Design, Implementation, and Evaluation of an Educational Intervention to Improve Clinical Learning Environments

Abstract

Introduction: Clinical learning environments are a fundamental component of medical education, as they constitute the setting in which resident physicians integrate theoretical knowledge with clinical practice, develop professional competencies, and build their professional identity. Evidence has shown that these environments influence learning, psychological well-being, the development of clinical skills, and the quality of patient care. Despite their importance, there is limited research focused on the design and implementation of specific strategies to improve clinical learning environments, particularly in middle-income countries such as Mexico. Objective: To design, implement, and evaluate the effectiveness of an educational intervention aimed at improving clinical learning environments in an indirect-entry medical specialty program at a tertiary-level hospital in Mexico City.

Method: An interventional, longitudinal, and analytical study was conducted using a convenience sample of 16 resident physicians enrolled in an indirect-entry medical specialty program. Three measures were used to evaluate changes: the Scale for Assessing Clinical Learning Environments in Medical Specialties, the 10-item Perceived Stress Scale, and a knowledge examination specifically designed to assess academic performance. Following an initial needs assessment, an educational intervention was developed to improve four dimensions of the clinical learning environment: interpersonal relationships, educational program and implementation, institutional culture, and service dynamics. The intervention was validated using the Delphi methodology with the participation of five medical education experts and was implemented over a full academic year. Pre- and post-intervention changes were analyzed using paired-samples Student’s t-tests and Cohen’s d effect sizes.

Results: Statistically significant improvements were observed in all evaluated dimensions of the clinical learning environment following the intervention. Interpersonal relationships increased from a mean of 1.88 to 3.82 (t = 11.73, p < .01; d = 4.35), educational program and implementation from 2.10 to 3.88 (t = 8.04, p < .01; d = 3.30), institutional culture from 2.45 to 3.86 (t = 7.58, p < .01; d = 3.26), and service dynamics from 2.13 to 3.72 (t = 7.48, p < .01; d = 3.27). Likewise, perceived stress decreased significantly from 2.92 to 1.45 (t = 6.35, p < .01; d = 2.25), while academic performance improved substantially, increasing from 2.90 to 8.16 points (t = 14.32, p < .01; d = 4.45).

Conclusions: The educational intervention was effective in improving clinical learning environments, reducing stress, and enhancing the academic performance of resident physicians. The main contribution of this study is the provision of a structured, evidence-based, and expert-validated methodology for directly intervening in the educational and working conditions of medical residency programs. These findings suggest that improving clinical learning environments is a feasible strategy for promoting the well-being of physicians in training, strengthening educational quality, and contributing to the development of safer, more humanized, and learning-centered healthcare systems.