Optimising the Clinical Learning
Environment
Prof Peter W Johnston
Depute Postgraduate Dean
Scotland Deanery, North Region
NACT London January 2017
Quality Education for a Healthier Scotland
What is this workshop about?
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Discuss education in the workplace
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Understand the CLE and why it is important
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The tensions that can impact on the CLE (research from ARI)
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Sharing experience of attempts to improve learning environments
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Explore other potential methods for optimising CLEs
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Discuss and generate possible actions/goals that could improve
your own CLEs.
Quality Education for a Healthier Scotland
How we do this
13.10
Introduction
13.15
13.25
13.35
Pressures & tensions - discussion in groups
Feedback
Research from ARI
13.45
14.55
Potential solutions – discussion in groups
Feedback
14.05
14.10
Optimising your own learning environment – final thoughts
Close
Quality Education for a Healthier Scotland
Clinical Learning Environment (CLE)
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The CLE is the sum of the internal and external circumstances and
influences surrounding and affecting a person's learning and
working:
• Physical surroundings
• Systems and structures
• Organisational culture (e.g. relationships between staff, patients
and students/trainees; shared values, norms and behaviours)
• Attitudes, norms “how we do things here”
• The learner – how s/he perceives the climate, interacts with the
environment and its opportunities
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Definition
Educational culture
• relates to systems values and common expectations of
behaviours within an organisation1
Educational climate
• relates to individuals’ own perception of the environment with
regard to education1
1.
James LR, Choi CC, Chia-Heui EK, McNeil PK, Minton MK, Wright MA, Kim K. Organizational and psychologic
climate: a review of theory and research. Europ J Work and Organisational Psychol, 2008;17:5-32
Quality Education for a Healthier Scotland
Learning or Working Environment?
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The clinical learning environment = the clinical working
environment
Majority of learning occurs within the workplace environment
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Why look at the CLE now?
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Why look at the CLE now?
Quality Education for a Healthier Scotland
Task 1
Pressures & Tensions in the CLE
Having a learning environment within a working environment can
create tensions, pressures and difficulties.
In groups:
• Consider the pressures and tensions in your own learning
environments
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Pressures & Tensions in the CLE – Feedback (1)
You’re not alone!
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Pressures & Tensions in the CLE – Research
(Roberts R, Cleland JA, Kitto S, Johnston PW)
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Examined CLE within 2 departments within ARI to understand the
factors that impact - the aim of supporting staff to direct improvements
Conducted 25 interviews with learners, trainers and management
Overarching tensions/themes:
• Service and training
• Workload
• Interpersonal relationships
• Sense of belonging & feeling valued
• Disparity between staff and management (trusting;
responsibility?)
• Who runs the service and training (departments or the hospital?)
• Seniors’ attitudes and behaviours (influential in CLE)
• Willingness to learn and change versus the status quo
Quality Education for a Healthier Scotland
Task 2
How have you done to improve your CLE?
In groups share experiences of initiatives to improve CLE:
1. What was the problem?
2. What did you do?
3. Did the situation change i.e. did it work? If so, what evidence do
you have?
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What worked?
(e.g. Student/staff involvement, attitude or behaviour changes, type of
approach – systems?, inductions/seminars/ward-rounds?,
measured/follow-up?)
Quality Education for a Healthier Scotland
Optimising the CLE
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Complex situations require complex, multi-faceted solutions
• Not just system factors and people factors but how these interact
• Acknowledge the complexity of the situation (e.g. Weick’s HRO
“need reluctance to simplify interpretations”)
Address and attempt to actively balance the tensions
• requires embracing and openly discussing the competing demands
(of service and training)
• Initiate a cycle of change and seeking a position that accommodate
opposing tensions
Try to better understand your own CLE – actively seek feedback
from many different people
• Use survey tools e.g. the UCEEM (Strand et al. email for a copy)
• Safe and open discussion of the problem(s)
Empower individuals to take responsibility and own the problem
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Optimising the CLE
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Practical points
• Foster a sense of belonging by making the students and trainees
feel welcome in all areas of the department
• Ensure the unit/supervisors are prepared and expecting student
entry
• Ensure supervisors are available for formal and informal feedback
• Do the students and trainees work together and support each
other?
• Consider benchmarking the quality of the CLE
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Optimising YOUR learning environment
1. Write down:
• What improvement would you like to see (by when?)
• Two actions to be taken within 6 months
• Two actions to be taken by the end of the month
• Two actions when you return to your desk on Monday
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Thank you for coming, final questions?
Prof Peter Johnson [email protected]
Dr Ruby Roberts [email protected]
Quality Education for a Healthier Scotland
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A number of high profile sources, including the GMC standards for training in medical education
and National Training Survey (NTS) returns, as well as more local reports such as the Health
Improvement Scotland (HIS) review of Aberdeen Royal Infirmary, highlight the need to constantly
review the quality of Clinical Learning Environments (CLEs) across specialties and localities. This is
relevant to all those involved in medical education, training and healthcare delivery as an optimised
CLE has the potential to cultivate learner capabilities, professionalism, well-being and enthusiasm
for the practice of medicine.
Drawing on local work funded by NHS Grampian and the Scottish Medical Education research
Consortium (SMERC), this workshop will initially provide an overview of what we mean by the CLE,
why it is relevant to medical education and training, and what factors/tensions can impact on a CLE.
We will then move to considering how best to optimise the CLE in real-life settings.
The aims of the workshop are:
to give the participants an understanding of the CLE and the tensions that can impact on it;
to share experiences of initiatives to improve CLEs;
to explore other potential methods for optimising CLEs;
to discuss and generate possible actions/goals that could improve their own CLEs.