Development of a checklist to evaluate clinical learning environments

Abstract

Introduction: Clinical learning environments are settings where actions focus on directly treating individuals with health problems. They utilize organized resources and social interactions to enhance learning processes and develop knowledge. Through the experiences gained in these environments, medical students can integrate knowledge, develop competencies, and acquire the culture, values, and attitudes inherent to the profession. Understanding the influence of these environments on the learning process is crucial, and for this, instruments are required to measure their characteristics. There are several instruments designed to measure the characteristics of clinical environments; however, all of them differ in their dimensions and in how they are scored.

Objective: For this reason, this study aimed to propose a standardized checklist to evaluate clinical learning environments. This would help meet the need for assessment tools in Spanish and tailored to the conditions of health systems in Latin America.

Method: A checklist proposal was created to evaluate clinical learning environments in medical education through a cross-sectional instrumental psychometric study using the Delphi methodology. Six experts in medical education were selected conveniently; they first independently reviewed the dimensions and contents of the main instruments used to measure clinical environments in the literature and made a proposal for dimensions and indicators. Subsequently, their proposals were compared, and a final version was reached through consensus in an in-person working session. The study was approved by a Research Committee and an Ethics in Research Committee, and informed consent was obtained from the judges.

Results: The experts defined the essential dimensions for evaluating clinical learning environments by analyzing the content of the dimensions of the instruments available in the literature, which could be classified into four categories: social climate, formal educational program, clinical work, and institutional culture. Subsequently, once the dimensions were defined, indicators were proposed to measure each of them based on the content of existing instruments and theory, defining 16 relevant characteristics.

Conclusions: This work aimed to develop an instrument to measure the characteristics of clinical learning environments, with standardized content, which will contribute to the development of comprehensive theories about how clinical environments impact the learning processes and competency development of medical students. This structured approach will allow for comparable results across diverse regions and cultural contexts.