Medical Student Perceptions of the Learning Environment in Medical School Change as Students Transition to Clinical Training in Undergraduate Medical School

Abstract

After controlling for gender, race/ethnicity, and school, students reported worsening perceptions toward the medical school learning environment, with the worst perceptions in the 3rd year of medical school as students begin their clinical experiences, and some recovery in the 4th year after Match Day. The drop in MSLES scores associated with the transition to the clinical learning environment (-0.26 point drop in addition to yearly change, effect size = 0.52, p < .0001) is more than 3 times greater than the drop between the 1st and 2nd year (0.07 points, effect size = 0.14, p < .0001). The largest declines were from items related to work-life balance and informal student relationships. There was some, but not complete, recovery in perceptions of the medical school learning environment in the 4th year. Insights: Perceptions of the medical school learning environment worsen as students continue through medical school, with a stronger decline in perception scores as students' transition to the clinical learning environment. Students reported the greatest drop in finding time for outside activities and students helping one another in the 3rd year. Perceptions differed based on gender and race/ethnicity. Future studies should investigate the specific features of medical schools that contribute most significantly to student perceptions of the medical school learning environment, both positive and negative, to pinpoint potential interventions and improvements.

Beyond the struggles: a scoping review on the transition to undergraduate clinical training

“…It therefore was important to facilitate meaningful interactions and relationship building with others . Examples of these social strategies included initiating peer groups, near‐peer teaching sessions, facilitating students sharing experiences, and creating peer learning communities . Additionally, to promote student–staff relationships in the clinical environment, some researchers reported on the use of multidisciplinary approaches to educational inductions and including residents in these orientations .…”

“…Included studies were from the USA (n = 21), Europe (n = 11), UK (n = 8), Canada (n = 3) and Australia (n = 2). There were 12 qualitative studies, 10,11,14,[19][20][21][22][23][24][25][26][27] 11 cross-sectional surveys, [6][7][8]13,[28][29][30][31][32][33][34] eight descriptive case studies 5,[35][36][37][38][39][40][41] (two of which were related, using the same participants and intervention), 36,37 seven longitudinal studies, [42][43][44][45][46][47][48] three descriptive comparative studies, 12,49,50 three review papers 1,3,9 and one concept paper. 51…”

“…25,43,48 Examples of these social strategies included initiating peer groups, 25 nearpeer teaching sessions, 48 facilitating students sharing experiences, 43 and creating peer learning communities. 45 Additionally, to promote studentstaff relationships in the clinical environment, some researchers reported on the use of multidisciplinary approaches to educational inductions and including residents in these orientations. 12,39 Regarding measuring outcomes, increased social support was likely to reduce stress 19 and, in one study, increased students' perceptions of preparedness as it related to integrating into the clinical team.…”

Empathy and Osteopathic Manipulative Medicine: Is It All in the Hands?

“…When attributing this phenomenon to a high workload, 38 massive debt-to-income ratios, 39 unspoken mistreatment, 40 accumulated burden of distress, 41 and an overall worsening learning environment, 42 it may become a matter of survival that physicians become less empathetic. This self-surviving explanation corresponds with neurophysiologic studies on physicians that demonstrate a suppression of the pain matrix 43 and the mirror neuron system, 44 which enables identification with others.…”

Rethinking Education Environment: The Clinical Education Environment Framework

“…Interestingly, the notion of education environment was initially conceptualised based on the dynamic of student stress and its impact on learning (1). However, with the recent understanding, education environment is now best defined as the physical, social, and psychological contexts in which students learn, and it is influenced by interactions with peers, staff, faculty, curriculum, facilities, and infrastructure (2,3). A significant number of studies have shown education environment characteristics affect and influence students' cognitive, motivation, affect, and behaviour (4,5).…”