Towards healthy learning climates in postgraduate medical education: exploring the role of hospital-wide education committees

Milou E. W. M. Silkens, Kiki M. J. M. H. Lombarts, Albert J. J. A. Scherpbier, Maas Jan Heineman, Onyebuchi A. Arah

Postgraduate medical education prepares residents for delivery of high quality patient care during training as well as for later practice, which makes high quality residency training programs crucial to safeguard patient care. Healthy learning climates contribute to high quality postgraduate medical education. In several countries, modernization of postgraduate medical education has resulted in hospital-wide responsibilities for monitoring learning climates. This study investigates the association between the actions undertaken by hospital-wide education committees and learning climates in postgraduate medical education. Research conducted in December 2010 invited 57 chairs of hospital-wide education committees to complete a questionnaire on their implemented level of quality improvement policies. We merged the survey data from 21 committees that oversaw training programs and used the Dutch Residency Educational Climate Test (D-RECT) instrument in 2012 to measure their training programs' learning climate. We used descriptive statistics and linear mixed models to analyse associations between the functioning of hospital-wide education committees and corresponding learning climates. In total, 812 resident evaluations for 99 training programs in 21 teaching hospitals were available for analysis. The implementation level of the internal quality management systems as adopted by the hospital-wide education committees varied from 1.6 to 2.6 on a 5 point Likert-scale (ranging from 1 (worst) to 5 (best)). No significant associations were found between the functioning of the committees and corresponding learning climates. The contribution of hospital-wide committees to creating healthy learning climates is yet to be demonstrated. The absence of such an association could be due to the lack of a Plan-Do-Check-Act cycle guiding the policy as implemented by the committees and the lack of involvement of departmental leadership. Insight into the impact of these strategies on learning climates will benefit the quality of postgraduate medical education and, hopefully, patient care.