Measuring the clinical learning environment in anaesthesia

Perception of the operation theater learning environment and related factors among anesthesia students in Ethiopian higher education teaching hospitals: a multicenter cross-sectional study

INTRODUCTION

Operation theater learning involves three key elements: clinical work, learning, and the environment. There is little evidence regarding the operating theatre learning environment for anesthesia trainees. Identifying the overall perception of the operation theater learning environment helps to establish an efficient operation theater learning environment and produce competent anesthesia professionals.

OBJECTIVE

The aim of this study was to assess the perceptions of the operating theater learning environment and associated factors among undergraduate anesthesia students in Ethiopian higher education teaching hospitals from April to May 2023.

METHODS

A multicenter cross-sectional study was conducted on 313 undergraduate anesthesia students who began operation room clinical practice at 13 higher education teaching hospitals. The data were entered into EpiData version 4.6. A generalized ordered logistic regression model was used to analyze and identify factors associated with the operating theater learning environment using STATA software version MP17.

RESULTS

The findings of this study revealed that 45.05%,26.52%), 23% and 5.43% of the participants reported having desirable, moderately desirable, very desirable and undesirable perceptions of the operating theater learning environment, respectively, from highest to lowest. Preoperative discussion (AOR = 4.98 CI = 1.3-18.8), lack of teaching facilities (AOR = 0.16 CI = 0.03-0.75), noise from played music (AOR = 0.22 CI = 0.07-0.63), absence of tutors (AOR = 0.03 CI = 0.01-0.22), respect for students (AOR = 3.44 CI = 1.6-7.2), roll modeling for students (AOR = 3.23 CI = 1.5-6.8) and strict supervision of students (AOR = 0.24 CI = 0.07-0.88) were significantly associated with perceptions of the operation theater learning environment, with 95% CIs.

CONCLUSION

No study participant agreed that the operation theater learning environment in operation theatres was very undesirable. A lack of teaching facilities at the OR, a lack of tutors from the OR, noise from played music in the OR, a tutor respecting their student, a tutor role model for their student, a preoperative discussion with a tutor and strict supervision of the student are strongly associated with the operation theatre learning environment.

The clinical learning environment in anaesthesiology in Kerala---Is it good enough?---A web-based survey

Background and Aims

Evaluation of postgraduate (PG) training is important so that necessary modifications can be made. The quality of anaesthesiology teaching in our country has not been explored. We performed a survey among the anaesthesiology PGs of Kerala to assess their perceptions about their learning environment as well as to look for the deficits in the training program.

Methods

An online web-based survey was conducted. The questionnaire was developed after a detailed validation process and circulated via Google forms. The questionnaire had three parts. First part asked for demographic details. Second part had 22 statements in four domains to evaluate the quality of training, which were to be answered based on a five-point Likert scale. The third part asked for the suggestions of the trainees on changes to be made for the improvement in quality of their training.

Results

The response rate was 64%. The social atmosphere was perceived positively in general by our PGs. Majority of them received feedback on their work and had a regular class schedule. Only 34% of the residents got training in non-technical skills. More tutorials and case discussions were the most common change suggested by the residents. Lack of research training and training in simulation labs were the major lacunae identified.

Conclusion

The clinical learning environment (CLE) was perceived to be of medium to high quality by the anaesthesiology PGs of Kerala. Lack of routine assessments and regular academic sessions were reflected in the responses.

Developing and validating a tool for measuring the educational environment in clinical anesthesia

PURPOSE

We aimed to develop a contemporary measure for anesthesia teaching and learning in the operating theatre that was applicable to a variety of training jurisdictions, the Measure for the Anaesthesia Theatre Educational Environment (MATE).

METHODS

A systematic review of the literature and modified Delphi approach was used to identify items for content validity. Reliability and exploratory factor analyses were conducted after a pilot survey of trainees to show construct validity, with removal of redundant items. Item domains were identified through a global assessment of factor structure accuracy and relation to real-world constructs.

RESULTS

Literature review generated an initial 73-item list. A modified Delphi approach with 24 experts identified 44 relevant items. The pilot survey generated 390 responses. Reliability analysis, exploratory factor analysis, and global assessment refined the measure to 33 items. Four domains were identified according to factor structure: teaching preparation and practice, assessment and feedback, procedures and responsibility, and overall atmosphere. The educational environment was rated by trainees at 74.6 ± 15.6% with excellent internal consistency (Cronbach's α = 0.975).

CONCLUSION

The MATE survey tool generated valid and reliable scores when measuring the educational environment in the operating theatre. Further research is required to investigate possible differences between the training countries and age of junior doctors and the associated underlying factors. Other researchers are invited to administer the survey and share results within a central database.

Burnout and the Learning Environment of Anaesthetic Trainees

Burnout has a high prevalence among healthcare workers and is increasingly recognised as an environmental problem rather than reflecting a personal inability to cope with work stress. We distributed an electronic survey, which included the Maslach Burnout Inventory Health Services Survey and a previously validated learning environment instrument, to 281 Victorian anaesthetic trainees. The response rate was 50%. We found significantly raised rates of burnout in two of three subscales. Ninety-one respondents (67%) displayed evidence of burnout in at least one domain, with 67 (49%) reporting high emotional exhaustion and 57 (42%) reporting high depersonalisation. The clinical learning environment tool demonstrated a significant negative correlation with burnout (r=-0.56, P <0.001). Burnout was significantly more common than when previously measured in Victoria in 2008 (62% versus 38%). Trainees rated examination preparation the most stressful aspect of the training program. There is a high prevalence of burnout among Victorian anaesthetic trainees. We have shown a significant correlation exists between the clinical learning environment measure and the presence of burnout. This correlation supports the development of interventions to improve the clinical learning environment, as a means to improve trainee wellbeing and address the high prevalence of burnout.