“…Themes from descriptive studies of the learning environment (+, =, -) Personal (+} Resilience (Seltz et al, 2016) (Thomson et al, 2014) and invest time in doing so (Wear and Skillicorn, 2009) (+) Teachers role model skills (Thomson et al, 2014) and values (Wear and Skillicorn, 2009), observe and give feedback to learners for improvement (Thomson et al, 2014;Suksudaj et al, 2015), provide clear expectations for learning (Thomson et al, 2014) (+) Multiple levels of learners together (Thomson et al, 2014) (-) Mistreatment, neglect of learners, negative attitudes toward learners, unclear expectations for learners (Castillo-Angeles et al, 2017) (-) Insufficient supervision/no feedback (Thomson et al, 2014), too few opportunities to examine patients independently (Thomson et al, 2014), staff unmotivated to teach and held negative attitudes toward students (Thomson et al, 2014) Organizational (+) Teaching arrangements well organized (Thomson et al, 2014) (+) Continuity of participants (teachers, learners, patients) (Seltz et al, 2016) (+) Smaller, rural clinical sites perceived as better (Condon et al, 2017) (+) PBL perceived as less stressful and more meaningful than traditional curriculum (Moore-West et al, 1988) (-) Unclear expectations of learners (Thomson et al, 2014), failure to integrate students into surgical teams (Castillo-Angeles et al, 2017), too many students (Dolmans et al, 2008), lack of organization (Dolmans et al, 2008…”