Psychometric Study of the Clinical Learning Environment Instrument for Mexican Medical Residents

Abstract

Introduction: Clinical learning environments are educational settings focused on directly treating individuals with health problems. Through the experiences gained in these environments, resident physicians can integrate knowledge, develop competencies, and acquire the culture, values, and attitudes inherent to the profession. Understanding the influence of these environments on learning is crucial, and for this, instruments are needed to measure their characteristics. Various instruments exist to measure clinical environments, but there is still a need to develop tools that respond to the needs of health systems in Latin America, which face staff shortages, excessive care burdens, and significant variability in technological resources and infrastructure. One instrument developed in Mexico for this purpose is the instrument for evaluating clinical learning environments in medical specialties, created by Hamui and collaborators based on working groups with experts. Despite demonstrating good reliability, there is uncertainty about whether its structure is unidimensional or has four dimensions.

Objective: For this reason, the objective of the present study was to psychometrically validate the instrument and analyze the structure of the scale through confirmatory factor analysis to identify whether it is a unidimensional scale or one with four dimensions.

Method: The study involved 248 resident physicians enrolled in specialty courses at a tertiary hospital in Mexico City. 52.82% (131) were women, aged between 24 and 49 years, with an average age of 29.19 years (SD = 2.92). The instrument consisted of 30 items to measure four dimensions: interpersonal relationships, the educational program and its implementation, institutional culture, and service dynamics. The study was approved by a Research Committee and an Ethics in Research Committee, and informed consent was obtained. The scale was administered in a face-to-face session at the hospital. Analyses were conducted to obtain evidence for three psychometric properties: discriminative power, construct validity, and reliability.

Results: After comparing the unidimensional structure with that of the four dimensions (interpersonal relationships, academic program and its implementation, service dynamics, and organizational culture), a four-factor version with 21 items was obtained, showing adequate fit (CFMIN = 1.37, CFI = .98, SRMR = .05, RMSEA .06) and high reliability (ordinal α = .96).

Conclusions: This study resulted in a reliable and valid version of the instrument, which will allow it to be used to investigate the role of clinical learning environments in medical education and diagnose needs in Mexican hospitals.