Assessing learning climate in residency: Revisiting the D-RECT tool Author: Alina Smirnova, MD Date: October 23, 2015
I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization. Je n ai aucune affiliation (financière ou autre) avec une entreprise pharmaceutique, un fabricant d appareils médicaux ou un cabinet de communication. Author: Alina Smirnova Date: October 23, 2015
Key points D-RECT is a valid and reliable tool for evaluating the learning climate in residency: 1. Educational atmosphere 2. Peer collaboration 3. Teamwork 4. Coaching and assessment 5. Patient sign-out 6. Work is adapted to residents competence 7. Formal education 8. Role of specialty tutor 9. Accessibility of supervisors 3
Theoretical background Learning climate: Informal / formal Educational / care outcomes If we evaluate, then we can improve Need for valid and reliable tools 4
Background of the D-RECT Dutch Resident Educational Climate Test Resident perceptions of the learning climate Developed based on qualitative research, expert opinions and Delphi panel (75 items) Validation in a pilot (50 items; 11 domains) (Boor et al. 2011) 5
Aim of research Investigate the 50 item questionnaire for: Internal validity Internal consistency Generalizability At the resident and the department level 6
Methods Setting: Departments providing hospital-based residency training in the Netherlands Using D-RECT for quality improvement Data collection: January 2012 - December 2013 Web-based and paper-based 7
1. Discuss practical importance of items 2. Exploratory factor analysis on 1/3 of sample items with loadings <0.4 excluded 3. Exploratory factor analysis on remaining items 4. Confirmatory factor analysis on 2/3 of sample On department & resident level 5. Internal consistency, interscale correlations, item-total correlations 6. Generalizability 8
Results 2306 residents evaluating 291 departments in 48 hospitals EFA: 9-factor structure, 35 items CFA:» Good fit on resident level» Satisfactory fit on department level 9
Results Internal consistency: Cronbach s alpha >0.7 Corrected item-total correlations: > 0.4 Inter-scale correlations: <0.7 Generalizability:» Minimum of 8 for subscales» Minimum of 3 for overall score 10
The proposed D-RECT Coaching and assessment Patient sign-out Adaptation of work to resident s needs Educational atmosphere Peer collaboration Teamwork Cognitive Affective Formal education Accessibility of supervision Role of specialty tutor Instrumental 11
What have we learned? Fewer items D-RECT / fewer residents needed Resident /department level Cognitive, affective and instrumental facets 12
Take home message Optimized D-RECT tool Starting point for quality improvement activities 13
Questions? a.smirnova@amc.nl @asmirnova7 Special thanks to: M. Silkens; R. Stalmeijer; O. Arah; A. Scherpbier; C. van der Vleuten & M. Lombarts 14
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