A model of influences on the clinical learning environment: the case for change at one U.S. medical school

BMC Medical Education

Research Article

Wei-Hsin Lu¹  Howard B. Fleit²  Janet E. Fischel³  Latha Chandran⁴  Richard J. Iuli⁵ 

[1] Department of Family, Preventive and Population Health, Stony Brook University School of Medicine, Stony Brook, USA;Department of Pathology, Stony Brook University School of Medicine, 11794-8691, Stony Brook, NY, USA;Department of Pediatrics, Division Chief, Developmental and Behavioral Pediatrics, Stony Brook Children’s Hospital, Stony Brook University School of Medicine, Stony Brook, USA;Donoho Academy of Clinical and Educational Scholars, Stony Brook University School of Medicine, Stony Brook, NY, USA;Stony Brook University School of Medicine, Stony Brook, USA;

关键词: Clinical learning environment;    Medical student mistreatment;    Professionalism;    Institutional leadership;    Patient safety;   

DOI  :  10.1186/s12909-017-0900-9

 received in 2016-11-04, accepted in 2017-03-10,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe learning environment within a school of medicine influences medical students’ values and their professional development. Despite national requirements to monitor the learning environment, mistreatment of medical students persists.MethodsWe designed a program called WE SMILE: We can Eradicate Student Mistreatment In the Learning Environment with a vision to enhance trainee and faculty awareness and ultimately eliminate medical student mistreatment. We provide a description of our program and early outcomes.ResultsThe program has enhanced student awareness of what constitutes mistreatment and how to report it. Faculty members are also aware of the formal processes and procedures for review of such incidents. Our proposed model of influences on the learning environment and the clinical workforce informs the quality of trainee education and safety of patient care. Institutional leadership and culture play a prominent role in this model. Our integrated institutional response to learning environment concerns is offered as a strategy to improve policy awareness, reporting and management of student mistreatment concerns.ConclusionsOur WE SMILE program was developed to enhance education and awareness of what constitutes mistreatment and to provide multiple pathways for student reporting, with clear responsibilities for review, adjudication and enforcement. The program is demonstrating several signs of early success and is offered as a strategy for other schools to adopt or adapt. We have recognized a delicate balance between preserving student anonymity and informing them of specific actions taken. Providing students and other stakeholders with clear evidence of institutional response and accountability remains a key challenge. Multiple methods of reporting have been advantageous in eliciting information on learning environment infringements. These routes and types of reporting have enhanced our understanding of student perceptions and the specific contexts in which mistreatment occurs, allowing for targeted interventions. A common platform across the healthcare professions to report and review concerns has afforded us opportunities to deal with interprofessional issues in a respectful and trustworthy manner. We offer a model of learning environment influences with leadership and institutional culture at the helm, as a way to frame a comprehensive perspective on this challenging and complex concern.

【 授权许可】

CC BY   
© The Author(s). 2017