Janice L. Hanson, PhD, Virginia F. Randall, MD, Uniformed Services University, Bethesda, MD
BACKGROUND: The LCME requires medical educators to evaluate the learning environment and ensure it promotes professionalism. Other researchers have defined learning environment primarily from educators’ perspectives and have included positive role models; teacher-learner relationships; student self-efficacy; atmosphere. Purpose: To identify factors that influence medical students’ views of their learning environment, examined exclusively from students’ perspectives. METHODS: Students (N=316) responded to an end-of-clerkship questionnaire (6 pediatric clerkship sites; anonymous to clerkship faculty; required by Dean’s office). All free-text responses from AY 2005-2006 (155 of 155) and AY 2006-2007 (161 of 161) were analyzed using the constant comparative method. Two researchers analyzed the text independently, then discussed and compared coding decisions until reaching agreement on labels for themes, organization as three major themes with subthemes, and placement of all text in the themes. RESULTS: Three major themes emerged: 1) Structure and organization of the clerkship--physical conditions; learning activities; organization. 2) Teacher-learner interactions for education--facilitated learning clinical medicine at the MS3 level; feedback, evaluation, clear expectations; students included on the team. 3) Faculty attributes and professionalism--attitude about teaching and medical students; role model; expertise of faculty. DISCUSSION: Qualitative analysis of students’ free-text responses to a questionnaire described the learning environment in terms of organization, teacher-learner interactions and faculty attributes and professionalism. While developed in a pediatric clerkship, the themes may apply to other clerkships or residencies. Themes, subthemes and descriptors will form the basis of a questionnaire to assess clinical clerkships and assist faculty in identifying elements that promote a positive learning environment and professionalism and those that need improvement. Both qualitative analysis of free-text responses and a targeted questionnaire can assist clerkships in addressing the LCME requirement.