Development of a brief learning environment measure for use in healthcare professions education: The Healthcare Education Micro Learning Environment Measure (HEMLEM)

Abstract

Background: The learning environment impacts many aspects of healthcare education, including student outcomes. Rather than being a single and fixed phenomenon, it is made up of multiple micro learning environments. The standard clinical learning environment measurement tools do not consider such diversity and may fail to adequately capture micro learning environments. Moreover, the existing tools are often long and may take a prohibitive amount of time to complete properly. This may have a negative impact on their usefulness in educational improvement strategies. In addition, there is no universal tool available which could be utilised across several healthcare student groups and placement settings. Aim: To create an evidence-based measurement tool for assessing clinical micro learning environments across several healthcare profession student groups. Methods: The measurement tool was developed through a step-wise approach: 1) literature review with iterative analysis of existing tools; 2) generation of new items via thematic analysis of student experiences; 3) a Delphi process involving healthcare educators; 4) piloting of the prototype; and 5) item reduction. Results: The literature review and experiential data from healthcare students resulted in 115 and 43 items respectively. These items were refined, leaving 75 items for the Delphi process, which produced a prototype with 57 items. This prototype was then completed by 257 students across the range of healthcare professions, with item reduction resulting in a 12-item tool. Conclusion: This paper describes a mixed methods approach to developing a brief micro learning environment measurement tool. The generated tool can be used for measuring student perceptions of clinical environments across several healthcare professions. Further cross-cultural and cross-professional validation studies are needed to support widespread use, possibly through mobile application. © 2020 The Author(s).

Keywords

Author Keywords

Not provided

Index Keywords

clinical competence human medical education psychology Humans Internship and Residency Article learning environment Thematic analysis medical student Students, Medical health student human experiment major clinical study program evaluation perception Education, Medical Program development validation study Education, Medical, Undergraduate Delphi study mobile application evidence based medicine Evidence-Based Medicine

Author Affiliations

Department of Medical Education, The University of Manchester, Manchester, Greater Manchester, United Kingdom

Lancaster Medical School, Lancaster, Lancashire, United Kingdom, Accident and Emergency Department, North Manchester General Hospital, Manchester, Greater Manchester, United Kingdom

Royal Liverpool University Hospital, Liverpool, Merseyside, United Kingdom

Department of Medical Education, UCL Medical School, London, United Kingdom

Funding & Acknowledgements

University College London, UCL

Funding text 1: This research was funded by a research grant from Health Education England (North West). Health Education England staff had no role in the design of the study, or the collection, analysis, and interpretation of the data, or the preparation of this manuscript. Colleagues at Health Education England (North West) facilitated distribution of recruitment emails via their networks of educators.; Funding text 2: RI is a core-funded member of Lancaster Medical School, having previously been employed at the Liverpool School of Tropical Medicine during the time of data collection. The bulk of the grant from Health Education England (North West) was used to partially \u201Cbuy out\u201D her time from her NHS job at The Pennine Acute Hospitals NHS Trust to enable her to carry out this study. CR is a recently-qualified doctor, having been a medical student during the study. She received payment from the Health Education England (North West) grant for her time spent on data analysis and writing up the project. KW is funded by a National Institute for Health Research fellowship and is a core funded UCL faculty member. She received payment from the Health Education England (North West) grant for the psychometric analysis. LBD is a core-funded member of the Division of Medical Education, University of Manchester, who places healthcare professional students into learning environments in the North West of England. LBD received payment from the Health Education England (North West) grant for the design of the study.

National Institute for Health Research, NIHR

Funding text 1: This research was funded by a research grant from Health Education England (North West). Health Education England staff had no role in the design of the study, or the collection, analysis, and interpretation of the data, or the preparation of this manuscript. Colleagues at Health Education England (North West) facilitated distribution of recruitment emails via their networks of educators.; Funding text 2: RI is a core-funded member of Lancaster Medical School, having previously been employed at the Liverpool School of Tropical Medicine during the time of data collection. The bulk of the grant from Health Education England (North West) was used to partially \u201Cbuy out\u201D her time from her NHS job at The Pennine Acute Hospitals NHS Trust to enable her to carry out this study. CR is a recently-qualified doctor, having been a medical student during the study. She received payment from the Health Education England (North West) grant for her time spent on data analysis and writing up the project. KW is funded by a National Institute for Health Research fellowship and is a core funded UCL faculty member. She received payment from the Health Education England (North West) grant for the psychometric analysis. LBD is a core-funded member of the Division of Medical Education, University of Manchester, who places healthcare professional students into learning environments in the North West of England. LBD received payment from the Health Education England (North West) grant for the design of the study.

Fundação para a Ciência e a Tecnologia, FCT

Grant: Incentivo/SAU/LA0001/2013

Funding text 1: This research was funded by a research grant from Health Education England (North West). Health Education England staff had no role in the design of the study, or the collection, analysis, and interpretation of the data, or the preparation of this manuscript. Colleagues at Health Education England (North West) facilitated distribution of recruitment emails via their networks of educators.; Funding text 2: RI is a core-funded member of Lancaster Medical School, having previously been employed at the Liverpool School of Tropical Medicine during the time of data collection. The bulk of the grant from Health Education England (North West) was used to partially \u201Cbuy out\u201D her time from her NHS job at The Pennine Acute Hospitals NHS Trust to enable her to carry out this study. CR is a recently-qualified doctor, having been a medical student during the study. She received payment from the Health Education England (North West) grant for her time spent on data analysis and writing up the project. KW is funded by a National Institute for Health Research fellowship and is a core funded UCL faculty member. She received payment from the Health Education England (North West) grant for the psychometric analysis. LBD is a core-funded member of the Division of Medical Education, University of Manchester, who places healthcare professional students into learning environments in the North West of England. LBD received payment from the Health Education England (North West) grant for the design of the study.

Fundação para a Ciência e a Tecnologia, FCT

Funding text 1: This research was funded by a research grant from Health Education England (North West). Health Education England staff had no role in the design of the study, or the collection, analysis, and interpretation of the data, or the preparation of this manuscript. Colleagues at Health Education England (North West) facilitated distribution of recruitment emails via their networks of educators.; Funding text 2: RI is a core-funded member of Lancaster Medical School, having previously been employed at the Liverpool School of Tropical Medicine during the time of data collection. The bulk of the grant from Health Education England (North West) was used to partially \u201Cbuy out\u201D her time from her NHS job at The Pennine Acute Hospitals NHS Trust to enable her to carry out this study. CR is a recently-qualified doctor, having been a medical student during the study. She received payment from the Health Education England (North West) grant for her time spent on data analysis and writing up the project. KW is funded by a National Institute for Health Research fellowship and is a core funded UCL faculty member. She received payment from the Health Education England (North West) grant for the psychometric analysis. LBD is a core-funded member of the Division of Medical Education, University of Manchester, who places healthcare professional students into learning environments in the North West of England. LBD received payment from the Health Education England (North West) grant for the design of the study.

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Development of a brief learning environment measure for use in healthcare professions education: The Healthcare Education Micro Learning Environment Measure (HEMLEM)

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