Creating a Learning Environment to Produce Competent Residents: The Roles of Culture and Context

Abstract

Six core competencies have been developed for use by residency programs in assessing individual resident training outcomes. The authors propose that it is important to consider the role of residency culture and work context in helping residents achieve the required competencies. Specifically, the development of a learning-oriented culture and favorable work conditions that facilitate the presence of that culture should be a high priority for residency programs and the organizations (e.g., hospitals) in which they are housed. This places formal accountability at the doorstep of these programs and organizations in helping to create a "competent" resident. Using ideas from management theory, the authors identify specific attitudes, behaviors, and interactions that define a learning culture and show their usefulness when applied to residents' achievement of the competencies. They assert that current features of everyday resident work life decrease the chances that such attitudes, behaviors, and interactions will occur. Identifying and prioritizing the components of desired work environments for promoting a learning-oriented culture, in addition to assessing the presence or absence of both the components and learning best practices within residency programs, should become normal activities that complement the process of assessing competencies.

Why supervisors should promote feedback-seeking behaviour in medical residency

“…Therefore, clinical departments should also create a supportive learning-oriented, no-blame culture (Hoff et al 2004;Fullan 2008;Garvin et al 2008). In such a culture supervisors structure and organize the work of their subordinates, are clear about goals and expectations, promote feedback-seeking and are friendly, approachable and considerate.…”

Does Psychological Safety Impact the Clinical Learning Environment for Resident Physicians? Results From the VA's Learners' Perceptions Survey

“…1 The Accreditation Council for Graduate Medical Education (ACGME) requires graduate medical education (GME) programs to provide a clinical environment where residents learn competencies for independent practice, and patients receive supervised, safe, and high-quality care. 2 A critical element often overlooked in assessing clinical learning environments is whether residents believe their clinical environment is psychologically safe.…”

Alienation and engagement in postgraduate training at a South African medical school

“…Hoff et al (2004) state that the establishment of a supportive, learning-oriented environment is crucial for creating competent physicians. Furthermore, he believes that the organisational work context determines the establishment and maintenance of such a culture.…”