From good to excellent: Improving clinical departments’ learning climate in residency training

Figures & data

Table

Practice points

Supportive learning climates in residency training are crucial for high quality of training and patient care. Clinical departments can be classified in four distinct learning climate groups: substandard performers, adequate performers, good performers and excellent performers. Contextual factors such as the teaching performance of clinical departments can significantly predict departments’ learning climate performance. To move between learning climate groups, departments should embark on targeted performance improvement.

Table 1. Characteristics of the study population.

Characteristics	N (%)
Number of teaching hospitals	36 (100%)
Academic	4 (11%)
Top clinical	15 (42%)
General	17 (47%)
Number of departments	211 (100%)
Surgical^a	71 (34%)
Nonsurgical^b	140 (66%)
Number of training programs per hospital
1–5	22 (61%)
6–10	7 (20%)
11–15	3 (8%)
16–20	3 (8%)
21–25	1 (3%)
Number of resident evaluations	1733 (100%)
Male	661 (38%)
Female	1068 (62%)
Missing	1 (0%)
Year of training
1	285 (17%)
2	298 (17%)
3	246 (14%)
4	237 (14%)
5	183 (11%)
6	89 (5%)
Doctor not in residency training	370 (21%)
Fellow	20 (1%)
Missing	2 (0%)

^a Surgical: general surgery, obstetrics and gynecology, neurosurgery, orthopedic surgery, urology, otolaryngology, ophthalmology, plastic surgery, oral and maxillofacial surgery.

^b Medical: internal medicine, pediatrics, neurology, cardiology, emergency medicine, psychiatry, rehabilitation medicine, gastroenterology, pulmonology, anesthesiology, dermatology, intensive care, geriatrics, pathology, nuclear medicine, medical microbiology, radiotherapy, radiology, clinical chemistry, clinical physics, pharmacy, rheumatology.

Table 2. Summary statistics for the subscales and mean leaning climate (D-RECT) score per group.

		Educational atmosphere	Teamwork	Role of specialty tutor	Coaching and assessment	Formal education	Resident peercollaboration	Work is adapted to residents’ competence	Accessibility of supervisors	Patientsign-out	Mean Total Score
Mean (sd)	Group 1	3.3 (.5)	3.5 (.4)	3.7 (.3)	3.1 (.4)	3.5 (.4)	4.0 (.4)	3.7 (.3)	4.0 (.4)	3.3 (.7)	3.6 (.2)
	Group 2	3.9 (.3)	3.9 (.3)	4.1 (.3)	3.3 (.3)	3.8 (.3)	4.2 (.3)	4.0 (.2)	4.3 (.2)	3.6 (.4)	3.9 (.1)
	Group 3	4.3 (.2)	4.2 (.3)	4.3 (.2)	3.6 (.2)	4.2 (.3)	4.5 (.2)	4.3 (.2)	4.6 (.2)	4.1 (.5)	4.2 (.1)
	Group 4	4.5 (.3)	4.5 (.3)	4.7 (.2)	4.3 (.2)	4.4 (.2)	4.8 (.3)	4.7 (.2)	4.9 (.2)	4.5 (.3)	4.6 (.1)
Min	Group 1	2.3	2.6	2.8	2.3	2.3	2.7	2.9	3.2	2.0	3.2
	Group 2	3.1	3.1	3.4	2.3	2.9	3.5	3.2	3.6	1.9	3.6
	Group 3	3.7	3.6	3.9	3.1	3.2	3.8	3.8	3.7	2.5	4.1
	Group 4	4.0	4.1	4.3	4.1	4.2	3.9	4.4	4.6	4.1	4.5
Max	Group 1	4.4	4.2	4.2	3.8	4.1	4.7	4.4	4.8	5.0	4.0
	Group 2	4.7	4.5	4.7	3.9	4.4	4.7	4.6	4.9	4.6	4.1
	Group 3	4.8	4.7	4.8	4.2	4.8	5.0	4.8	5.0	5.0	4.5
	Group 4	4.9	5.0	4.9	4.8	4.8	5.0	5.0	5.0	5.0	4.8

Table 3. Regression coefficients (95% confidence intervals) and p values derived from multilevel models of the predictors of learning climate scores.

	Random intercept multilevel model
	Regression coefficient (95% CI)	p value
Type of hospital
Academic versus top clinical	−0.21 (−0.34 to −0.09)	0.01
General versus top clinical	−0.07 (−0.18 to 0.04)	0.19
Type of specialty (nonsurgical versus surgical)	0.04 (−0.04 to 0.13)	0.30
Number of D-RECT evaluations	0.02 (−0.02 to 0.05)	0.32
Ratio juniors/seniors	−0.00 (−0.00 to 0.05)	0.42
Ratio residents/nonresidents	0.00 (−0.00 to 0.00)	0.22
Ratio of male/female residents	−0.00 (−0.00 to 0.00)	0.72
Ratio male/female faculty	0.00 (−0.00 to 0.00)	0.56
Average age of faculty	−0.00 (−0.01 to 0.01)	0.64
Average percentage of time spent on educational activities by faculty	−0.01 (−0.02 to −0.00)	0.03
Faculty teaching performance score	0.70 (0.51 to 0.90)	<0.001