<p> 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) <i>Pathways to Excellence</i>, and existing CLE measurement instruments informed these results. Findings showed that a CLE framework consists of three mediating factors: <i>learning</i>, <i>people</i>, and <i> change.</i> As the clinical setting is a unique environment for learning, the <i>people</i> dimension (as a community of practice) was found to be the most influential on learning outcomes for students. The dimension of <i>change</i> 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.</p>
| Identifer | oai:union.ndltd.org:PROQUEST/oai:pqdtoai.proquest.com:10041765 |
| Date | 18 March 2016 |
| Creators | Padmore, Jamie Sue |
| Publisher | University of Maryland University College |
| Source Sets | ProQuest.com |
| Language | English |
| Detected Language | English |
| Type | thesis |
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