Keywords
aprendizaje
educación médica
habilidades clínicas
ambientes de trabajo
How to Cite
Abstract
The topic of the Clinical Learning Environment (ACA) is at the forefront of discussions among educators, accreditors, educational organizations, and health professionals, and has long been a focus of research and improvement efforts in medical education.
Objective: To evaluate the clinical learning environments of our hospital, as well as their differences.
Materials and methods: Observational, cross-sectional, analytical, prospective study with the ACA-UNAM-MEX instrument, we included variables of age, sex, year of residence, marital status, and specialty. Measures of central tendency and measures of dispersion, Chi square or Fisher's exact test for differences, Kendall's Tau b for correlation and bivariate logistic regression were applied to clarify predictor variables, we used SPSS version 24 for Windows.
Results: 135 responses were obtained, age ẍ=28.72 years SD ± 2,455, males 75 (55.62%) married 24 (17.81%), Internal Medicine 34 (25.2%) and Anesthesiology 20 (14.8%). most common, first year 42 (31%), and third year 36 (27%) were the most frequent, in the perception IR 79.3% very restrictive, PEyI 78.5% very restrictive, CI 95.6% very restrictive and DS 91.1% very restrictive, there was a statistically significant difference in DS and sex p=0.02, DS and specialty p= 0.002, CI and specialty p=0.013, PE and academic year p= 0.202 (p value ≤ 0.05 ) When applying Kendall's Tau b, low negative correlations were found in most of the variables, the bivariate logistic regression, it was found that marital status value of p=0.010 and year of residence p=0.000, predicted the perception of an environment most restrictive p=≤0.05)
Conclusion: Apparently the clinical learning environment, evaluated at our hospital site, is in restrictive ranges, if there was a statistically significant difference in DS and sex p=0.02, DS and specialty p= 0.002, CI and specialty p=0.013, PE and year academic p= 0.202 (p value ≤ 0.05).
Roff S, McAleer S, Skinner A. Development and validation of an instrument to measure the postgraduate clinical learning and teaching educational environment for hospital-based junior doctors in the UK. Med Teach. 2005;27(4):326-31.
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
Biggs J, Tang C. Teaching for quality learning at university: what the student does. Higher Education. SRHE and Open University Press; 2007.
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.
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
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.
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
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
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
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
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
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
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.
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
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
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
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.
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
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.
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.
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.
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
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
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.
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.
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
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/
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.
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
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