The Educational Environment QHPE 610 PDF

The Educational Environment QHPE 610 Innovation in Curriculum Plan and Design Learning Objectives Define educational environment. Describe the components of an educational environment. Understand the characteristics of successful educational environments. Understand the effects of...

The Educational Environment QHPE 610 Innovation in Curriculum Plan and Design Learning Objectives Define educational environment. Describe the components of an educational environment. Understand the characteristics of successful educational environments. Understand the effects of rudeness and bullying in the workplace. Describe the tools and approaches that have been developed to measure the educational environment 2 Educational Environment Definition Why is it important? ‘The educational environment is a It is found that a positive learning dynamic, complex structure with environment is associated with multiple facets that involve the trainee, better workplace learning within the trainee’s interactions with peers, clerkship and residency (Delva et supervisors, other members of the al., 2004). team, the training program and the In contrast, an intimidating and structure of the organization’ (Harden, hostile educational environment has 2001). the capacity to cause an erosion of empathy (Hojat et al., 2009). 3 Components of Educational Environment Emotional Physical climate Intellectual environment climate Educational environment 4 Physical Environment Overview Food: availability of healthy food, including that at night Space to rest and/or socialize: on call rooms and staff rooms Safety and security: especially in EDs and mental health departments Facilities for breast feeding 5 ACGME Accreditation Council for Graduate Medical Education (ACGME) Foundational Requirements for Postgraduate Training Clean and private facilities for lactation, which have refrigeration capabilities and proximity that is appropriate for safe patient care (II.D.1.c). 6 Emotional Climate Some of the essential factors to be considered are as follows: Constructive feedback Being supported Absence of bullying and harassment 7 Bullying and Harassment Bullying is a behaviour that is characterized as offensive, intimidating, malicious, or insulting. It is an abuse or misuse of power through means intended to undermine, humiliate, denigrate, or injure the recipient. Bullying may be committed by an individual against an individual or involves groups of people. In the UK, harassment is defined as bullying that occurs in view of a specific characteristic of the victim. Gender Ethnicity Religion Other Bullying behaviour is unwanted and unwarranted. 8 Incivility Role of Incivility Incivility Rudeness Bullying Harassment 9 Incivility (Cont.1) 10 Incivility (Cont.2) When Rudeness in Teams Turns Deadly (Incivility in Nursing) – Chris Turner (0:00–15:17) Link: ‘When rudeness in teams turns deadly | Chris Turner | TEDxExeter’ 11 Quote ‘The standard you walk past is the standard you accept.’ - Lieutenant General - David Morrison - Australian Chief of Army 12 Intellectual Climate Characteristics of Intellectual Climate are: Learning with patience Relevant Evidence-based Active participation Motivating 13 Some Problems with the Educational Environment Focus on knowledge rather than the problem-solving skills Limited use of simulation Teaching at the wrong level Passive observation Limited reflection and discussion Teaching by humiliation 14 Coles & Mountford (1999) Support education in a clinical environment Studied several hospitals in the UK with good trainee feedback Spoke to senior educators as well as to trainees They found that successful hospitals had three common characteristics. The authors summarised them as the ‘3 Cs’: Community Collegiality Criticality 15 Coles & Mountford (1999) (Cont.1) Community Trainees reported of having a sense of being a part of a community in those units where education was a priority. They ‘belonged’ and took pride in the unit. Individuals in the ‘community’ had concern for each other. 16 Coles & Mountford (1999) (Cont.2) Collegiality All the members of staff were colleagues (not just employees in the same organization). Trainees felt accepted by seniors and felt seniors saw them as colleagues — ‘mutual respect. In addition, collegiality included having a joint ‘scholarship’. There is a body of people not just working together, but learning together. There is a community of practice. 17 Coles & Mountford (1999) (Cont.3) Criticality Definition: As professional practitioners, we should be looking at what we do, learning from this, and changing when necessary. The study participants felt that ‘criticality’ is what makes professional people professional. There is collective deliberation and 2-way questioning. 18 Measures of Educational Environment Tools Efforts to develop tools to measure the education environment date back to the 1960s. Instruments have been developed for a variety of healthcare professional groups in a variety of settings. In 1997, The Dundee Ready Education Environment Measure (DREEM) was developed (Roff et al., 1997). 50 items A high degree of consistency and validity 19 Measures of Educational Environment (Cont.1) DREEM DREEM has been extensively studied in the undergraduate medical environment. However, in postgraduate training, other unique features are present, such as the complex relationship between postgraduate doctors, their employers, trainers, training institutions, and patients (Swanwick, 2015). 20 Measures of Educational Environment (Cont.2) PHEEM The Postgraduate Hospital Educational Environment Measure (PHEEM) 40 items 3 sub-scales Perceptions of role autonomy Perceptions of teaching Perceptions of social support Overall score: 0–40: very poor 41–80: plenty of problems 81–120: mainly positive, but room for improvement 121–160: excellent 21 Measures of Educational Environment (Cont.3) PHEEM A systematic review found the PHEEM to be the most suitable instrument to examine the educational environments for postgraduate medical training (Soemantri et al., 2010). Its features include: Positive correlation with in-training exams Negative correlation with burnout 22 Clinical Learning Environment Review (CLER) The CLER program of inspections is designed to provide US ACGME- accredited institutions with feedback that addresses the following six areas: Patient safety Healthcare Quality Care transitions Supervision Duty hours and fatigue management and mitigation Professionalism In this program, a large range of metrics are reviewed. 23 Clinical Learning Environment Review (CLER) (Cont.) 24 Summary A positive educational environment is associated with better learning and well being. An educational environment has physical, emotional, and intellectual components. Rudeness affects team performance and is a patient safety issue. The 3 Cs of successful departments are as follows: Community, Collegiality, and Criticality. A range of measures have been developed to measure the educational environment, and as a result, they help monitor the response to change. 25 References Chambers, R., & Wall, D. (2000). Teaching made easy: A manual for health professionals. Radcliffe Medical. Coles., C., & Mountford, D. (1999). Supporting education in a clinical environment. Wessex Postgraduate Medical and Dental Deanery. Delva, M. D., Kirby, J., Schultz, K., & Godwin, M. (2004). Assessing the relationship of learning approaches to workplace climate in clerkship and residency. Acad Med., 79(11), 1120–6. https://doi.org/10.1097/00001888-200411000-00025 Harden, R. (2001). The learning environment and the curriculum. Medical Teacher, 23(4), 335–336. https://doi.org/10.1080/01421590120063321 Hojat, M., Vergare, M. J., Maxwell, K., Brainard, G., Herrine, S. K., Isenberg, G. A., Veloski, J., & Gonnella, J. S. (2009). The devil is in the third year: A longitudinal study of erosion of empathy in medical school. Academic Medicine, 84(9), 1182–1191. https://doi.org/10.1097/acm.0b013e3181b17e55 Porath, C., & Pearson, C. (2013). The price of incivility. Harvard Business Review, 91(1), 114–121. Roff, S., McAleer, S., Harden, R. M., Al-Qahtani, M., Ahmed, A. U., Deza, H., Groenen, G., & Primparyon, P. (1997). Development and validation of the Dundee Ready Education Environment Measure (DREEM). Medical Teacher, 19(4), 295– 299. https://doi.org/10.3109/01421599709034208 Roff, S., McAleer, S., & Skinner, A. (2005). Development and validation of an instrument to measure the postgraduate clinical learning and teaching educational environment for hospital-based junior doctors in the UK. Medical Teacher, 27(4), 326–331. https://doi.org/10.1080/01421590500150874 Soemantri, D., Herrera, C., & Riquelme, A. (2010). Measuring the educational environment in health professions studies: A systematic review. Medical Teacher, 32(12), 947–952. https://doi.org/10.3109/01421591003686229 Swanwick, T. (2015). Postgraduate medical education: The same, but different. Postgraduate Medical Journal, 91(1074), 179–181. https://doi.org/10.1136/postgradmedj-2014-132805 26 Credits The following faculty is attributed with the slides and ideas of this session: Dr. Adeel Ghaffar 27