Dunham Lisette, Dekhtyar Michael, Gruener Gregory, CichoskiKelly Eileen, Deitz Jennifer, Elliott Donna, Stuber Margaret L, Skochelak Susan E
a Medical Education Outcomes , American Medical Association , Chicago , Illinois , USA.
b Department of Neurology , Loyola University Chicago Stritch School of Medicine , Maywood , Illinois , USA.
Teach Learn Med. 2017 Oct-Dec;29(4):383-391. doi: 10.1080/10401334.2017.1297712. Epub 2017 Mar 20.
Phenomenon: The learning environment is the physical, social, and psychological context in which a student learns. A supportive learning environment contributes to student well-being and enhances student empathy, professionalism, and academic success, whereas an unsupportive learning environment may lead to burnout, exhaustion, and cynicism. Student perceptions of the medical school learning environment may change over time and be associated with students' year of training and may differ significantly depending on the student's gender or race/ethnicity. Understanding the changes in perceptions of the learning environment related to student characteristics and year of training could inform interventions that facilitate positive experiences in undergraduate medical education.
The Medical School Learning Environment Survey (MSLES) was administered to 4,262 students who matriculated at one of 23 U.S. and Canadian medical schools in 2010 and 2011. Students completed the survey at the end of each year of medical school as part of a battery of surveys in the Learning Environment Study. A mixed-effects longitudinal model, t tests, Cohen's d effect size, and analysis of variance assessed the relationship between MSLES score, year of training, and demographic variables.
After controlling for gender, race/ethnicity, and school, students reported worsening perceptions toward the medical school learning environment, with the worst perceptions in the 3rd year of medical school as students begin their clinical experiences, and some recovery in the 4th year after Match Day. The drop in MSLES scores associated with the transition to the clinical learning environment (-0.26 point drop in addition to yearly change, effect size = 0.52, p < .0001) is more than 3 times greater than the drop between the 1st and 2nd year (0.07 points, effect size = 0.14, p < .0001). The largest declines were from items related to work-life balance and informal student relationships. There was some, but not complete, recovery in perceptions of the medical school learning environment in the 4th year. Insights: Perceptions of the medical school learning environment worsen as students continue through medical school, with a stronger decline in perception scores as students' transition to the clinical learning environment. Students reported the greatest drop in finding time for outside activities and students helping one another in the 3rd year. Perceptions differed based on gender and race/ethnicity. Future studies should investigate the specific features of medical schools that contribute most significantly to student perceptions of the medical school learning environment, both positive and negative, to pinpoint potential interventions and improvements.
现象：学习环境是学生学习所处的物理、社会和心理环境。支持性的学习环境有助于学生的幸福感，并增强学生的同理心、专业素养和学业成就，而缺乏支持的学习环境可能导致倦怠、疲惫和愤世嫉俗。学生对医学院校学习环境的认知可能会随时间变化，并与学生的培训年份相关，且可能因学生的性别或种族/族裔而有显著差异。了解与学生特征和培训年份相关的学习环境认知变化，可为促进本科医学教育积极体验的干预措施提供依据。
对2010年和2011年在美国和加拿大23所医学院校之一入学的4262名学生进行了医学院校学习环境调查（MSLES）。作为学习环境研究系列调查的一部分，学生在医学院校每年年末完成该调查。采用混合效应纵向模型、t检验、科恩d效应量和方差分析来评估MSLES分数、培训年份和人口统计学变量之间的关系。
在控制了性别、种族/族裔和学校因素后，学生报告对医学院校学习环境的认知变差，在医学院校第3年开始临床实习时认知最差，在配对日之后的第4年有所恢复。与向临床学习环境过渡相关的MSLES分数下降（除年度变化外下降0.26分，效应量=0.52，p<.0001）比第1年和第2年之间的下降（0.07分，效应量=0.14，p<.0001）大3倍多。最大的下降来自与工作生活平衡和非正式学生关系相关的项目。在第4年，对医学院校学习环境的认知有一定但不完全的恢复。见解：随着学生在医学院校的学习进程，对医学院校学习环境的认知变差，随着学生向临床学习环境的过渡，认知分数下降更为明显。学生报告在第3年用于课外活动的时间减少以及学生之间互相帮助的情况下降最为明显。认知因性别和种族/族裔而异。未来的研究应调查对学生对医学院校学习环境的认知（包括积极和消极方面）贡献最大的医学院校的具体特征，以确定潜在的干预措施和改进方向。
