The hospital setting provides an environment for patients to receive medical care, for medical professionals to provide treatment, and for medical students and residents to learn the practice of medicine through supervised patient encounters. Education provided at the point of care allows students and residents to apply knowledge and develop clinical skills needed for medical practice. The hospital environment is also a confluence of learning and work, where applied learning takes place in an integrated and simultaneous manner with work duties. This setting, referred to as the clinical learning environment (CLE), is a focus for educators, scholars, administrators, regulators and accrediting agencies to understand, measure and improve it. While several instruments have been developed to measure the CLE, they suffer from great variation in subscales and content. The purpose of this study is to deconstruct the CLE, apply theories from related fields, and frame those theories in the context of the hospital setting to develop a conceptual framework for the CLE. A systematic review of the literature and thematic synthesis of existing research about the CLE provided evidence to inform and test a learning environment framework in the clinical setting. Data from qualitative CLE assessments, the ACGME Clinical Learning Environment Review (CLER) Pathways to Excellence, and existing CLE measurement instruments informed these results. Findings showed that a CLE framework consists of three mediating factors: learning, people, and change. As the clinical setting is a unique environment for learning, the people dimension (as a community of practice) was found to be the most influential on learning outcomes for students. The dimension of change was found to be most influential from the perspective of improving organizational or work outcomes, including patient care, clinical quality and patient safety. Findings from this study provide researchers and scholars with a framework to for developing measures of clinical learning environment effectiveness, and informing practitioners of CLE components and relationships that impact both learning and organizational outcomes.
|Advisor:||Mierzwa, Thomas J., Breckon, Denise A.|
|School:||University of Maryland University College|
|Department:||Doctor of Management Program|
|School Location:||United States -- Maryland|
|Source:||DAI-B 77/08(E), Dissertation Abstracts International|
|Subjects:||Educational sociology, Adult education, Medicine|
|Keywords:||Clinical learning environment, Community of practice, Graduate medical education, Learning outcomes, Medical education, Medical students, Organizational outcomes, Residency, Teaching hospital|
Copyright in each Dissertation and Thesis is retained by the author. All Rights Reserved
The supplemental file or files you are about to download were provided to ProQuest by the author as part of a
dissertation or thesis. The supplemental files are provided "AS IS" without warranty. ProQuest is not responsible for the
content, format or impact on the supplemental file(s) on our system. in some cases, the file type may be unknown or
may be a .exe file. We recommend caution as you open such files.
Copyright of the original materials contained in the supplemental file is retained by the author and your access to the
supplemental files is subject to the ProQuest Terms and Conditions of use.
Depending on the size of the file(s) you are downloading, the system may take some time to download them. Please be