Clinical Learning Environments in Medical Specialty Residences at a Third Level of Care
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feb 16, 2024
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Resumen
The clinical learning environment (CLE) has long been a focus of research and improvement efforts in medical education. Aim: To evaluate the CLE of a hospital site. Materials and methods: Observational, cross-sectional, analytical, prospective study using the ACA-UNAM-MEX instrument. Variables included were age, sex, year of residency, marital status and specialty. Measures of central tendency and measures of dispersion, Fisher's exact test for differences, Kendall's tau b for correlation and bivariate logistic regression were applied to clarify predictor variables. Results: 135 responses were obtained, with an average age of 28.72 years. For 79.3% interpersonal relationships (IR) were very restrictive, for 78.5% educational programs and their implementation (PE&I) were very restrictive, for 95.6% institutional culture (IC) was very restrictive and for 91.1% service dynamics (SD) was very restrictive. There were statistically significant differences between SD and gender (p = 0.02), SD and specialty (p = 0.002), IC and specialty (p = 0.013), EP and academic year (p = 0.202). When Kendall's tau b was applied, low negative correlations were found for most variables. Bivariate logistic regression found that marital status (p = 0.010 and year of residency (p = 0.000) predicted the perception of a more restrictive environment (p ≤ 0.05). Conclusion: It appears that the ACAs assessed are in restrictive ranges.
Keywords
ambientes, aprendizaje, educación médica, habilidades clínicas, ambientes de trabajoambientes, aprendizado, educação médica, habilidades clínicas, ambiente de trabalhoambientes, aprendizaje, educación médica, habilidades clínicas, ambiente de trabajo
References
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27. Villanueva González CG, Vyeira López ME, Gómez Alonso C, Rodríguez Orozco AR. Ambientes clínicos de aprendizaje y estilos de aprendizaje en residentes de medicina familiar: estudio preliminar. Cuad Aten Prim [Internet]. 2017;23(2):5-9. Available from: https://revista.agamfec.com/ambientes-clinicos-de-aprendizaje-y-estilos-de-aprendizaje-en-residentes-de-medicina-familiar-estudio-preliminar/
28. Vera Muñoz MAM, Anzaldo Vera, Anzaldo Vera MF. Influencia del clima laboral y ambiente clínico de aprendizaje en los residentes médicos de instituciones de salud del sector público en México. Innov Desarro Tecnol Rev Digit. 2018;10(2):73-89.
29. Sutton AH, Puig PV, Montalvo CL, Halabe J, Fernando O, De R, et al. Ambientes clínicos de aprendizaje en departamentos de medicina interna de hospitales mexicanos [internet research project]. 2011. Available from: http://datosabiertos.unam.mx/DGAPA:PAPIIT:IN306512
2. Lombarts KMJMH, Heineman MJ, Scherpbier AJJA, Arah OA. Effect of the learning climate of residency programs on faculty’s teaching performance as evaluated by residents. PLoS One. 2014;9(1):e86512. https://doi.org/10.1371/journal.pone.0086512
3. Biggs J, Tang C. Teaching for quality learning at university: what the student does. Higher Education. SRHE and Open University Press; 2007.
4. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet. 2010; 1923-58.
5. Feletti GI, Clarke RM. Construct validity of a learning environment survey for medical schools. Educ Psychol Meas. 1981;41(3):875-82. https://doi.org/10.1177/001316448104100330
6. Pololi L, Price J. Validation and use of an instrument to measure the learning environment as perceived by medical students. Teach Learn Med. 2000;12(4):201-7.
7. Nordquist J, Hall J, Caverzagie K, Snell L, Chan MK, Thoma B, et al. The clinical learning environment. Med Teach. 2019;41(4):366-72. https://doi.org/10.1080/0142159X.2019.1566601
8. Gruppen L, Irby DM, Durning SJ, Maggio LA. Interventions designed to improve the learning environment in the health professions: a scoping review. MedEdPublish. 2018;7:211. https://doi.org/10.15694/mep.2018.0000211.1
9. Kilty C, Wiese A, Bergin C, Flood P, Fu N, Horgan M, et al. A national stakeholder consensus study of challenges and priorities for clinical learning environments in postgraduate medical education. BMC Med Educ. 2017;17(1):226. https://doi.org/10.1186/s12909-017-1065-2
10. Norman RI, Dogra N. A survey of the practice and experience of clinical educators in UK secondary care. BMC Med Educ. 2014;14(1):229. https://doi.org/10.1186/1472-6920-14-229
11. Vázquez Martínez FD, Delgado Domínguez C, Quiroz Hernández FJ. Razones de incumplimiento de los médicos residentes con los cursos universitarios virtuales. Veracruz, México. Investig Educ Méd. 2017;6(22):88-95. https://doi.org/10.1016/j.riem.2016.06.005
12. Vieira JE. The postgraduate hospital educational environment measure (PHEEM) questionnaire identifies quality of instruction as a key factor predicting academic achievement. Clinics. 2008;63(6):741-6. https://doi.org/10.1590/s1807-59322008000600006
13. Sutton AH, Hernández FF, Barreto SG, Ramírez SC, Montalvo CL, Puig PV. Correlaciones entre las dimensiones de los ambientes clínicos de aprendizaje desde la percepción de los médicos residentes. Gac Med Mex. 2014;150(2):144-53.
14. Fuller A, Unwin L. Fostering workplace learning: looking through the lens of apprenticeship. Eur Educ Res J. 2003;2(1):41-55. https://doi.org/10.2304/eerj.2003.2.1.9
15. Tamblyn R, Abrahamowicz M, Dauphinee D, Girard N, Bartlett G, Grand’Maison P, et al. Effect of a community oriented problem based learning curriculum on quality of primary care delivered by graduates: Historical cohort comparison study. Br Med J. 2005;331(7523). https://doi.org/10.1136/bmj.38636.582546.7C
16. Asch DA, Nicholson S, Srinivas S, Herrin J, Epstein AJ. Evaluating obstetrical residency programs using patient outcomes. Obstet Anesth Dig. 2010;30(4):1277-83. https://doi.org/10.1001/jama.2009.1356
17. Cadieux G, Tamblyn R, Dauphinee D, Libman M. Predictors of inappropriate antibiotic prescribing among primary care physicians. C Can Med Assoc J. 2007;177(8):877-83.
18. Weiss KB, Bagian JP, Nasca TJ. The clinical learning environment: the foundation of graduate medical education. JAMA. 2013 Apr 24;309(16):1687-8. https://doi.org/10.1001/jama.2013.1931
19. Weiss KB, Co JPT, Bagian JP. Challenges and opportunities in the 6 focus areas: CLER National Report of Findings 2018. J Grad Med Educ. 2018;10(4):25-48.
20. Hamui-Sutton A, Lavalle-Montalvo C, Díaz-Villanueva A, Gómez-Lamont DS, Carrasco- Rojas JA, Vilar-Puig P. Las actividades académicas en contextos clínicos por especialidades: percepción de los estudiantes. Investig Educ Méd. 2013;2(5):25-36.
21. Sutton AH, Chacalo MA, de la Cruz Flores G, de la Roche OFR, Montalvo CL, Puig PV. Construcción y validación de un instrumento para evaluar ambientes clínicos de aprendizaje en las especialidades médicas. Gac Med Mex. 2013;149(4):394-405.
22. Vera Muñoz MAM, Anzaldo Vera N, Anzaldo Vera MF. Ambiente clínico de aprendizaje-laboral y residentes médicos de instituciones de salud del sector público mexicano. Rev Glob Negocios [Internet]. 2019;7(1):67-81. Available from: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3345223
23. Zhang J, Shields L, Ma B, Yin Y, Wang J, Zhang R, et al. The clinical learning environment, supervision and future intention to work as a nurse in nursing students: a cross-sectional and descriptive study. BMC Med Educ. 2022;22(1):548. https://doi.org/10.1186/s12909-022-03609-y
24. Hernández-Domínguez J, Ramírez-Dueñas LK, Roco-Zúñiga AL, Fernández-Vázquez MU. Ambiente clínico académico de las residencias médicas en el Instituto Mexicano del Seguro Social, Puebla. Rev Educ Desarro. 2022;62(julio-septiembre):37-46.
25. Medina ML, Medina MG, Gauna NT, Molfino L, Merino LA. Evaluation of the educational environment in the paediatric clinic residency in a provincial referral hospital. Educ Med. 2020;21(1):24-31.
26. Ruiz González G. Evaluación del ambiente clínico de aprendizaje en la especialidad en medicina familiar de la unidad de medicina familiar número 27 [Internet specialisation thesis]. Tijuana: Universidad Autónoma de Baja California; 2018. Available from: https://hdl.handle.net/20.500.12930/4709
27. Villanueva González CG, Vyeira López ME, Gómez Alonso C, Rodríguez Orozco AR. Ambientes clínicos de aprendizaje y estilos de aprendizaje en residentes de medicina familiar: estudio preliminar. Cuad Aten Prim [Internet]. 2017;23(2):5-9. Available from: https://revista.agamfec.com/ambientes-clinicos-de-aprendizaje-y-estilos-de-aprendizaje-en-residentes-de-medicina-familiar-estudio-preliminar/
28. Vera Muñoz MAM, Anzaldo Vera, Anzaldo Vera MF. Influencia del clima laboral y ambiente clínico de aprendizaje en los residentes médicos de instituciones de salud del sector público en México. Innov Desarro Tecnol Rev Digit. 2018;10(2):73-89.
29. Sutton AH, Puig PV, Montalvo CL, Halabe J, Fernando O, De R, et al. Ambientes clínicos de aprendizaje en departamentos de medicina interna de hospitales mexicanos [internet research project]. 2011. Available from: http://datosabiertos.unam.mx/DGAPA:PAPIIT:IN306512
Cómo citar
Lugo Machado, J. A., García Ramírez, P. E., Medina Valentón, E., Méndez Cázares, J. A., & Pacheco Sánchez, A. A. (2024). Clinical Learning Environments in Medical Specialty Residences at a Third Level of Care. Universitas Medica, 65. https://doi.org/10.11144/Javeriana.umed65.acar
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