSS) and Burnout Assessment Tool (BAT) to collect quantitative data. Semistructured interviews were conducted with five purposively selected preceptors to collect qualitative data regarding their experiences while accompanying students during the COVID-19 pandemic.

Results

Subscales within the CSS and BAT instruments were mapped against an existing preceptor support framework. Overall CSS data for each subscale indicated an average score varying from no stress to moderate stress, while BAT data shows that respondents rarely experienced burnout. However, some respondents experienced very high levels of stress and burnout. Qualitative data supplemented results.

Conclusion

The COVID-19 pandemic influenced preceptors’ role in supporting students and reflecting that they amended their functioning role. Existing preceptor professional development programmes should be reviewed to ensure that the necessary concepts that foster resilience are integrated to enhance the functional role of preceptors in adversity.

Contribution

Existing preceptor professional development programmes should be reviewed to ensure that the necessary concepts that foster resilience are integrated to enhance the functional role of preceptors in adversity.

How Perceived Burnout Alters Frontline Educators' Assessments in the Clinical Learning Environment

OBJECTIVE

This study explores frontline educators' experience with learner burnout in the clinical learning environment (CLE) and how perceived burnout may impact assessment.

METHODS

A survey was sent to 105 Pediatric Hospital Medicine faculty and fellows at 7 sites across the United States representing diverse CLEs. They were invited to participate in an 11-question web-based survey that was developed, edited, and revised in step-wise fashion. It consisted of 5-point Likert scale, forced-choice, and dichotomous questions. Data from the web-based survey were compiled for descriptive purposes and analyzed for trends.

RESULTS

The response rate was 53%. Most respondents (83%) perceive learner burnout at least once per year, but median comfort in identifying burnout was 3 (scale 1-5, 3 = neutral). Factors associated with comfort were education as primary niche (P = .01) and having wellness training (P = .045). In terms of the impact of perceived learner burnout impacts on assessment, 88% report impact on feedback sessions and 60% reported impact on summative assessment; most are more lenient. Stated belief in whether perceived burnout should or should not impact assessment had 60% sensitivity and 84% specificity in predicting whether it does.

CONCLUSIONS

Frontline educators routinely perceive learner burnout in the CLE and it often impacts educators' assessment of a learner. The discrepancy between the expected and actual impact may suggest amplification of known barriers to accurate assessment in the CLE. Comfort associated with wellness training suggests that interventions targeting frontline educators in the CLE may improve their ability to simultaneously support and assess learners.

Interprofessional education in the clinical learning environment: a mixed-methods evaluation of a longitudinal experience in the primary care setting

Team collaboration in our healthcare workforce is necessary to effectively address multifaceted medical and social needs, especially for those impacted by systemic inequities. Effective interprofessional practice and education models including curricula are needed to prepare a practice ready healthcare workforce for team collaboration. Most healthcare trainee interprofessional experiences take place episodically in classroom settings. However, creating a culture that supports team-based learning and interprofessional clinical practice requires teaching skills (e.g., communication, collaboration, shared decision-making, coordination of care) longitudinally in the clinical setting. A weekly interprofessional clinic for patients/clients with chronic health conditions was organized in three primary care practices. Trainees from nutrition, social work, medicine, and physician assistant programs worked with supervising clinicians from each field. Surveys, interviews, and focus groups assessed the effects of interprofessional education and training in the primary care setting. Results show the longitudinal experiential IPE program significantly improved knowledge, attitudes, skills, and values addressing key interprofessional competencies. Qualitative results complement survey data and highlight key themes addressing patient-centered care and team dynamics. These findings demonstrate the importance of longitudinal, immersive team-based interprofessional training in the clinical learning environment.

Training and Preparedness of Clinical Coaches for Their Role in Training Student Veterinary Nurses in the United Kingdom: An Exploratory Inquiry

The experience that student veterinary nurses (SVNs) have in the clinical learning environment can be greatly influenced by the clinical coach (CC); the supervisory relationship will affect student retention and clinical competency. To support a positive student experience, the training and development of CCs must be critically reviewed and regularly updated. This research aimed to ascertain the current CC training undertaken and the preparedness of CCs for their role in training SVNs. We used a prospective cross-sectional study design. An online survey was distributed over 4 weeks to CCs across the United Kingdom representing a range of educational institutions, and it generated 80 responses. Prior to undertaking their initial CC training, CCs had been qualified practitioners for a median of 2.2 years (IQR = 4.16y). CCs stated they needed more course content during their training regarding student teaching and pastoral support, more support from associated institutions, and there was a call for a longer training period leading to a formal qualification. Providing CC training with broader course content and some level of evaluation should be considered to develop and assess the non-clinical skills that are vital to the role.

Meeting Undergraduate Nursing Students' Clinical Needs: A Comparison of Traditional Clinical, Face-to-Face Simulation, and Screen-Based Simulation Learning Environments

BACKGROUND

Nurse educators expanded replacement of traditional clinical practice and face-to-face simulation experiences with screen-based simulation (SBS) during the COVID-19 (coronavirus disease 2019) pandemic.

PURPOSE

The purpose of this research was to understand the student experience when learning in 3 types of clinical education environments.

METHODS

This quantitative descriptive survey study used the Clinical Learning Environment Comparison Survey 2.0 (CLECS 2.0) to compare prelicensure nursing students' perceptions of learning in 3 clinical learning environments.

RESULTS

The CLECS 2.0 was completed by 113 participants from 3 countries. Most scores were highest for the traditional clinical practice environment, and all were lowest for the SBS environment.

CONCLUSIONS

The findings are concerning as discussions about whether SBS can replace traditional clinical practice hours unfolds. The findings support the need for concentrated efforts to improve specific areas of the SBS experience.

Dundee Ready Education Environment Measure of Dentistry: Analysis of Dental Students' Perception about Educational Environment in College of Dentistry, Mustaqbal University

INTRODUCTION

Evaluation of the educational environment is an important element which can be used to improve our curriculum. The aims and objectives of this cross-sectional study were to identify the student's perception about educational environment in College of Dentistry, Mustaqbal University. As the educational environment has a significant impact on the learning and academic performance of the students, the present study will help us identify areas of improvement and refining the dental curriculum.

MATERIALS AND METHODS

A total of 120 students of year 4, 5, 6, and interns, both male and female, responded to the Dundee Ready Education Environment Measure (DREEM) in the 1^st month of the second semester, 2021. This scale measures the student's perceptions of the educational environment overall and for five domains: learning, teaching, academic self-perception, atmosphere, and social self-perception.

RESULTS

A total of 92 students responded and were generally positive about their learning environment, with a total DREEM score of 130.87 ± 32.73/200. The lowest score for Domain 5 (social self-perception) and the highest score for Domain 1 (student's perception of learning.) were noted.

CONCLUSION

Students' perception of educational environment of College of Dentistry, Mustaqbal University, was more positive than negative. This study provided a valuable insight of how students perceive their course and identified several weak areas that need to be worked upon, hence helping in improvement of the curriculum.

Final clinical practicum shapes the transition experience and occupational commitment of newly graduated nurses in Europe-A longitudinal study

Aims

The aim of the study was to examine the association between the characteristics of a nursing student’s final clinical practicum and the success of transition of newly graduated nurses (NGNs) in six European countries.

Design

A longitudinal design with two data collections points (pre‐ and post‐graduate).

Methods

The data were collected with an online survey between May 2018 and April 2020 from graduating nursing students (n = 1796) in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Altogether, 642 NGNs responded to the second questionnaire 1 year after graduation. Logistic and linear regression analyses were used to examine the associations between five clinical practicum characteristics and three indicators for the success of transition (ease of transition, turnover intentions and occupational commitment). Models were adjusted for demographic and background/workplace factors and professional competence.

Results

Several associations were observed between the different clinical practicum characteristics and the indicators for a successful transition. Good pedagogical atmosphere and good supervisory relationship were associated with higher likelihood of an easy transition. Good leadership style of the ward manager, good premises of nursing care on the ward and a good supervisory relationship were associated with higher occupational commitment. No consistent association with turnover intention was found.

Conclusion

Having a good final clinical practicum before graduation can contribute to an easier transition experience for newly NGNs and strengthen their commitment to the nursing profession.

Impact

This study adds to the limited existing knowledge about the importance of final clinical practicums in shaping the transition process and occupational commitment of NGNs. Investing in creating a good final practicum experience could help healthcare organizations engage new nursing professionals and thus alleviate the existing shortage of nurses.

An Interprofessional E-Learning Resource to Prepare Students for Clinical Practice in the Operating Room-A Mixed Method Study from the Students' Perspective

The operating room is a challenging learning environment for many students. Preparedness for practice is important as perceived stress and the fear of making mistakes are known to hamper learning. The aim was to evaluate students' perspectives of an e-learning resource for achieving preparedness. A mixed methods design was used. Students (n = 52) from three educational nursing and medical programs were included. A questionnaire was used to explore demographics, student use of the e-learning resource, and how the learning activities had helped them prepare for their clinical placement. Five focus group interviews were conducted as a complement. Most students (79%) stated that the resource prepared them for their clinical placement and helped them to feel more relaxed when attending to the operating room. In total, 93% of the students recommended other students to use the e-learning resource prior to a clinical placement in the operating room. Activities containing films focusing on practical procedures were rated as the most useful. We conclude that an e-learning resource seems to increase students' perceived preparedness for their clinical practice in the operating room. The development of e-learning resources has its challenges, and we recommend student involvement to evaluate the content.

Recognizing and Seizing the Teachable Moment

All medical educators have experienced "teachable moments" during their career, and most can likely share examples of these moments from both training and their role as educators. In addition, most if not all have faced a situation in which an educational opportunity fell short or was missed entirely. This View from the Association of Pediatric Program Directors is designed to help pediatric medical educators recognize these teachable moments and feel better prepared to seize them when they arise. First, the authors collate definitions of the "teachable moment" from a variety of sources into 1 coherent definition, using common themes of shared responsibility between educator and learner, spontaneity, consideration of the learning environment, and expanding teaching into other applications. Next the authors provide methods to help educators capitalize on teachable moments when they occur, including discussing goals and expectations, building a culture of error, anticipating common errors made by learners, withholding the answer, managing time effectively, and practicing mindfulness. Numerous examples are described to further understanding. By employing these tactics, both educators and learners can maximize their ability to utilize teachable moments in a variety of clinical settings.

The relationship between clinical placement duration and students' satisfaction with the quality of supervision and learning environment: A mediation analysis

Multiple factors that influence the learning experience of nursing students while they are in clinical training have been identified, such as the clinical learning environment, the supervision provided by supervisors, and the level of cooperation with the nurse teacher. The objective was to examine whether the relationship between the clinical placement duration and overall satisfaction with clinical training is mediated by the supervisory relationship and learning environment. A secondary analysis was conducted using the data from a cross-sectional study conducted in 17 higher educational institutions in nine European countries with the Clinical Learning Environment, Supervision and Nurse Teacher scale (n = 1903 pre-registration nursing students). Satisfaction with the supervisor and a good learning environment mediated the relationship between clinical placement duration and overall satisfaction as perceived by the students. Nursing students with longer clinical placement durations were more satisfied with clinical training as a result of both their satisfaction with their supervisor and their perceptions of good learning environment. The optimal duration a nursing student should remain in the different practice settings is approximately 7 weeks.

Protocol for a mixed-method systematic review on challenges perceived by final-year undergraduate nursing students in a clinical learning environment

Aims

To determine the challenges perceived by final‐year nursing students in the clinical learning environment.

Design

Data‐based convergent mixed‐method systematic review.

Methods

Three electronic databases (Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature) will be used in the identification stage. The first search will use the search string for each database to identify relevant studies. The articles retrieved will be screened by year of publication, article type and language. Abstracts and full‐text of selected studies will be screened for eligibility independently by a minimum of two reviewers. The reference lists will be manually screened to identify additional publications. The quality assessment will be conducted by two reviewers using the Mixed Methods Appraisal Tools. Quantitative and mixed‐method studies will be transformed into qualitative. A thematic approach will be used to synthesize and report the data. Ethics approval and funding have been approved in April 2020.

Discussion

This study will synthesize the types of challenges perceived by final‐year undergraduate nursing students in different clinical learning environments across the country.

Impact

The proposed study findings will help nursing education stakeholders and faculty provide assistance to final‐year nursing students in their transition year to become registered nurses.

Faculty and Peer Support During Pediatric Residency: Association With Performance Outcomes, Race, and Gender

PURPOSE

To examine the association of resident perception of colleague and faculty support with performance, as measured by milestones-based competency scores, exploring associations between race and gender and perception of support and milestone scoring.

METHODS

Resident satisfaction was measured using an annual survey of residents at 49 pediatric residency programs in 2016, 2017, and 2018. Satisfaction with colleague and faculty support was measured using Likert scale survey questions. Pediatric Milestone Competency scores were obtained from the Association of Pediatric Program Directors' Longitudinal Educational Assessment Research Network. Analysis included linear fixed-effects models to examine the relationship between support satisfaction, race, gender, and spring milestone scores.

RESULTS

Over 60% of eligible residents responded to the survey. The majority of residents were satisfied with colleague and faculty support, with those identifying as Asian or underrepresented in medicine (URM) reporting lower rates of satisfaction than White peers. Residents satisfied with colleague support had higher milestone scores compared to those with a neutral degree of satisfaction. Residents reporting dissatisfaction with colleague and faculty support had lower milestone scores in most competency domains. Residents identifying as URM had lower milestone scores than White residents, which was partially mediated by lower rates of support satisfaction.

CONCLUSIONS

Resident satisfaction with colleague and faculty support correlates with milestone performance. In particular, dissatisfied residents have lower scores than those who are neutral or satisfied. Racial inequities in resident milestone scores may be partially driven by lower rates of support satisfaction among underrepresented residents.

Clinical learning environment and graduating nursing students' competence: A multi-country cross-sectional study

The purpose of this study was to explore nursing students' perceptions of their final clinical learning environment and its association with their self-assessed competence, satisfaction with nursing education, and turnover intentions at graduation in six European countries. A multi-country comparative cross-sectional study was conducted with nursing students (n = 1746) from the Czech Republic, Finland, Italy, Portugal, Slovakia, and Spain using the Nurse Competence Scale and the Clinical Learning Environment and Supervision scale. Nursing students' overall perceptions of their final clinical learning environment and supervision were positive in all the countries studied. The correlation between the students' perceptions of their final clinical learning environment and competence was statistically significant and positive. Satisfaction with the nursing program and clinical practicum and no consideration of career change were related to positive perceptions of the final clinical learning environment. Highlighting the importance of the supervisory relationship and pedagogical atmosphere, nursing students' positive perceptions of the final clinical learning environment and supervision contribute to a better level of self-assessed competence and satisfaction with the nursing program and clinical practicum, leading to lower turnover intentions.

Newly graduated nurses' evaluation of the received orientation and their perceptions of the clinical environment: An intervention study

BACKGROUND

New graduate nurses (NGN) are the future of healthcare organizations where a shortage of nurses will soon be reality. The transition from a student to a registered nurse can be a demanding and challenging time, and in order to retain new graduate nurses, the transition should be as smooth as possible.

AIM

The aim of this study was to examine preceptors' education intervention's impact on NGNs' orientation period and their clinical learning environment from NGNs' point of view.

MATERIAL AND METHODS

This survey was a part of a longitudinal quasi-experimental intervention study. Participating units were randomized into intervention group and control group. The intervention group's preceptors (n=174)were provided a face-to-face education about orientation.

RESULTS

NGNs (n=72) were relatively satisfied with the received orientation. However, intervention group was more discontented with their orientation experiences than the control group. The control group's NGNs had longer orientation periods and more feedback discussions. They were also more satisfied with their preceptor's orientation skills and their working environment was more responsive.

DISCUSSION

Even though the impact of the intervention was inconclusive, this study provided us important information about NGNs' first steps towards the nursing profession by giving us clear improvement targets. We need a culture of feedback, individualized orientation and understanding that orientation should be our common interest. Investing in orientation is investing for the future.

CONCLUSION

This study indicated that the increase in knowledge did not translate into everyday practice. This finding will hopefully give rise to discussion within organizations on how to utilize employees' gained knowledge more effectively.

The connection of the clinical learning environment and supervision of nursing students with student satisfaction and future intention to work in clinical placement hospitals

AIMS AND OBJECTIVES

To analyse nursing students' perceptions of the clinical learning environment and supervision and the connection between their satisfaction and intention of staying in their placement hospitals.

BACKGROUND

Global nursing shortage necessitates strategies for the recruitment and retention of nurses. It is believed that nursing students' clinical placement experiences can affect their learning outcomes, as well as influence their choice of future workplace.

DESIGN

Cross-sectional, correlational study.

METHODS

One hundred and eighty nursing students participated in the study. The data were collected in person using The Clinical Learning Environment, Supervision and Nurse Teacher scale tool. Students' satisfaction with the clinical learning environment and learning process was measured using a 4-point Likert scale developed by the researchers. The STROBE checklist was used in this paper.

RESULTS

Nursing students perceived a favourable clinical learning environment and supervision in the hospitals where they undertook clinical placements, recording high levels of satisfaction and high levels of intention to stay and work there. The clinical learning environment and supervision established positive correlations with student satisfaction.

CONCLUSIONS

This study promotes the development of knowledge and understanding of how student satisfaction and intention to stay and work in their placement hospitals relates to the quality of the clinical learning environment and supervision, which could be helpful to the management of healthcare facilities and faculties in improving nursing education and retention/recruitment strategies.

RELEVANCE TO CLINICAL PRACTICE

Nursing students represent the future of the nursing workforce, so managers of healthcare facilities and faculties should move towards promoting a clinical learning and supervisory environment where supervisors, tutors and staff are aware of their commitment to student education and promote optimal learning and positive experiences in order for students to feel satisfied and motivated to work in their placement hospitals.

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.

The gap in the clinical learning environment: The viewpoints of nursing students

INTRODUCTION

The clinical environment is an essential and irreplaceable resource in preparing nursing students for their professional role. Despite many changes that occur in the clinical learning environment (CLE), these environments remain important to nurse training. With regard to the importance of students' viewpoints in the evaluation of CLE, this study was performed to the determination of nursing students' viewpoint of the actual and preferred CLE at Bushehr University of Medical Sciences in Iran 2013.

MATERIALS AND METHODS

In this cross-sectional analytic study, due to the small size of the research population, all nursing students (86 students) of Bushehr University of Medical Sciences in Iran who had passed at least one clinical course were selected through the census. Participants were invited to complete anonymously the actual and preferred Farsi versions of the CLE Inventory consisting of 42 items originally developed by Professor Chan (2001). Data were analyzed using frequency distribution, mean, standard deviation, and paired t-test.

RESULTS

The results indicated that there were significant differences between students' perceptions of the actual and the preferred CLE (P < 0.001). The highest and lowest mean scores of actual CLE belonged to student involvement and individualization, respectively, and the highest and lowest mean scores of preferred CLE belonged to task orientation and individualization, respectively.

CONCLUSION

In general, students prefer a more positive CLE than what they actually have experience and would prefer an environment with higher levels of clarification of personalization, student Involvement, satisfaction, task orientation, innovation, and individualization.

Magnet hospital attributes in nursing work environment and its relationship to nursing students' clinical learning environment and satisfaction

AIMS

To analyse nursing students' perception of the Magnet hospital attributes of the work environment at the hospitals where they perform their clinical placement and the relationship of this factor to their clinical learning environment and supervision, satisfaction and intention to stay in those hospitals once graduated.

DESIGN

This study had a cross-sectional, correlational, design.

METHODS

Data were collected using self-reported questionnaires from 180 nursing students at a university in southeast Spain between September-October 2018. Nursing work environment and clinical learning environment were measured using the Practice Environment Scale of the Nursing Work Index and Clinical Learning Environment, Supervision and Nurse Teacher scale, respectively. Students' satisfaction with the work environment and with the clinical learning process were measured using a four-point Likert scale developed by the researchers. Percentages, frequencies, mean, standard deviation, χ² test, Mann-Whitney U test, Spearman and phi correlation were used to analyse the data.

RESULTS

Nursing students' perception of greater Magnet-like features at work environment was associated with better clinical learning environment (Spearman rs = |0.22-0.54|; p < .01) and satisfaction with the work environment (Spearman rs = 0.18; p = .01) and with their learning process (Spearman rs = 0.21; p < .01). Greater intention to stay working in the hospital after graduation was significantly associated with greater satisfaction with the learning process (phi = 0.31; p < .01) and the work environment (phi = 0.23; p = .02).

CONCLUSION

Magnet-like features at the work environment lead to superior clinical learning environment and higher students' satisfaction, two factors that play a decisive role in their decision to stay at hospitals where they performed clinicals after graduation.

IMPACT

In the face of a global nurse shortage, nursing managers and faculty leaders should consider the improvement of nursing workplaces as a strategic alliance to promote satisfactory clinical learning experience and aid recruitment of nurses.

Social Media Used and Teaching Methods Preferred by Generation Z Students in the Nursing Clinical Learning Environment: A Cross-Sectional Research Study

Generation Z nursing students have a distinctive combination of attitudes, beliefs, social norms, and behaviors that will modify education and the nursing profession. This cross-sectional research study aimed to explore the social media use and characteristics of Generation Z in nursing students and to identify what were the most useful and preferred teaching methods during clinical training. Participants were Generation Z nursing degree students from a Spanish Higher Education Institution. A 41-item survey was developed and validated by an expert panel. The consecutive sample consisted of 120 students. Participants used social media for an average of 1.37 h (SD = 1.15) for clinical learning. They preferred, as teaching methods, linking mentorship learning to clinical experiences (x¯ = 3.51, SD = 0.88), online tutorials or videos (x¯ = 3.22, SD = 0.78), interactive gaming (x¯ = 3.09, SD = 1.14), and virtual learning environments (x¯ = 3, SD = 1.05). Regarding generational characteristics, the majority either strongly agreed or agreed with being high consumers of technology and cravers of the digital world (90.1%, n = 108 and 80%, n = 96). The authors consider it essential to expand our knowledge about the usefulness or possible use of teaching methods during clinical learning, which is essential at this moment because of the rapidly changing situation due to the Covid-19 pandemic.

Nursing students' views and satisfaction of their clinical learning environment in Singapore

Aims

This study aims to investigate final-year nursing students' actual perception of their clinical learning environment in Singapore.

Design

Descriptive cross-sectional survey.

Methods

An online survey based on the clinical learning environment inventory (CLEI; "Actual" version) was administered to final-year (third year) nursing students (N = 301) in a polytechnic in Singapore between May-July 2018.

Results

Most nursing students reported moderate satisfaction with their clinical learning environment, reflecting their positive (although not strongly positive) perceptions. Among the six constructs of the CLEI, the higher scores of the constructs of "Personalization" and "Task orientation" implied their greater contribution to the positive view. Conversely, the lower scores of "Individualization" and "Innovation" implied their lesser contribution. Additionally, the positive correlation between "satisfaction" and the other five CLEI constructs was found to be statistically significant.

Clustering clinical learning environment and mentoring perceptions of nursing and midwifery students: A cross-sectional study

AIMS

This study aimed to explore nursing and midwifery students' evaluation of the clinical learning environment and mentoring and to identify distinct student profiles relating to their perceptions.

DESIGN

This study employed a cross-sectional design.

SETTINGS

The study population included nursing and midwifery students in a university hospital in Finland.

PARTICIPANTS

All nursing and midwifery students who completed their clinical placement were invited to take part in the study in the academic year 2017-2018.

METHODS

The data (N = 2,609) were gathered through an online survey using the Clinical Learning Environment, Supervision and Nurse Teacher scale. The data were analysed using a K-mean cluster algorithm to identify nursing and midwifery students' profiles.

RESULTS

The findings from this study indicate four distinct profiles (A, B, C, & D) of nursing and midwifery students in relation to the clinical learning environment and mentoring. Profile A (N = 1,352) students evaluated their clinical learning environment and mentoring to the highest level (mean varied from 9.44-8.38); and Profile D (N = 151)- to the lowest (mean varied from 5.93-4.00).

CONCLUSION

The findings highlight that nursing and midwifery students evaluate their clinical learning environment and mentoring more highly when: they have a named mentor, student and mentor discuss learning goals, there is a final assessment in clinical learning, the mentor's guidance skills support student learning, the clinical learning supports the student's professional development and pre-clinical teaching in an educational institution supports learning in the clinical placement.

IMPACT

Clinical learning plays an important role in nurse and midwifery education. Mentoring of clinical practice was shown to have a great influence on students' perceptions of their success in clinical learning. We suggest that clinical practice should be strengthened by the building of collaboration between nursing teachers and registered nurses.

Perceived Stress Among Iranian Nursing Students in a Clinical Learning Environment: A Cross-Sectional Study

BACKGROUND

Nursing students experience a high level of stress in clinical settings. This study aimed to investigate the stress perceived by Iranian nursing students in the clinical learning environment and its relationship with the characteristics of students.

METHODS

In this cross-sectional study, 430 nursing students who had passed at least 1 clinical training unit were recruited from universities in the Southeast of Iran using the census method. Data were collected by administering a demographic and researcher-made questionnaire to assess the perceived clinical stress. Demographic characteristics included age, sex, marital status, year of study, interest in the field, and previous semester average. Data were analyzed using independent t-test, ANOVA, and correlation coefficient test (α < 0.05).

RESULTS

The mean score of overall stress experienced by the participants was 92.08±16.8 (out of 160), which was at a moderate level. Based on the study results, the most stress-inducing factors for students were instructors' limited clinical competence and instructors' inappropriate conduct. Gender (p = 0.01), fathers' education (p = 0.01), mothers' education (p = 0.01), interest in the field (p = 0.01), and year of study (p = 0.01) had a significant effect on the mean score of perceived clinical stress.

CONCLUSION

The results of this study showed a moderate level of stress among the students. Also, instructors' limited clinical competence and inappropriate conduct were 2 factors that caused the highest perceived stress among nursing students more than other factors.

Nursing and Midwifery Students' Viewpoints of Clinical Learning Environment: A Cross-Sectional Study

OBJECTIVE

To determine the viewpoints of nursing and midwifery students regarding the clinical learning environment and to identify the relationship between these viewpoints with some demographic characteristics of students.

METHODS

This cross-sectional study was carried out on nursing and midwifery students (n=119) in the educational hospitals affiliated to Kermanshah University of Medical Sciences from February to June 2017. The data-gathering tools were a demographics questionnaire and the standard undergraduate clinical education environment measure. This tool comprises two main scales of learning through experiencing and social participation, with four subscales of opportunities to learn in and through work and quality of supervision, preparedness for student entry, workplace interaction patterns and student inclusion, and equal treatment. The score ranged from 25 to 125 and the higher the score the higher the quality of the educational environment. The collected data were analyzed in "Statistical Package for the Social Sciences" (Version20).

RESULTS

The nursing and midwifery students' viewpoint of the clinical learning environment was suboptimal. There was a significant difference between the female and male students' viewpoints of the clinical learning environment (p=0.007). There was no significant difference between students' viewpoints of the clinical learning environment with marital status, employment, domicile, grade-point average, and number of days of internship. Nursing students had more positive viewpoints of the clinical learning environment than midwifery students (p=0.001).

CONCLUSION

The results showed that the clinical learning environment was suboptimal based on the nursing and midwifery students' perspectives. Intervention to improve the clinical learning environment is recommended.

Self-reported psychological problems amongst undergraduate dental students: A pilot study in seven European countries

AIM

To map psychological problems amongst undergraduate dental students with a focus on different time points in clinical work in seven Eastern European and Scandinavian countries.

MATERIALS AND METHODS

A total of 1063 3rd- and 5th-year dental students (response rate 70%) participated in this pilot study and completed a pre-tested, structured questionnaire, which collected information on sociodemographic characteristics and self-reported psychological problems. Data were analysed by bivariate and multivariate methods.

RESULTS

The majority of participants were female and were younger than male participants. Most participants, though more females than males, agreed that the clinical work of dentistry was psychologically difficult. Almost half of participants felt nervous before working with patients (N = 506, 48%) and experienced a lot of stress whilst working with patients (N = 488, 46%); almost one-third (N = 287, 27%) felt anxious/worried after working with patients. Being a 3rd- and 4th-year student (vs 5th-year) reduced the odds for anxiety after working with patients; being a 3rd-year student (vs 5th-year) increased the odds for stress whilst working with patients. Studying in countries other than Norway reduced the odds for stress whilst working with patients. Less than good self-perceived health, presence of psychological health complaints before starting dental education, female gender and lack of physical activity increased the odds for psychological problems.

CONCLUSION

A high number of undergraduate dental students reported psychological problems in connection with clinical work. It is unlikely that "one size fits all"; therefore, further qualitative investigations on stressors in clinical learning environments should be done in order to design tailor-made supportive strategies.

Saudi Nurses' Competency Learnings and Experiences from the Newly Developed Advanced Nursing Practice Diploma Program in Saudi Arabia: A Phenomenological Study

Introduction  In response to Saudi Vision 2030, the Saudi Commission for Health Specialties has taken the lead in supporting healthcare system development by providing advanced nursing practice training diplomas. The aim of this study is to explore the experience of nursing trainees during their enrollment in the newly established Saudi Commission for Health Specialties (SCFHS) Advanced Nursing Practice (ANP) diplomas. Methods  We employed a descriptive phenomenological approach in this study. Collaizi's distinctive process was utilized as a guide for the data analysis of 12 interviews. Results Exploring the participants' experiences revealed four themes: (1) the organizational culture valuing the learner and their learnings; (2) the commitment to continuous quality care improvement; (3) challenges in the trainer-trainee relationship; and (4) the vague career track of the trainees. Conclusion The identified challenges faced by the nursing trainees may hinder the optimum utilization of these program outcomes. Interventions to overcome the identified challenges should be initiated by all stakeholders.

Steps towards validation of the Dental Education Clinical Learning Instrument (DECLEI) in American dental schools (DECLEI-USA)

PURPOSES/OBJECTIVES

Few tools assess the dental school clinical learning environment from students' perspectives. Considering previous efforts to validate the Dental Education Clinical Learning Instrument (DECLEI) in the United States, the goal of this study was to look for the fewest number of items that accounted for the most amount of variability in responses and/or had the highest correlation to the total DECLEI score using a larger, multi-center sample.

METHODS

The DECLEI was distributed to 286 students in two dental schools (University of Iowa and University of Texas at Houston) during the 2017-2018 academic year. Two alternative methods were applied. In the first approach, all 24-items were regressed on the total composite score using a forward conditional method. In the second approach, the item-total correlation for the full scale was calculated and then items with relatively poor coefficients were eliminated. A cutoff of 0.30 or less was used.

RESULTS

The first approach, Total R2 by Regression Model, produced a 9-item scale accounting for 90% of the variance in total score and a Cronbach's α coefficient of 0.79. The second approach, Item-Total Correlation, produced a larger scale (20 items), as well as a higher Cronbach's α coefficient of 0.89. The instrument also presented appropriate sensitivity to measure differences between race groups and school of origin.

CONCLUSION

DECLEI may have the potential to be used as an instrument to measure clinical learning environments for U.S. dental students using either a smaller, concise scale (Mini DECLEI-USA) or a larger (DECLEI-USA), more thorough scale.

Otolaryngology Resident Well-Being and Perceptions of the Clinical Learning Environment

OBJECTIVE

To measure the current state of organizational and well-being factors in otolaryngology residency programs and associate these perceptions with demographics, pursuit of subspecialty fellowships, and performance on the Otolaryngology Training Examination (OTE).

MATERIALS AND METHODS

Anonymous mail and online survey study of otolaryngology residents from the Southern, Mid-Atlantic, and East South-Central Regions of the United States.

SUMMARY OF RESULTS

A total of 46 otolaryngology residents across 14 residency training programs (22% resident response rate) completed our survey. Residents who scored above the 80th percentile on the OTE perceived greater organizational support (median = 3.84) than residents who scored below the 40th percentile (median = 3.31), U = 48.00, P = .047, η² = 0.14. Residents interested in fellowship reported less burnout (median = 2.44) compared to those who did not plan to pursue fellowship (median = 3.56), U = 105.00, P = .010, η² = 0.05. Residents pursuing fellowship also reported less work-life strain (median = 2.56) than those forgoing fellowship (median = 2.89), U = 126.00, P = .044, η² = 0.10. Residents with children reported greater work-life strain (median = 3.11) compared to those without (median = 2.56), U = 60.50, P = .008, η² = 0.15.

CONCLUSION

For otolaryngology residents in this survey sample, the perception of organizational support and well-being may influence resident performance (on OTE examinations) and ultimate career goals (fellowship applications). Program directors and coordinators can use this information to strengthen the perceptions of organizational support as well as improve the clinical learning environment to optimize training conditions for their residents. Residency program directors can also use the identified study measures to assess resident perceptions of the clinical learning environment and well-being for annual evaluation and improvement purposes.

Oral Health and Dental Students' Perceptions of Their Clinical Learning Environment: A Focus Group Study

Creating an optimal clinical learning environment poses a challenge to health professions educators. To evaluate and improve the clinical learning environment, it is necessary to understand students' experiences of their environment and the factors they perceive as having an impact on their learning. The aim of this explorative qualitative study was to examine University of Otago Faculty of Dentistry students' perceptions of their clinical learning environment to gain insights into how learning outcomes could be enhanced. In 2015, all approximately 600 students at all levels of the Bachelor of Oral Health and Bachelor of Dental Surgery degrees at the University of Otago, Dunedin, New Zealand, were invited to participate in focus groups. Focus groups facilitated by the faculty education research fellow and another researcher employed for the project were conducted during the second half of the academic year. Transcribed data were analyzed using a general inductive approach. Twenty-one students from all levels of the two programs attended one of six confidential focus groups. Three broad themes were evident in the results from all groups: feedback processes, assessments and grading, and tutor interactions. In the focus groups, students expressed dissatisfaction regarding current feedback practices, types of feedback to benefit learning, consistency in the grading system, and impact of different educators' teaching styles on learning. These results indicated a need for further research and curricular efforts to promote good student-teacher relationships in the clinical learning environment, which are paramount for creating an optimal teaching and learning environment and enhancing student outcomes.

Dental Schools

Research on dental students' perceptions of clinical learning environments is needed to identify strengths, weaknesses, and need for interventions to sustain high-quality dental education, but a primary challenge has been the absence of an instrument designed to assess these perceptions. The Dental Clinical Learning Environment Instrument (DECLEI) is a new instrument developed specifically for dental clinical learning environments according to psychometric standards and validated in Europe. The aim of this study was to perform a preliminary validation of DECLEI in a U.S. dental school, thus providing data for subsequent validation in a larger, multi-institution sample. After five experienced faculty members assessed DECLEI's item relevance and content validity, the instrument was distributed in 2016 to 144 third- and fourth-year dental students at the University of Iowa College of Dentistry & Dental Clinics. All 144 questionnaires were completed (100% response rate). The results were tabulated and submitted to principal component analysis with an orthogonal rotation to assess internal structure of the measure. Internal consistency reliability was assessed using Cronbach's alpha coefficient and corrected item-total correlations. The results showed that, of the initial 24 items, principal component analysis allowed 18 items grouped in five domains: student-faculty interaction, equipment and patient issues, didactic-clinical components interaction, negative perceptions, and self-assessment. The Cronbach's alpha coefficients for these five domains ranged from 0.52 to 0.80. These results suggest that DECLEI has the potential for use as a reliable instrument to assess students' perceptions of clinical learning environments at U.S. dental schools, thus supporting the need for a definitive validation analysis in a larger sample.