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Background: There is a gradual increase in the number of optometry education programs in Africa yet there is limited knowledge on optometry students' experiences of their clinical training. Therefore, the purpose of this study was to explore the optometry students' experiences of their clinical learning environment at a national referral and teaching hospital in Uganda. Methods: Between April 2023 and May 2023, face to face in-depth interviews were conducted to explore the experiences of the participants. All 16 optometry students in fourth-year at university were purposefully recruited into the study. Data was collected at the end of the students' clinical training at the eye clinic of a national referral and teaching hospital. Interviews were audio recorded and transcribed for analysis using an inductive thematic approach. Results: Two themes, learning at the eye clinic and organization of the eye clinic, were identified to represent participants' experiences. Each theme had three sub themes. Conclusion: Training optometry students at an eye clinic enhances their clinical skills and knowledge of diagnosing and managing various eye conditions. Future studies should compare optometry students' experiences in lower-level health units to those in national referral hospitals. [ABSTRACT FROM AUTHOR]

Though technological capabilities to provide high-quality, flexible interprofessional education (IPE) have continued to grow, this remains a largely undeveloped area in the clinical learning environment (CLE). To address this gap, the University of Minnesota launched the Collaboration in Action: Learner-Driven Curriculum (CIA-LDC) as an IPE model designed for sustainability in a post-pandemic world. Over the course of two academic years, the CIA-LDC framework evolved and expanded through an iterative, data-informed approach incorporating student feedback, academic programme co-creation, evolving literature, and lessons learned. Modifications to individual activities and the overall model are presented, as well as key lessons learned. The majority of CIA-LDC evaluation responses across 2 years agreed that the amount of time spent was reasonable, participation placed little to no burden on their preceptor or site, the experience supported target interprofessional competency development, and that IPE should be provided in the CLE. The CIA-LDC holds promise as a successful, quality model for IPE in the CLE, available to learners from any profession in any geographic location in any practice setting. Outcomes demonstrate a pedagogical design with buy-in and feasibility in a post-pandemic world, with tremendous potential for advanced educational research to prepare the next generation as a collaborative practice-ready workforce. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Nursology is the property of Ataturk University Coordinatorship of Scientific Journals and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abdishakur Mohamud Hassan Hidigow,1 Najib Isse Dirie,2 Zakarie Abdi Warsame3 1Department of Intensive Care Unit, Dr. Sumait Hospital, Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia; 2Department of Urology, Dr. Sumait Hospital, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia; 3Faculty of Economics, SIMAD University, Mogadishu, SomaliaCorrespondence: Abdishakur Mohamud Hassan Hidigow, Tel +252618887374, Email abdishakur.hidigow@simad.edu.soIntroduction: The clinical learning environment is central to nursing and midwifery education, providing critical contexts for student training and professional development. This study fills a gap by offering a comprehensive bibliometric analysis of trends in The clinical learning environment research within nursing and midwifery education.Methods: A descriptive bibliometric study was conducted on June 7, 2024, using the Scopus database to retrieve research articles related to The clinical learning environment from 1957 until June 2024. VOSviewer software was used to analyze scientific collaborations and map co-occurrence networks of key terms.Results: The United States and Australia led in publications and citations. Key journals included Nurse Education Today, Nurse Education in Practice, Journal of Advanced Nursing, and Journal of Clinical Nursing. Prominent authors like Saarikoski M. Levett-Jones T. and Henderson A. significantly contributed. Co-occurrence analysis highlighted themes such as student experiences, clinical competence, psychological factors, and teaching methodologies.Discussion: This study highlights key trends in The clinical learning environment research and the significant contributions of specific countries, journals, and authors. The collaboration networks provide insights into the interrelated nature of various factors influencing the clinical learning environment. Limitations of the study include the reliance on a single database, which may not capture all relevant articles, particularly those in less prominent journals or non-English languages. Additionally, citation metrics may be influenced by factors such as self-citations or field-specific citation practices.Conclusion: These insights highlight areas for future research, including the role of virtual learning environments and cultural competency in The clinical learning environment. The findings contribute to shaping future research and practice in nursing and midwifery education.Keywords: clinical learning environment, nursing students, midwifery students, bibliometric analysis, Nursing education, Midwifery education

Abstract Background There is a gradual increase in the number of optometry education programs in Africa yet there is limited knowledge on optometry students’ experiences of their clinical training. Therefore, the purpose of this study was to explore the optometry students’ experiences of their clinical learning environment at a national referral and teaching hospital in Uganda. Methods Between April 2023 and May 2023, face to face in-depth interviews were conducted to explore the experiences of the participants. All 16 optometry students in fourth-year at university were purposefully recruited into the study. Data was collected at the end of the students’ clinical training at the eye clinic of a national referral and teaching hospital. Interviews were audio recorded and transcribed for analysis using an inductive thematic approach. Results Two themes, learning at the eye clinic and organization of the eye clinic, were identified to represent participants’ experiences. Each theme had three sub themes. Conclusion Training optometry students at an eye clinic enhances their clinical skills and knowledge of diagnosing and managing various eye conditions. Future studies should compare optometry students’ experiences in lower-level health units to those in national referral hospitals.

Background: Clinical teaching and educational activities are of the utmost importance in nursing education for overcoming the theory–practice gap. There is a significant paucity of knowledge on nursing students’ experiences in the clinical learning setting and how supervision is carried out. AIM: The intent of this research is to determine the perception of undergraduate nursing student towards clinical learning environment and supervision. Methods: An institution-based, cross-sectional, descriptive-exploratory study comprising 476 nursing students selected through stratified sampling, conducted in the selected Institutes of National Importance (INI) using Google Form. The study instrument used includes self-structured demographic section and rating scale to assess the students’ perception towards the clinical learning environment and supervision. Descriptive and inferential statistics were used for data analysis using IBM SPSS (version 23). Results: A study of 476 nursing students from across INI, majority were aged 21–24 years (74.8%), found significant differences in their perceptions of the clinical learning environment and supervision. In terms of the clinical learning environment, almost all of first-year students (94.1%) considered nursing officers in the unit were learning sources, and 92.4% said that they learned something new every day in clinical settings. The majority of third-year students (89.1%) stated that increasing exposure to patients was the primary source of their clinical learning. First-year students had positive perceptions of supervision, although their expectations differed from those of higher-year students. Conclusion: According to the study, the majority of students feel that effective clinical learning environment necessitates excellent communication skills, a positive attitude, motivation and effective problem-solving strategies. Regarding supervision, students respect good communication skills, confidence in the supervisory relationship, constructive criticism and trust.

Amaç: Bu çalışma hemşirelik öğrencilerinin bakım davranışları ile klinik öğrenim çevresi arasındaki ilişkiyi değerlendirmeyi amaçlamaktadır.Yöntemler: Araştırma tanımlayıcı-ilişki arayıcı desende yürütülmüştür. Araştırmanın örneklemini bir devlet üniversitesindeki 241 hemşirelik öğrencisi oluşturmuştur. Veri toplama aracı olarak; “Kişisel Bilgi Formu”, “Bakım Davranışları Ölçeği-24” ve “Klinik Öğrenim Çevresi Ölçeği” kullanılmıştır.Bulgular: Öğrencilerin yaş ortalamasının 21,25 olduğu, %74,3’ünün kadın, %34,9’unun 3. sınıfta öğrenim gördüğü saptanmıştır. Hemşirelik mesleğini sevenlerin Personel Öğrenci İlişkileri, Öğrenci Memnuniyeti, Hiyerarşi ve Rutinler alt boyutları ve Klinik Öğrenim Çevresi Ölçeği toplam puan ortalamasının anlamlı düzeyde daha yüksek olduğu tespit edilmiştir. Hemşirelik yapan bir yakını olan öğrencilerin Hasta İlişkileri ve Güvence alt boyut puan ortalamasının anlamlı düzeyde daha yüksek olduğu belirlenmiştir. Klinik uygulama öncesi uygulama hakkında bilgilendirilen öğrencilerin Bakım Davranışları Ölçeği-24 alt boyut ve toplam puan; Personel Öğrenci İlişkileri, Öğrenci Memnuniyeti, Klinik Öğrenim Çevresi Ölçeği toplam puan ortalamaları anlamlı düzeyde yüksek bulunmuştur. Kliniklerde teorik bilgiyi uygulama alanına oldukça yeterli ve yeterli yansıtan öğrencilerin, Bakım Davranışları Ölçeği-24 alt boyut ve toplam, Klinik Öğrenim Çevresi toplam puan ortalamasının istatistiksel olarak anlamlı düzeyde yüksek olduğu saptanmıştır. Çalışmada hemşirelik öğrencilerinin bakım davranışları ile klinik öğrenme çevresi arasında pozitif yönde anlamlı ilişki bulunmuştur.Sonuç: Öğrencilerin bakım davranışlarına yönelik algılarının yüksek olduğu ve klinik öğrenim çevresine ilişkin değerlendirmelerinin olumlu olduğu belirlenmiştir.

Abstract Background Sierra Leone has one of the world’s highest maternal and infant mortality rates and suffers from a shortage of well-trained health professionals, including midwives. Prior to engaging in systematic interventions, it is critical to measure organizational readiness to gauge members’ psychological and behavioral preparedness to implement change. We aimed to measure the organizational readiness for implementing change and compare results among midwives and administrative leaders at two schools of midwifery in Sierra Leone prior to the rollout of a midwifery preceptor program. Methods The Organizational Readiness for Implementing Change (ORIC) survey is a validated 12-item questionnaire designed to assess two domains of organizational readiness for change: change commitment (motivation) and change efficacy (capacity). All survey items begin with the same prompt and a five-item Likert scale response, with seven questions about change commitment and five about change efficacy. Data collection occurred in two schools of midwifery in Sierra Leone during two day-long meetings with stakeholders. Statistical analysis was conducted using descriptive statistics and Wilcoxon rank-sum test to compare independent samples: School 1 versus School 2 (site), midwife versus other roles (role). Results Participants included 42 respondents (mean age 41 years, 95% female). Surveys were distributed evenly between the two sites. Occupations included midwifery faculty (n = 8), administrators (n = 5), clinicians (n = 25), and clinical educators (n = 4). Domain 1 (change commitment) had a mean score of 4.72 (SD 0.47) while Domain 2 (change efficacy) had a mean score of 4.53 (SD 0.54) out of a total potential score of five. There were no statistically significant differences between site responses for Domain 1 (p = 0.5479) and Domain 2 (p = 0.1026) nor role responses for Domain 1 (p = 0.0627) and Domain 2 (p = 0.2520). Conclusion Stakeholders had very high overall readiness for change across all ORIC questions for both change commitment and change efficacy. Mean scores for change commitment were slightly higher which is not surprising given the low-resourced settings stakeholders work in while training students. High mean scores across sites and roles is encouraging as this novel preceptor program is currently being rolled out.

Background: Sierra Leone has one of the world's highest maternal and infant mortality rates and suffers from a shortage of well-trained health professionals, including midwives. Prior to engaging in systematic interventions, it is critical to measure organizational readiness to gauge members' psychological and behavioral preparedness to implement change. We aimed to measure the organizational readiness for implementing change and compare results among midwives and administrative leaders at two schools of midwifery in Sierra Leone prior to the rollout of a midwifery preceptor program. Methods: The Organizational Readiness for Implementing Change (ORIC) survey is a validated 12-item questionnaire designed to assess two domains of organizational readiness for change: change commitment (motivation) and change efficacy (capacity). All survey items begin with the same prompt and a five-item Likert scale response, with seven questions about change commitment and five about change efficacy. Data collection occurred in two schools of midwifery in Sierra Leone during two day-long meetings with stakeholders. Statistical analysis was conducted using descriptive statistics and Wilcoxon rank-sum test to compare independent samples: School 1 versus School 2 (site), midwife versus other roles (role). Results: Participants included 42 respondents (mean age 41 years, 95% female). Surveys were distributed evenly between the two sites. Occupations included midwifery faculty (n = 8), administrators (n = 5), clinicians (n = 25), and clinical educators (n = 4). Domain 1 (change commitment) had a mean score of 4.72 (SD 0.47) while Domain 2 (change efficacy) had a mean score of 4.53 (SD 0.54) out of a total potential score of five. There were no statistically significant differences between site responses for Domain 1 (p = 0.5479) and Domain 2 (p = 0.1026) nor role responses for Domain 1 (p = 0.0627) and Domain 2 (p = 0.2520). Conclusion: Stakeholders had very high overall readiness for change across all ORIC questions for both change commitment and change efficacy. Mean scores for change commitment were slightly higher which is not surprising given the low-resourced settings stakeholders work in while training students. High mean scores across sites and roles is encouraging as this novel preceptor program is currently being rolled out. [ABSTRACT FROM AUTHOR]

Background: The clinical learning environment (CLE) plays a crucial role in shaping the learning experiences and professional development of medical professionals. Understanding and optimising this environment is essential for improving doctors' knowledge acquisition, clinical skills, and overall well-being. The development of the Postgraduate Hospital Educational Environment Measure (PHEEM) and its translation to numerous languages has been a milestone in clinical education. Even though PHEEM was recently translated into Arabic, its psychometric properties in this form remain unevaluated. Therefore, this study aims to conduct a comprehensive psychometric analysis of the Arabic version of the PHEEM questionnaire. Methods: This is a cross-sectional questionnaire survey validation study. The defined population were medical residents in Damascus, Syria. A paper-based survey as well as an online-based one were conducted using several non-probability sampling methods namely, convenience, river and, snowball sampling between June 15, 2023, and June 21, 2023. Both exploratory (EFA) and confirmatory (CFA) factor analyses were conducted. Several psychometric criteria were applied including scree plot, eigenvalue > 1.5 and the 'proportion of variance accounted for' criterion. Results: A total of 543 participants completed the questionnaire (56.9% female). Kaiser-Meyer-Olkin measure for sample adequacy was high (0.937) and the P-value for Bartlett's test was < 0.001. EFA revealed five meaningful factors which were labelled: perception of teachers, learner's engagement and social participation, external regulation, work culture, and living conditions. These factors had the following eigenvalues: 12.6, 2.18, 2.03, 1.86, and 1.41 respectively, with a total explained variance of 43.45%. Cronbach's Alpha was 0.938. CFA confirmed the model structure of EFA (SRMR = 0.067 and RMSEA = 0.066). The Average Variance Explained (AVE) value of any given factor was > 0.7. Discussion: The Arabic PHEEM inventory demonstrated satisfactory psychometric properties. The extracted domains are of theoretical relevance to the psychosocial-material conceptual framework for learning environment. Nonetheless, this validation was performed in the Syrian context; therefore, future studies in other Arabic countries are recommended to support the applicability of Arabic PHEEM in the wide Arab World. [ABSTRACT FROM AUTHOR]

Aims Background Methods Results Conclusion Implications for nursing practice and policy To investigate how nursing students’ professional identity, clinical learning environment, financial incentives, and career opportunities influence their intention to migrate.There is a preponderance of studies about nurse migration and its impact on the global nursing workforce. However, a critical gap remains about nursing students' intentions to migrate, particularly among developing countries like the Philippines.Using a cross‐sectional design, third‐ and fourth‐year nursing students (n = 316) from the largest comprehensive university in Manila were conveniently recruited. Data were collected from November to December 2023 using five validated self‐report scales. Descriptive (e.g., mean, standard deviation) and inferential statistics (e.g., Spearman rho, covariance‐based structural equation modeling) were used to analyze data.The emerging model demonstrated acceptable model fit indices. Nursing students’ professional identity (β = 0.18, p = 0.043) and financial incentives (β = 0.10, p = 0.046) significantly and positively influence the intention to migrate. The satisfaction with future career opportunities (β = –0.12, p = 0.038) and clinical learning environment perception (β = –0.15, p = 0.048) negatively influence the intention to migrate. These four predictors accounted for 4.60% of the total variance of intention to migrate.Nursing students’ professional identity and financial incentives directly impact intent to migrate, whereas future career opportunities satisfaction and clinical learning environment inversely affect intent to migrate.This study underscores the imperative for nursing colleges and faculty to promote positive professional identity and provide a conducive clinical learning environment to develop sustainable nurses’ migration policies. [ABSTRACT FROM AUTHOR]

Introduction In Syria, specialist dentists undergo five years of undergraduate education and four years of postgraduate education. In the latter, students engage in treating complex cases as part of their professional training. This study aimed to obtain in-depth qualitative understanding of the clinical learning environment at Damascus University Faculty of Dental Medicine, Syria. Methods Semi-structured interviews were held with eight postgraduate dental students at Damascus University Faculty of Dental Medicine. The faculty has eight clinical departments; therefore, a single participant was purposively sampled from each department. The male-female ratio of the eight interviewed participants was 1:1. All interviews were conducted between 26th April 2020 and 8th January 2021. Data were analyzed inductively using reflective thematic analysis. Pragmatic saturation was discussed during the analysis and the authors made an interpretative judgement to stop data collection at the eighth interview. Results Major themes which emerged covered different aspects of the clinical learning environment such as clinical training, social interaction and assessment procedures. Faculty’s negligence of their teaching duties was one of the most recurrent themes. In clinical training and due to faculty inaccessibility, students had to rely on themselves or their senior peers in training. The social climate was perceived negatively and assessment was described as unfair and biased. Discussion The findings of this study were framed within Gruppen et al. (2019) theory of the learning environment wherein four dimensions emerge: the personal, the social, the organizational and the material. The findings of this study showcased the continuing deterioration of the clinical learning environment at Damascus University. It is hoped that these findings will encourage decision makers to introduce a comprehensive reform that addresses the curriculum, teaching practices and assessment procedures in clinical professional training.

Introduction Burnout in medical trainees challenges their work effectiveness and impedes their ability to learn. Teachers in the clinical learning environment (CLE) are well situated to identify burnout and are often responsible for learner assessment. Methods We developed a workshop to improve clinical teachers’ identification and understanding of learner burnout while empowering them to provide constructive feedback and support. Building on best-practice feedback techniques and utilizing the Maslach Burnout Inventory (MBI) as a framework, we designed the GetINBurnOUT method to provide feedback and support for learners experiencing burnout. Applying Kern's six-step approach to curriculum development, we created and implemented a workshop for clinical teachers centered on advanced burnout knowledge, application of the MBI to the CLE, and use of the GetINBurnOUT feedback method. Kolb's experiential learning theory informed workshop activities such as group discussion, case practice, and self-reflection. Participants completed surveys immediately after the workshop to assess planned behavior. Results We delivered the workshop eight times at local, regional, and national faculty development programs/conferences to over 188 participants. Participants rated the workshop favorably, with average scores of 4.5–4.8 out of 5 across all domains and program objectives; all participants planned to make a change to their practice. Positive comments emphasized the topic's importance and the GetINBurnOUT tool's practicality. Discussion This workshop can enhance clinical teachers’ understanding of burnout and provide them with the tools to address it in the CLE. The GetINBurnOUT method offers a practical approach for providing honest assessments while supporting learners in the CLE.

Abstract Background Expanding the quality and quantity of midwifery and nursing clinical preceptors is a critical need in many sub-Saharan educational settings to strengthen students’ clinical learning outcomes, and ultimately to improve maternal and child mortality. Therefore, this study protocol was developed to establish a year-long, four step, precepting program to (1) improve partnership building and program development (2) provide an evidence-based course to expand competency and confidence in precepting students (3) select preceptors to become train the trainers and (4) secure accreditation for the program, ultimately to engage and support cohorts of preceptors and continue to monitor and evaluate the effectiveness of the program over five years. Methods Qualitative and quantitative approaches will be used including evaluation of preceptors, faculty and leadership involved with the program, as well as students taught by preceptors. Data will include validated self-assessment scales, objective structured clinical examinations (OSCEs), satisfaction surveys, and direct clinical observation, in-depth interviews and/or focus group discussions (preceptors); feedback forms (students); process mapping and organizational readiness for implementing change surveys (faculty and leadership). Median change in scores will be the primary outcome for quantitative data. Content analysis within a deductive framework to identify key implementation and adoption themes will be used for qualitative data analysis. Discussion This study aims to assess the readiness and early effectiveness for implementing a preceptor program for midwifery and nursing in Sierra Leone and Malawi. Determining the effectiveness of this program will guide future adaptations in order to strengthen the program for sustainability and potential scale-up.

Abstract Background Exploration of the relationship between nursing students’ abusive supervision and their future intention to leave the nursing profession before completing the final clinical practicum is critical to the issue of nursing staff shortages and how to alleviate them. In order to further dissect the factors influencing turnover intention among student nurses in clinical practice, our study used the conservation of resources theory and job demands-resources model to explain the specific pathways that influence student nurses’ intention to leave the nursing profession, with particular focus on nursing students’ personality traits and certain organizational factors. Method This study followed a cross-sectional design. Between March and May 2022, a convenience sampling method was used to select 531 nursing students from two medical universities in Fuzhou. The Abusive Supervision, Emotional Exhaustion, Nurse-Patient Relationship, and Turnover Intention Scales were employed to collect data. The PROCESS macro (Models 4 and 7) for SPSS 25.0 by Hayes and 5,000 bootstrap samples were used to examine the moderation and mediation impacts. Results Abusive supervision was found to significantly positively predict nursing students’ intention to leave the nursing profession. Emotional exhaustion significantly mediated the relationship between abusive supervision and an intention to leave the nursing profession. The moderating effect of the nurse-patient relationship in the mediation model was also found to be significant. Conclusions Abusive supervision by clinical teaching staff is a work-related stressor that leads to emotional exhaustion, consequently decreasing nursing students’ future intention to work as a nurse. A nurse-patient relationship based on trust could buffer the negative effect of abusive supervision on emotional exhaustion. Healthcare organizations and nurse educators should implement programs that educate and train individuals about abusive supervision, emotion regulation, and positive nurse-patient relationships; this would serve to decrease nursing students’ intention to leave the nursing profession. This study provides relevant implications for helping nursing instructors develop effective intervention strategies to retain talented nursing personnel.

Abstract Background Medical students view clinical workplace placements as an inspiring and motivating learning environment where active student participation is pivotal to development of students’ identity. The progress from pre-clerkship to clerkship education harbors many challenges which consist of experiential learning, adjusting to the clinical environment, and understanding roles & responsibilities. Workplace learning is underpinned by various adult learning theories including social theories,constructivism, supported participation and legitimate peripheral participation. Workplace learning course was recently initiated for pre-clerkship students at a medical university in UAE, which will enable their smooth entry into the clerkship phase of the curriculum. Objectives The research aims to explore students’ perceptions of various domains of their clinical learning environment (CLE), highlight the challenges they face, and extract valuable feedback to improve their environment. Methods This study was conducted qualitatively by using focus groups method in order to explore students’ perceptions of the clinical learning environment. Two focus group discussions were conducted (n = 8 +/-10) to determine the common challenges of workplace learning and its potential solutions. Data were analyzed using thematic analysis. The approach used to carry out this study was phenomenology, as it helps to understand the learning and behavior of these students who are undergoing this pre-clerkship training in order to transition smoothly to the clerkship phase. Result The focus groups helped to deeply explore the perceptions of students about their clinical learning environment. It helped to reveal the challenges encountered by the students including the significance of proper orientation of staff and students, language barrier, availability of learning opportunities, and supervision quality. The focus groups provided worthwhile suggestions to improve the learning opportunities in the clinical learning environment which include orientation of the staff and students what to expect, improved supervision, mentoring and providing learning opportunities to encourage participation. Conclusion This study attempted to identify the pre-clerkship students’ perception of their clinical learning environment and the challenges they face over there. Possible suggestions by the students included a formal orientation for the staff and students to be carried out at the beginning. Efforts should be made by clerkship directors to provide students with learning opportunities by increasing patient exposure, encouraging participation, and providing high-quality supervision.

ABSTRACTIntroduction Optimizing the clinical learning environment (CLE) is a medical education priority nationwide.Materials and Methods We developed a virtual, one-hour workshop engaging students, housestaff and faculty in small-group discussions of five case scenarios adapted from reported unprofessional behaviors in the CLE, plus didactics regarding mistreatment, microaggressions and bystander interventions.Results Over two sessions (2021–2022), we engaged 340 students and 73 faculty/housestaff facilitators. Post-session surveys showed significant improvement in participants’ ability to recognize and respond to challenges in the CLE.Discussion Our innovative workshop, including scenarios derived from institutional reports of unprofessional behaviors, advanced participants’ knowledge and commitment to improve the CLE.

Background: Expanding the quality and quantity of midwifery and nursing clinical preceptors is a critical need in many sub-Saharan educational settings to strengthen students' clinical learning outcomes, and ultimately to improve maternal and child mortality. Therefore, this study protocol was developed to establish a year-long, four step, precepting program to (1) improve partnership building and program development (2) provide an evidence-based course to expand competency and confidence in precepting students (3) select preceptors to become train the trainers and (4) secure accreditation for the program, ultimately to engage and support cohorts of preceptors and continue to monitor and evaluate the effectiveness of the program over five years. Methods: Qualitative and quantitative approaches will be used including evaluation of preceptors, faculty and leadership involved with the program, as well as students taught by preceptors. Data will include validated self-assessment scales, objective structured clinical examinations (OSCEs), satisfaction surveys, and direct clinical observation, in-depth interviews and/or focus group discussions (preceptors); feedback forms (students); process mapping and organizational readiness for implementing change surveys (faculty and leadership). Median change in scores will be the primary outcome for quantitative data. Content analysis within a deductive framework to identify key implementation and adoption themes will be used for qualitative data analysis. Discussion: This study aims to assess the readiness and early effectiveness for implementing a preceptor program for midwifery and nursing in Sierra Leone and Malawi. Determining the effectiveness of this program will guide future adaptations in order to strengthen the program for sustainability and potential scale-up. [ABSTRACT FROM AUTHOR]

Background: Medical students view clinical workplace placements as an inspiring and motivating learning environment where active student participation is pivotal to development of students' identity. The progress from pre-clerkship to clerkship education harbors many challenges which consist of experiential learning, adjusting to the clinical environment, and understanding roles & responsibilities. Workplace learning is underpinned by various adult learning theories including social theories,constructivism, supported participation and legitimate peripheral participation. Workplace learning course was recently initiated for pre-clerkship students at a medical university in UAE, which will enable their smooth entry into the clerkship phase of the curriculum. Objectives: The research aims to explore students' perceptions of various domains of their clinical learning environment (CLE), highlight the challenges they face, and extract valuable feedback to improve their environment. Methods: This study was conducted qualitatively by using focus groups method in order to explore students' perceptions of the clinical learning environment. Two focus group discussions were conducted (n = 8 +/-10) to determine the common challenges of workplace learning and its potential solutions. Data were analyzed using thematic analysis. The approach used to carry out this study was phenomenology, as it helps to understand the learning and behavior of these students who are undergoing this pre-clerkship training in order to transition smoothly to the clerkship phase. Result: The focus groups helped to deeply explore the perceptions of students about their clinical learning environment. It helped to reveal the challenges encountered by the students including the significance of proper orientation of staff and students, language barrier, availability of learning opportunities, and supervision quality. The focus groups provided worthwhile suggestions to improve the learning opportunities in the clinical learning environment which include orientation of the staff and students what to expect, improved supervision, mentoring and providing learning opportunities to encourage participation. Conclusion: This study attempted to identify the pre-clerkship students' perception of their clinical learning environment and the challenges they face over there. Possible suggestions by the students included a formal orientation for the staff and students to be carried out at the beginning. Efforts should be made by clerkship directors to provide students with learning opportunities by increasing patient exposure, encouraging participation, and providing high-quality supervision. [ABSTRACT FROM AUTHOR]

Background: The clinical learning environment (CLE) is a key focus of the Accreditation Council of Graduate Medical Education. It impacts knowledge acquisition and professional development. A previous single‐center study evaluated the psychological safety and perceived organizational support of the CLE across different specialties. Building on this work, we explored and evaluated psychological safety and perceived organizational support across multiple heterogeneous emergency medicine (EM) residencies to identify trends and factors affecting perceptions of the CLE. Methods: Using the Psychological Safety Scale (PSS) and Survey of Perceived Organizational Support (SPOS), residents from seven U.S. EM residencies were surveyed using REDCap software from September through November 2021, with 300 potential respondents. As an adjunct to these surveys, three open‐ended questions were included regarding features of their learning environments. Results: A total of 137 out of 300 residents completed the survey. The overall response rate was 45.7%. There was a variable response rate across programs (26.0%–96.7%). Pooled results demonstrate an overall positive perception of CLEs, based on positive mean responses (i.e., "Members of my department are able to bring up problems and tough issue" had a mean of 4.2 on a 5‐point Likert scale). Open responses identified teaching, collegiality, and support from program leadership as supportive features of the CLE. Confrontational interdisciplinary communication, a sense of being devalued, and off‐service rotations were identified as threats or areas for improvement to the CLE. Conclusions: PSS and SPOS scores were generally positive in this multi‐institution study, consistent with the prior single‐institution study indicating that EM is often considered psychologically safe and supportive. EM training programs can consider using the PSS/SPOS to audit their own programs to identify areas for improvement and foster supportive features already in place. [ABSTRACT FROM AUTHOR]

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AbstractPurposeMaterials and methodsResultsConclusionsThe clinical learning environment (CLE) affects resident physician well-being. This study assessed how aspects of the learning environment affected the level of resident job stress and burnout.Three institutions surveyed residents assessing aspects of the CLE and well-being via anonymous survey in fall of 2020 during COVID. Psychological safety (PS) and perceived organizational support (POS) were used to capture the CLE, and the Mini-Z Scale was used to assess resident job stress and burnout. A total of 2,196 residents received a survey link; 889 responded (40% response rate). Path analysis explored both direct and indirect relationships between PS, POS, resident stress, and resident burnout.Both POS and PS had significant negative relationships with experiencing a great deal of job stress; the relationship between PS and stress was noticeably stronger than POS and stress (POS: B= −0.12, p=.025; PS: B= −0.37, p<.001). The relationship between stress and residents’ level of burnout was also significant (B = 0.38, p<.001). The overall model explained 25% of the variance in resident burnout.Organizational support and psychological safety of the learning environment is associated with resident burnout. It is important for educational leaders to recognize and mitigate these factors. [ABSTRACT FROM AUTHOR]

Background Aims Methods Results Conclusion The resilience education of intern nursing students has significant implications for the development and improvement of the nursing workforce. The clinical internship period is a critical time for enhancing resilience.To evaluate the resilience level of Chinese nursing interns and explore the effects of factors affecting resilience early in their careers, focusing on the mediating roles of career adaptability between clinical learning environment and resilience.The cross‐sectional study design was adopted. From March 2022 to May 2023, 512 nursing interns in tertiary care hospitals were surveyed online with the Connor‐Davidson Resilience Scale, the Clinical Learning Environment Scale for Nurse and the Career Adapt‐Abilities Scale. Structural equation modelling was used to clarify the relationships among these factors. Indirect effects were tested using bootstrapped confidence intervals.The nursing interns showed a moderately high level of resilience [M (SD) = 70.15 (19.90)]. Gender, scholastic attainment, scholarship, career adaptability and clinical learning environment were influencing factors of nursing interns' resilience. Male interns with good academic performance showed higher levels of resilience. Career adaptability and clinical learning environment positively and directly affected their resilience level (β = 0.62, 0.18, respectively, p < .01). Career adaptability was also positively affected by the clinical learning environment (β = 0.36, p < .01), and mediated the effect of clinical learning environment on resilience (β = 0.22, p < .01).Clinical learning environment can positively affect the resilience level of nursing interns. Career adaptability can affect resilience directly and also play a mediating role between clinical learning environment and resilience. Thus, promotion of career adaptability and clinical teaching environment should be the potential strategies for nursing interns to improve their resilience, especially for female nursing interns with low academic performance. [ABSTRACT FROM AUTHOR]

Background: Clinical accompaniment is an activity predominantly supervised by the clinical facilitator to develop the skills of the students. In South Africa, clinical accompaniment aims to develop the skills of the students to equip them in delivering efficient health services to the patients. Previous studies revealed that students experienced challenges and were negatively affected due to inadequate clinical accompaniment in the learning practice. Aim: The aim was to determine the challenges faced by University of KwaZulu-Natal (UKZN) undergraduate nursing students during their clinical accompaniment. Methods: An observational cross-sectional study design, with an analytic component was implemented. Questionnaires were used to collect data. Of the 400 registered nursing students, 245 were undergraduates; of these, 241 consented to participate in this study. Data captured into SPSS Statistics Package V28. ANOVA were used in comparing challenges amongst participants. A p-value less than 0.05 was considered significant. Results: A total of 241 participants responded to the questionnaires, which yielded a response rate of 98.4%. This study comprised first-year (32.4%), second-year (32.8%) and third-year (34.9%) students. There was no remarkable difference in terms of challenges amongst study participants (1st; 2nd; 3rd), p=0.592. Conclusion: This study revealed the challenges faced by undergraduate nursing students during their clinical accompaniment. Contribution: Study results might assist in developing effective guidelines to resolve the challenges encountered by students.

Abstract Objective To develop a clinical learning environment scale for Chinese nursing students and test its reliability and validity. Methods Based on Moos social environment theory, qualitative interviews and expert consultations were used to develop a pretest version of the Chinese Nursing Students’ Clinical Learning Environment Scale. With a convenience sampling method, 255 and 1582 Chinese nursing students were selected as the prediction and validation samples, respectively, from December 2022 to March 2023. Exploratory and confirmatory factor analyses were conducted to determine the construct validity. Results The scale consisted of 19 items. Exploratory factor analysis revealed three sub-scales, named goal orientation, interpersonal relation, and learning support, which explained 71.500% of the total variance. The results of the confirmatory factor analysis showed that the GFI was 0.848, the AGFI was 0.806, the RMSEA was 0.090, the RMR was 0.041, the NFI was 0.910, the IFI was 0.916, the CFI was 0.916, the PCFI was 0.798, and the PNFI was 0.793. The reliability values of the three dimensions were 0.870, 0.858, and 0.943, respectively, and the convergent validity values were 0.574, 0.603, and 0.625, respectively. Conclusion The reliability and validity of the dimensions of the Chinese Nursing Students’ Clinical Learning Environment Scale are acceptable, and the scale can be used as a useful tool for measuring the clinical learning environment of Chinese nursing students.

Caring is a fundamental professional nursing value. This study examined the effect of the clinical learning environment (CLE) on nursing students' caring behaviors during the COVID-19 pandemic. Valuing nursing work in the CLE increased the knowledge and skills aspect of caring behavior. Higher CLE scores in affordances and engagement and student centeredness increased the respectful deference of others and positive connectedness aspects of caring behaviors. These results may inform efforts to promote aspects of nursing students' caring behaviors during global health emergencies by enhancing the value of nursing work, engagement, and student-focused qualities of the CLE. [ABSTRACT FROM AUTHOR]

Introduction: Establishing a supportive clinical environment is paramount for enhancing nursing students' engagement in clinical practice, their clinical proficiencies, and satisfaction. The increase in nursing student enrollment at the Nursing College, driven by the collaborative efforts between Abu Dhabi Health Services Company (SEHA) and universities, has given rise to concerns regarding the quality of education and clinical instruction. These concerns are primarily due to the increased student-to-instructor ratio. Furthermore, the unsupportive clinical settings and learning tensions underscore the need to understand students' learning experiences and address research gaps within the field of clinical learning in the United Arab Emirates (UAE). Objectives: The purpose of this study is to investigate the undergraduate nursing students' perceptions of their clinical learning environment, with a focus on perceived benefits and challenges. Methods: This study used a cross-sectional survey design. The researchers administered a five-point Likert scale questionnaire, which had been adapted and contextualized, to a convenience sample of 217 third and fourth-year nursing students who willingly participated in this study. Results: Despite the presence of positive aspects, such as diverse clinical experiences and strong support from both clinical instructors and peers, several challenges affect the students' clinical learning. These challenges encompass disparate perceptions of supervision among staff nurses, learning tensions related to student academic workload, insufficient clinical supervision, and difficulties in finding assistance when needed. Conclusion: There is a clear need to enhance the overall ward learning environment to optimize students' academic motivation and clinical skills. Several measures can be taken to achieve this goal, including incentivizing and reducing the workload of staff nurses, investing in the professional development of clinical instructors, promoting peer interactions and group learning, and adopting a block pattern of education in years three and four for better clinical knowledge assimilation and reduced theoretical workload. [ABSTRACT FROM AUTHOR]

Teamwork in graduate medical education (GME) is often hindered in clinical learning environments where discontinuity among residents, supervisors, and other health care professionals is typical. Teaming is a conceptual approach to teamwork in dynamic environments with constantly changing team members and goals. Teaming is built on principles of project management and team leadership, which together provide an attractive strategy for addressing teamwork challenges in GME. Indeed, teaming is now a requirement of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program. However, many clinician-educators and leaders may be unfamiliar with teaming and how to integrate it into their GME programs. In this article, the teaming framework is described with a specific example of how it can be applied to improve hospital ward rounds, a common setting of teamwork breakdown. The goal of this article is to educate and encourage GME leaders as they learn new ways to implement teaming to improve patient care and education in their programs. [ABSTRACT FROM AUTHOR]

Objective: To develop a clinical learning environment scale for Chinese nursing students and test its reliability and validity. Methods: Based on Moos social environment theory, qualitative interviews and expert consultations were used to develop a pretest version of the Chinese Nursing Students' Clinical Learning Environment Scale. With a convenience sampling method, 255 and 1582 Chinese nursing students were selected as the prediction and validation samples, respectively, from December 2022 to March 2023. Exploratory and confirmatory factor analyses were conducted to determine the construct validity. Results: The scale consisted of 19 items. Exploratory factor analysis revealed three sub-scales, named goal orientation, interpersonal relation, and learning support, which explained 71.500% of the total variance. The results of the confirmatory factor analysis showed that the GFI was 0.848, the AGFI was 0.806, the RMSEA was 0.090, the RMR was 0.041, the NFI was 0.910, the IFI was 0.916, the CFI was 0.916, the PCFI was 0.798, and the PNFI was 0.793. The reliability values of the three dimensions were 0.870, 0.858, and 0.943, respectively, and the convergent validity values were 0.574, 0.603, and 0.625, respectively. Conclusion: The reliability and validity of the dimensions of the Chinese Nursing Students' Clinical Learning Environment Scale are acceptable, and the scale can be used as a useful tool for measuring the clinical learning environment of Chinese nursing students. [ABSTRACT FROM AUTHOR]

• The study supported the previously confirmed four-factor model. • The Czech version of The CLES has satisfactory psychometric properties. • The CLES can be recommended to use in Czech Republic. The clinical learning environment has significant importance in nursing education. To measure the quality of clinical learning environment a valid and reliable instrument should be available. Therefore, the aim of this cross-sectional validation study was to test validity and reliability of the Czech version of The Clinical Learning Environment and Supervision (CLES) scale. Participants were 166 final-year nursing students from four Czech universities. Data were collected using the paper and pencil form of The Clinical Learning Environment and Supervision scale from February 2018 to July 2019. Internal consistency and structure validity were tested. The Czech final-year nursing students assessed clinical learning environment rather positively. The Cronbach alpha of total The Clinical Learning Environment and Supervision scale was 0.968. Exploratory factor analysis supported four factors. The Czech version of the scale has satisfactory psychometric properties and can be recommended for evaluation the clinical learning environment for Czech nursing students. [ABSTRACT FROM AUTHOR]

Alignment between graduate medical education (GME) and health system priorities is foundational to meaningful engagement of residents and fellows in systems improvement work within the clinical learning environment. The Residents and Fellows Leading Interprofessional Continuous Improvement Teams program at the University of California San Francisco was designed over a decade ago to address barriers to trainee participation in health system-based improvement work. The program provides structure and support for health system-aligned trainee-led improvement projects in the clinic learning environment. Project champions (residents/fellows) from GME programs attend workshops where they learn improvement methodologies and develop proposals for health system-based improvement projects for their training programs. Proposals are supported by local faculty mentors and are reviewed and approved by GME and health systems' leaders. During the academic year, teams share their progress using visual management boards and interactive leader rounds. The health system provides a modest financial incentive for successful projects. Since the program's inception, thousands of trainees from 58 residency and fellowship programs have participated either as champions or participants in the program at least once, and in total over 300 projects have been implemented. Approximately three-quarters of the specific improvement goals were met, all projects meaningfully engaged residents and fellows, and many projects continued after the learners graduated. This active partnership between GME and a health system created a symbiotic relationship; trainees received education and support to complete improvement projects, while the health system reaped additional benefits from the alignment and impact of the projects. This partnership continues to grow with steady increases in participating programs, spread to partner health systems, and scholarship for trainees and faculty. [ABSTRACT FROM AUTHOR]

BACKGROUND: The practical training process represents a crucial step in the university process for students on degree courses in the health and medical professions. This discussion is emphasized for nursing students, who, for each stage of the internship, may have the opportunity to enrich themselves in practical terms and to be able to compare themselves with the reality of work physically. Based on this discussion, it is essential to carry out a periodic evaluation of the working realities. OBJECTIVES: The main objective of this work is to implement an evaluation tool for the clinical training environment to ensure feedback for both the healthcare facility under consideration and to improve the quality of university clinical training. METHOD: This research study protocol envisages an observational study as the type of study, with recruitment of nursing degree courses to subsequently include students from the various academic years. The study involves the application of the CLES+T questionnaire in participating degree courses, initially to be able to have an overall vision and subsequently to be able to implement it as a permanent evaluation tool. EXPECTED RESULTS: It is expected, from the study described in this protocol, that the participating population will consider the questionnaire as a way of critically analysing the clinical environment. A broad participation of the nursing student population and good feedback of the examined environments is expected.

Aim: The study aimed to describe how undergraduate nursing students evaluated the clinical learning environment of their studies during the Covid-19 pandemic. Design: Longitudinal cohort study. Methods: The research sample of 49 full-time students who completed their first year clinical practice in the academic year of 2018/2019 was followed over three years of study. The Clinical Learning Environment, Supervision and Nurse Teacher evaluation scale (CLES+T) was used for data collection. Quantitative data were evaluated using descriptive and inductive statistics. Results: Overall, students evaluated the clinical environment throughout their studies as average. Interaction with a tutor received the lowest rating, while relationship with mentor and external factors of the clinical environment (nursing management and nursing care in the workplace) received the highest rating. Second-year students rated the practice environment most highly. Students were satisfied with individual supervision in the first two years. However, due to the Covid-19 pandemic, group supervision prevailed in the third year, resulting in reduced student satisfaction. Conclusion: Students' perception of the clinical learning environment changed during their studies. These changes were driven by the quality of certain academic and clinical factors. The Covid-19 pandemic represented a significant impingement on the course and organization of clinical practice.

The pandemic forced final year clinical students in six health-profession programs in a Caribbean University to suddenly transition from a clinical learning environment to an exclusively online environment for clinical instruction. The change in curriculum delivery allowed students to compare teaching of clinical skills using clinical and online learning environments. In June 2020, 278 students (78% response rate) completed a survey rating the online teaching experience. Students from each discipline also participated in a focus group discussion. Of the sample, 88% of students felt that the online environment was enthusiastic and stimulating but did not view it as satisfactory for skills transfer; 77% felt connected with their teachers but deprived of the social connectedness, peer support, and vicarious learning afforded by face-to-face instruction. Clinical students perceived the online environment as a convenient and beneficial platform to deliver didactic components of the clinical curriculum, thus providing downtime for students and ensuring equitable exposure of all students to all teachers. In the post-pandemic era, medical teachers should make the effort to maintain and refine online approaches, not just for use in times of emergency, but for integration into curriculum delivery strategies to improve the clinical learning environment and student satisfaction, while maintaining the hands-on method of clinical instruction.

Background: Improving midwifery education is critical to improving maternal and infant health outcomes in Sierra Leone. A significant priority within midwifery education is to strengthen the clinical teaching and students’ hands-on experience in the clinical setting. Objectives: To identify facilitators and challenges within midwifery students’ clinical placements and to highlight areas to strengthen the clinical midwifery education system as well as the role of preceptors. Methods: We conducted a participatory process mapping with two schools of midwifery in Sierra Leone to detail steps taken by practicing midwives and midwifery faculty when students are placed in clinical settings for midwifery rotations. Findings: There were 42 participants from the Bo and Makeni regions of Sierra Leone. Participants included midwifery faculty from the Schools of Midwifery in Makeni and Bo, clinical midwives from two regional government hospitals, clinical midwives from two affiliated community health centers, and midwives from the District Health Management Teams. Three recurring themes emerged in the process. First, there was always some element of preparing or teaching the student. Second, there were administrative tasks to coordinate between the schools, clinical sites, and students, before, during, and after clinical placements. And third, there were elements of communication and collaboration between schools and clinical sites/preceptors that could be improved through shared understanding and standardization. Additional themes were inconsistencies across activities before, during, and after students’ clinical placement and limited opportunities and confusion around systems of evaluating all components of the clinical placement experience. Conclusions: This study provides insight into the process of midwifery students’ clinical placement and highlights facilitators to be standardized and some modifiable barriers to be addressed. As Sierra Leone and many other similar countries in sub-Saharan Africa attempt to strengthen students’ clinical education through educating and developing preceptors, processing mapping can be a useful tool.

A hotel-based clinic to serve Project RoomKey residents is a model for meeting the health care needs of an unhoused population. The purpose of this paper is to describe the health services provided by students and licensed clinicians at a hotel that was designed to allow unhoused community residents to shelter in place during the early stages of the Covid pandemic (May 1-June 30, 2020). Documents developed for the project may be useful to others who are setting up similar services for unhoused residents in their own communities.

Aim: To develop a measurement tool to evaluate the clinical learning environment for nursing students in operating rooms. Background: In this study, a scale for evaluating the clinical learning environment for nursing students in operating rooms was developed and subjected to reliability and validity tests. Design: A cross-sectional, methodological study. Methods: Qualitative interviews, the Delphi method, a literature review and pilot testing were employed to develop the scale. A purposive sampling method was used to select September 2021 through May 2022; a total of 227 nursing students with internship experience in operating rooms at several teaching hospitals in North China were selected to evaluate the reliability and validity of the scale. Results: The 32-item, four-dimensional evaluation scale was developed through two rounds of consultation with 17 experts. The reliability and validity test showed that the overall Cronbach's alpha was 0.984 and 0.96. The split-half reliability for the total scale was 0.937, indicating good reliability. Conclusion: The proposed scale has high reliability and validity in evaluating the clinical learning environment of nursing students in operating rooms and improving clinical nursing education.

Background: The clinical learning environment is a multidimensional entity that affects the clinical learning outcomes of nursing students. Most studies in Ethiopia showed that nursing students' clinical competency was below half and their satisfaction with clinical practice is crucial to enhance their competency. However, in Ethiopia satisfaction of nursing students with their clinical learning environment is unknown. Objective: This study aimed to assess satisfaction with the clinical learning environment and associated factors among undergraduate nursing students. Methods: Institution-based cross-sectional study was conducted in public universities, in northwest Ethiopia. A total of 416 undergraduate nursing students were selected by a simple random sampling technique. Data were collected by a structured, pre-tested, self-administered questionnaire, entered into Epi-Info and exported to SPSS for analysis. Bivariable and multivariable binary logistic regression analyses were done to test the association. The odds ratio at 95 % CI and P-value

Psychological safety (PS) is the belief that the environment is safe for risk taking. Available data point to a lack of PS in medical education. Based on literature in other fields, PS in clinical learning environments (CLEs) could support trainee well-being, belonging, and learning. However, the literature on PS in medical education has not been broadly assessed. In 2020, authors searched PubMed, Web of Science, CINAHL, Scopus, ERIC, PsycInfo, and JSTOR for articles published prior to January 2020. Authors screened all search results for eligibility using specific criteria. Data were extracted and thematic analysis performed. Fifty-two articles met criteria. The majority focused on graduate medical education (45%), and 42% of studies took place within a CLE. Articles addressed organizational and team level constructs (58%), with fewer descriptions of specific behaviors of team members that promote or hinder safety. The impacts of safe environments for trainees and patients are areas in need of more exploration. Future research should focus on defining specific organizational and interpersonal leader behaviors that promote PS, seek to understand how PS is determined by individual trainees, and measure the impact of PS on learners, learning, and patient care outcomes. [ABSTRACT FROM AUTHOR]

The General Practice (GP) postgraduate program exists for 80% out of workplace learning. The quality of the clinical learning environment (CLE) has a direct effect on the quality of training and the professional development of GP trainees. Participatory research was used to involve all stakeholders in the development process of a 360° evaluation tool that should improve the average quality of GP training practices, guide GP trainees towards the best training practices and detect and remediate GP trainers of lower quality. TOEKAN (Tool for Communication and Evaluation of Quality Standards) was developed, which consists of a 72-item questionnaire for GP trainees and GP trainers and an 18-item questionnaire for those who coach and remediate GP trainers. The outcomes of the TOEKAN questionnaires are visualized in an online dashboard. TOEKAN is the first 360° evaluation tool for CLE in GP education. All stakeholders will complete the survey on a regular basis and have access to the results. By creating intrinsic and extrinsic motivation as well as mediation measures, the quality of CLE will improve. Continuous monitoring of the use and outcomes of TOEKAN will allow to critically review and improve this new evaluation tool as well as support the broader implementation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore how decision making and informal and incidental learning (IIL) emerged in the clinical learning environment (CLE) during the height of the Covid‐19 pandemic. The authors' specific interest was to better understand the IIL that took place among frontline physicians who had to navigate a CLE replete with uncertainty and complexity with the future goal of creating experiences for medical students that would simulate IIL and use uncertainty as a catalyst for learning. Method: Using a modified constructivist, grounded theory approach, we describe physicians' IIL while working during times of heightened uncertainty. Using the critical incident technique, we conducted 45‐min virtual interviews with seven emergency department (ED) and five intensive care unit (ICU) physicians, who worked during the height of the pandemic. The authors transcribed and restoried each interview before applying inductive, comparative analysis to identify patterns, assertions, and organizing themes. Results: Findings showed that the burden of decision making for physicians was influenced by the physical, emotional, relational, and situational context of the CLE. The themes that emerged for decision making and IIL were interdependent. Prominent among the patterns for decision making were ways to simplify the problem by applying prior knowledge, using pattern recognition, and cross‐checking with team members. Patterns for IIL emerged through trial and error, which included thoughtful experimentation, consulting alternative sources of information, accumulating knowledge, and "poking at the periphery" of clinical practice. Conclusions: Complexity and uncertainty are rife in clinical practice and this study made visible decision‐making patterns and IIL approaches that can be built into formal curricula. Making implicit uncertainty explicit by recognizing it, naming it, and practicing navigating it may better prepare learners for the uncertainty posed by the clinical practice environment. [ABSTRACT FROM AUTHOR]

Objectives: Improving medical student placements relies on being able to reliably evaluate how students experience clinical learning environments. The Undergraduate Clinical Education Environment Measure (UCEEM) is an increasingly used validated tool designed to allow such evaluations. This study aims to further characterize how the UCEEM relates to qualitative evaluation. methods: Students on placement at one hospital were invited to complete the UCEEM before and after the implementation of an innovative new placement structure. Additionally, focus groups were employed to collect qualitative data on their experiences. a novel protocol to triangulate the output of the UCEEM with the qualitative data was developed. Results: The UCEEM showed good internal consistency (Cronbach's Alpha 0.79-0.91) and internal correlation. Implementation of the intervention created significant improvements in the overall UCEEM scores (P =.008) and in the "Learning in and through work and quality of supervision" (P =.048), "Preparedness for student entry" (P =.033) and "Workplace interaction patterns and student inclusion" (P =.039) domains. The triangulation of qualitative data with UCEEM output showed that the UCEEM allowed evaluation of some perceptions not reached through open questioning. However, mixed interpretations of UCEEM items by students led to the conflation of themes and challenges in deriving the meaning behind the score. This appeared to be the case for 14 of the 24 UCEEM items. Conclusion: This investigation adds to the literature supporting the UCEEM as a validated tool. It also elucidates the limitations and relationships to qualitative data that investigators need to be aware of in its use. [ABSTRACT FROM AUTHOR]

This paper describes the Centers of Excellence in Primary Care Education (CoEPCE), a seven-site collaborative project funded by the Office of Academic Affiliations (OAA) within the Veterans Health Administration of the United States Department of Veterans Affairs (VA). The CoEPCE was established to fulfill OAA's vision of large-scale transformation of the clinical learning environment within VA primary care settings. This was accomplished by funding new Centers within VA facilities to develop models of interprofessional education (IPE) to teach health professions trainees to deliver high quality interprofessional team-based primary care to Veterans. Using reports and data collected and maintained by the National Coordinating Center over the first six years of the project, we describe program inputs, the multicomponent intervention, activities undertaken to develop the intervention, and short-term outcomes. The findings have implications for lessons learned that can be considered by others seeking large-scale transformation of education within the clinical workplace and the development of interprofessional clinical learning environments. Within the VA, the CoEPCE has laid the foundation for IPE and collaborative practice, but much work remains to disseminate this work throughout the national VA system. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Pediatric residency programs prioritize clinical learning environment components depending on resource availability, institutional constraints and culture, and accreditation requirements. However, there is limited literature on the landscape of implementation and maturity of clinical learning environment components across programs nationally. METHODS: We used Nordquist's clinical learning environment conceptual framework to craft a survey around the implementation and maturity of learning environment components. We performed a cross-sectional survey of all pediatric program directors enrolled in the Pediatric Resident Burnout-Resiliency Study Consortium. RESULTS: Components with the highest implementation rates were resident retreats, in-person social events, and career development, while components least likely to be implemented were scribes, onsite childcare, and hidden curriculum topics. The most mature components were resident retreats, anonymous systems for reporting patient safety events, and faculty-resident mentoring programs, while the least mature components were use of scribes and formalized mentorship for trainees underrepresented in medicine. Learning environment components included in the Accreditation Council of Graduate Medical Education Program Requirements were significantly more likely to be implemented and mature than non-required components. CONCLUSIONS: To our knowledge, this is the first study to use an iterative and expert process to provide extensive and granular data about learning environment components for pediatric residencies. [ABSTRACT FROM AUTHOR]

Abstract Background Clinical placement is recognised as essential for nursing students’ development of clinical competence. However, difficulties in providing supportive clinical learning environments are a well-known challenge in nursing education. In Norway, the use of nurse educators in joint university and clinical roles has been recommended as an initiative to strengthen the clinical learning environment and enhance the educational quality. In this study we use the term practice education facilitator in a generic sense for these roles. The aim of this study was to explore how practice education facilitators can contribute to strengthen the clinical learning environments for nursing students. Methods This study has a qualitative explorative design with a purposive sample of practice education facilitators affiliated to three different universities located in southeast, mid-, and northern Norway. Individual in-depth interviews with 12 participants were conducted during spring 2021. Results A thematic analysis resulted in four themes: “coherence between theory and practice”; “student support and guidance during placement”; “supporting the supervisors to support the students” and “factors influencing the practice education facilitators’ performance in their role”. The participants experienced that the practice education facilitator role contributed to strengthened clinical learning environments. However, their performance in the role was found to be contingent upon factors such as time allocated for the role, personal and professional attributes of the post holder, and a common understanding within the organisations regarding practice learning and role remits for the practice education facilitator. Conclusions Findings indicate that the practice education facilitator role can be a valuable resource for clinical supervisors and nursing students in clinical placement. Moreover, nurse educators who are familiar with the clinical area, and who are insiders in both settings, are ideally placed to contribute to bridge the theory-practice gap. The benefits of using these roles, however, were influenced by personal attributes of the post holder, time allocated for the role and the number of practice education facilitators positions, and management anchorage. Thus, to achieve the full potential of these roles, efforts to reduce these barriers should be considered.