Understanding resident wellness: A path analysis of the clinical learning environment at three institutions.

PURPOSE: The clinical learning environment (CLE) affects resident physician well-being. This study assessed how aspects of the learning environment affected the level of resident job stress and burnout. MATERIALS AND METHODS: Three institutions surveyed residents assessing aspects of the CLE and well-being via anonymous survey in fall of 2020 during COVID. Psychological safety (PS) and perceived organizational support (POS) were used to capture the CLE, and the Mini-Z Scale was used to assess resident job stress and burnout. A total of 2,196 residents received a survey link; 889 responded (40% response rate). Path analysis explored both direct and indirect relationships between PS, POS, resident stress, and resident burnout. RESULTS: Both POS and PS had significant negative relationships with experiencing a great deal of job stress; the relationship between PS and stress was noticeably stronger than POS and stress (POS: B= -0.12, p=.025; PS: B= -0.37, p<.001). The relationship between stress and residents' level of burnout was also significant (B = 0.38, p<.001). The overall model explained 25% of the variance in resident burnout. CONCLUSIONS: Organizational support and psychological safety of the learning environment is associated with resident burnout. It is important for educational leaders to recognize and mitigate these factors.

The effects of clinical learning environment and career adaptability on resilience: A mediating analysis based on a survey of nursing interns.

BACKGROUND: The resilience education of intern nursing students has significant implications for the development and improvement of the nursing workforce. The clinical internship period is a critical time for enhancing resilience. AIMS: To evaluate the resilience level of Chinese nursing interns and explore the effects of factors affecting resilience early in their careers, focusing on the mediating roles of career adaptability between clinical learning environment and resilience. METHODS: The cross-sectional study design was adopted. From March 2022 to May 2023, 512 nursing interns in tertiary care hospitals were surveyed online with the Connor-Davidson Resilience Scale, the Clinical Learning Environment Scale for Nurse and the Career Adapt-Abilities Scale. Structural equation modelling was used to clarify the relationships among these factors. Indirect effects were tested using bootstrapped confidence intervals. RESULTS: The nursing interns showed a moderately high level of resilience [M (SD) = 70.15 (19.90)]. Gender, scholastic attainment, scholarship, career adaptability and clinical learning environment were influencing factors of nursing interns' resilience. Male interns with good academic performance showed higher levels of resilience. Career adaptability and clinical learning environment positively and directly affected their resilience level (ß = 0.62, 0.18, respectively, p < .01). Career adaptability was also positively affected by the clinical learning environment (ß = 0.36, p < .01), and mediated the effect of clinical learning environment on resilience (ß = 0.22, p < .01). CONCLUSION: Clinical learning environment can positively affect the resilience level of nursing interns. Career adaptability can affect resilience directly and also play a mediating role between clinical learning environment and resilience. Thus, promotion of career adaptability and clinical teaching environment should be the potential strategies for nursing interns to improve their resilience, especially for female nursing interns with low academic performance.

Development and psychometric properties of clinical learning environment scale for Chinese nursing students.

OBJECTIVE: To develop a clinical learning environment scale for Chinese nursing students and test its reliability and validity. METHODS: Based on Moos social environment theory, qualitative interviews and expert consultations were used to develop a pretest version of the Chinese Nursing Students' Clinical Learning Environment Scale. With a convenience sampling method, 255 and 1582 Chinese nursing students were selected as the prediction and validation samples, respectively, from December 2022 to March 2023. Exploratory and confirmatory factor analyses were conducted to determine the construct validity. RESULTS: The scale consisted of 19 items. Exploratory factor analysis revealed three sub-scales, named goal orientation, interpersonal relation, and learning support, which explained 71.500% of the total variance. The results of the confirmatory factor analysis showed that the GFI was 0.848, the AGFI was 0.806, the RMSEA was 0.090, the RMR was 0.041, the NFI was 0.910, the IFI was 0.916, the CFI was 0.916, the PCFI was 0.798, and the PNFI was 0.793. The reliability values of the three dimensions were 0.870, 0.858, and 0.943, respectively, and the convergent validity values were 0.574, 0.603, and 0.625, respectively. CONCLUSION: The reliability and validity of the dimensions of the Chinese Nursing Students' Clinical Learning Environment Scale are acceptable, and the scale can be used as a useful tool for measuring the clinical learning environment of Chinese nursing students.

Exploring perceptions of pre-clerkship students about workplace learning in the clinical learning environment at Gulf Medical University, UAE.

BACKGROUND: Medical students view clinical workplace placements as an inspiring and motivating learning environment where active student participation is pivotal to development of students' identity. The progress from pre-clerkship to clerkship education harbors many challenges which consist of experiential learning, adjusting to the clinical environment, and understanding roles & responsibilities. Workplace learning is underpinned by various adult learning theories including social theories,constructivism, supported participation and legitimate peripheral participation. Workplace learning course was recently initiated for pre-clerkship students at a medical university in UAE, which will enable their smooth entry into the clerkship phase of the curriculum. OBJECTIVES: The research aims to explore students' perceptions of various domains of their clinical learning environment (CLE), highlight the challenges they face, and extract valuable feedback to improve their environment. METHODS: This study was conducted qualitatively by using focus groups method in order to explore students' perceptions of the clinical learning environment. Two focus group discussions were conducted (n = 8 +/-10) to determine the common challenges of workplace learning and its potential solutions. Data were analyzed using thematic analysis. The approach used to carry out this study was phenomenology, as it helps to understand the learning and behavior of these students who are undergoing this pre-clerkship training in order to transition smoothly to the clerkship phase. RESULT: The focus groups helped to deeply explore the perceptions of students about their clinical learning environment. It helped to reveal the challenges encountered by the students including the significance of proper orientation of staff and students, language barrier, availability of learning opportunities, and supervision quality. The focus groups provided worthwhile suggestions to improve the learning opportunities in the clinical learning environment which include orientation of the staff and students what to expect, improved supervision, mentoring and providing learning opportunities to encourage participation. CONCLUSION: This study attempted to identify the pre-clerkship students' perception of their clinical learning environment and the challenges they face over there. Possible suggestions by the students included a formal orientation for the staff and students to be carried out at the beginning. Efforts should be made by clerkship directors to provide students with learning opportunities by increasing patient exposure, encouraging participation, and providing high-quality supervision.

Psychometric properties of the arabic version of PHEEM applied on a sample of medical residents in Syria.

BACKGROUND: The clinical learning environment (CLE) plays a crucial role in shaping the learning experiences and professional development of medical professionals. Understanding and optimising this environment is essential for improving doctors' knowledge acquisition, clinical skills, and overall well-being. The development of the Postgraduate Hospital Educational Environment Measure (PHEEM) and its translation to numerous languages has been a milestone in clinical education. Even though PHEEM was recently translated into Arabic, its psychometric properties in this form remain unevaluated. Therefore, this study aims to conduct a comprehensive psychometric analysis of the Arabic version of the PHEEM questionnaire. METHODS: This is a cross-sectional questionnaire survey validation study. The defined population were medical residents in Damascus, Syria. A paper-based survey as well as an online-based one were conducted using several non-probability sampling methods namely, convenience, river and, snowball sampling between June 15, 2023, and June 21, 2023. Both exploratory (EFA) and confirmatory (CFA) factor analyses were conducted. Several psychometric criteria were applied including scree plot, eigenvalue > 1.5 and the 'proportion of variance accounted for' criterion. RESULTS: A total of 543 participants completed the questionnaire (56.9% female). Kaiser-Meyer-Olkin measure for sample adequacy was high (0.937) and the P-value for Bartlett's test was < 0.001. EFA revealed five meaningful factors which were labelled: perception of teachers, learner's engagement and social participation, external regulation, work culture, and living conditions. These factors had the following eigenvalues: 12.6, 2.18, 2.03, 1.86, and 1.41 respectively, with a total explained variance of 43.45%. Cronbach's Alpha was 0.938. CFA confirmed the model structure of EFA (SRMR = 0.067 and RMSEA = 0.066). The Average Variance Explained (AVE) value of any given factor was > 0.7. DISCUSSION: The Arabic PHEEM inventory demonstrated satisfactory psychometric properties. The extracted domains are of theoretical relevance to the psychosocial-material conceptual framework for learning environment. Nonetheless, this validation was performed in the Syrian context; therefore, future studies in other Arabic countries are recommended to support the applicability of Arabic PHEEM in the wide Arab World.

Abusive supervision and nursing students' intention to leave the nursing profession: a moderated mediation model of emotional exhaustion and the nurse-patient relationship.

BACKGROUND: Exploration of the relationship between nursing students' abusive supervision and their future intention to leave the nursing profession before completing the final clinical practicum is critical to the issue of nursing staff shortages and how to alleviate them. In order to further dissect the factors influencing turnover intention among student nurses in clinical practice, our study used the conservation of resources theory and job demands-resources model to explain the specific pathways that influence student nurses' intention to leave the nursing profession, with particular focus on nursing students' personality traits and certain organizational factors. METHOD: This study followed a cross-sectional design. Between March and May 2022, a convenience sampling method was used to select 531 nursing students from two medical universities in Fuzhou. The Abusive Supervision, Emotional Exhaustion, Nurse-Patient Relationship, and Turnover Intention Scales were employed to collect data. The PROCESS macro (Models 4 and 7) for SPSS 25.0 by Hayes and 5,000 bootstrap samples were used to examine the moderation and mediation impacts. RESULTS: Abusive supervision was found to significantly positively predict nursing students' intention to leave the nursing profession. Emotional exhaustion significantly mediated the relationship between abusive supervision and an intention to leave the nursing profession. The moderating effect of the nurse-patient relationship in the mediation model was also found to be significant. CONCLUSIONS: Abusive supervision by clinical teaching staff is a work-related stressor that leads to emotional exhaustion, consequently decreasing nursing students' future intention to work as a nurse. A nurse-patient relationship based on trust could buffer the negative effect of abusive supervision on emotional exhaustion. Healthcare organizations and nurse educators should implement programs that educate and train individuals about abusive supervision, emotion regulation, and positive nurse-patient relationships; this would serve to decrease nursing students' intention to leave the nursing profession. This study provides relevant implications for helping nursing instructors develop effective intervention strategies to retain talented nursing personnel.

Development and initiation of a preceptor program to improve midwifery and nursing clinical education in sub-saharan Africa: protocol for a mixed methods study.

BACKGROUND: Expanding the quality and quantity of midwifery and nursing clinical preceptors is a critical need in many sub-Saharan educational settings to strengthen students' clinical learning outcomes, and ultimately to improve maternal and child mortality. Therefore, this study protocol was developed to establish a year-long, four step, precepting program to (1) improve partnership building and program development (2) provide an evidence-based course to expand competency and confidence in precepting students (3) select preceptors to become train the trainers and (4) secure accreditation for the program, ultimately to engage and support cohorts of preceptors and continue to monitor and evaluate the effectiveness of the program over five years. METHODS: Qualitative and quantitative approaches will be used including evaluation of preceptors, faculty and leadership involved with the program, as well as students taught by preceptors. Data will include validated self-assessment scales, objective structured clinical examinations (OSCEs), satisfaction surveys, and direct clinical observation, in-depth interviews and/or focus group discussions (preceptors); feedback forms (students); process mapping and organizational readiness for implementing change surveys (faculty and leadership). Median change in scores will be the primary outcome for quantitative data. Content analysis within a deductive framework to identify key implementation and adoption themes will be used for qualitative data analysis. DISCUSSION: This study aims to assess the readiness and early effectiveness for implementing a preceptor program for midwifery and nursing in Sierra Leone and Malawi. Determining the effectiveness of this program will guide future adaptations in order to strengthen the program for sustainability and potential scale-up.

Collaboration in action: successful implementation of a learner-driven virtual interprofessional education curriculum in the clinical learning environment.

Though technological capabilities to provide high-quality, flexible interprofessional education (IPE) have continued to grow, this remains a largely undeveloped area in the clinical learning environment (CLE). To address this gap, the University of Minnesota launched the Collaboration in Action: Learner-Driven Curriculum (CIA-LDC) as an IPE model designed for sustainability in a post-pandemic world. Over the course of two academic years, the CIA-LDC framework evolved and expanded through an iterative, data-informed approach incorporating student feedback, academic programme co-creation, evolving literature, and lessons learned. Modifications to individual activities and the overall model are presented, as well as key lessons learned. The majority of CIA-LDC evaluation responses across 2 years agreed that the amount of time spent was reasonable, participation placed little to no burden on their preceptor or site, the experience supported target interprofessional competency development, and that IPE should be provided in the CLE. The CIA-LDC holds promise as a successful, quality model for IPE in the CLE, available to learners from any profession in any geographic location in any practice setting. Outcomes demonstrate a pedagogical design with buy-in and feasibility in a post-pandemic world, with tremendous potential for advanced educational research to prepare the next generation as a collaborative practice-ready workforce.

Linking nursing students' professional identity, clinical learning environment, financial incentives, and career opportunities with migration intent: Structural equation modeling.

AIMS: To investigate how nursing students' professional identity, clinical learning environment, financial incentives, and career opportunities influence their intention to migrate. BACKGROUND: There is a preponderance of studies about nurse migration and its impact on the global nursing workforce. However, a critical gap remains about nursing students' intentions to migrate, particularly among developing countries like the Philippines. METHODS: Using a cross-sectional design, third- and fourth-year nursing students (n = 316) from the largest comprehensive university in Manila were conveniently recruited. Data were collected from November to December 2023 using five validated self-report scales. Descriptive (e.g., mean, standard deviation) and inferential statistics (e.g., Spearman rho, covariance-based structural equation modeling) were used to analyze data. RESULTS: The emerging model demonstrated acceptable model fit indices. Nursing students' professional identity (ß = 0.18, p = 0.043) and financial incentives (ß = 0.10, p = 0.046) significantly and positively influence the intention to migrate. The satisfaction with future career opportunities (ß = -0.12, p = 0.038) and clinical learning environment perception (ß = -0.15, p = 0.048) negatively influence the intention to migrate. These four predictors accounted for 4.60% of the total variance of intention to migrate. CONCLUSION: Nursing students' professional identity and financial incentives directly impact intent to migrate, whereas future career opportunities satisfaction and clinical learning environment inversely affect intent to migrate. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: This study underscores the imperative for nursing colleges and faculty to promote positive professional identity and provide a conducive clinical learning environment to develop sustainable nurses' migration policies.

Optometry students' experiences of their clinical training: A qualitative study in a low- resource setting.

Background: There is a gradual increase in the number of optometry education programs in low resource settings yet there is limited knowledge on optometry students' experiences of their clinical training. Therefore, the purpose of this study was to explore the optometry students' experiences of their clinical learning environment at a national referral and teaching hospital within a low resource setting. Methods: The study adopted a qualitative design using face to face in-depth interviews to explore experiences of the participants. All 16 optometry students in fourth-year at university were purposefully recruited into the study. Data was collected at the end of the students' clinical training at the eye clinic of a national referral and teaching hospital. Interviews were audio recorded and transcribed for analysis using an inductive thematic approach. Results: Two themes, learning at the eye clinic and organization of the eye clinic, were identified to represent participants' experiences. Each theme had three sub themes. Conclusion: The students' experiences in a clinical learning environment take a transformative nature from initial hesitancy and feelings of inferiority, anxiety, uncertainty and nervousness to increased confidence and active engagement. Future studies should compare optometry students' experiences in lower-level health units to those in national referrals hospitals.

Clinical learning environment for nursing students in operating rooms: Development of an evaluation scale.

Aim: To develop a measurement tool to evaluate the clinical learning environment for nursing students in operating rooms. Background: In this study, a scale for evaluating the clinical learning environment for nursing students in operating rooms was developed and subjected to reliability and validity tests. Design: A cross-sectional, methodological study. Methods: Qualitative interviews, the Delphi method, a literature review and pilot testing were employed to develop the scale. A purposive sampling method was used to select September 2021 through May 2022; a total of 227 nursing students with internship experience in operating rooms at several teaching hospitals in North China were selected to evaluate the reliability and validity of the scale. Results: The 32-item, four-dimensional evaluation scale was developed through two rounds of consultation with 17 experts. The reliability and validity test showed that the overall Cronbach's alpha was 0.984 and 0.96. The split-half reliability for the total scale was 0.937, indicating good reliability. Conclusion: The proposed scale has high reliability and validity in evaluating the clinical learning environment of nursing students in operating rooms and improving clinical nursing education.

The role of competency based medical education in addressing health inequities and cultivating inclusive learning environments.

Pediatric health inequities are pervasive and reflect the confluence of social and structural determinants of health including racism in all its forms. Current approaches in graduate medical education that prepare trainees to address health inequities and improve population health are inadequate. Competency based medical education (CBME) can advance equity-oriented efforts to improve patient outcomes, optimize the learning environment and encourage lifelong learning. We briefly describe the impact of racism and discrimination on the clinical learning environment. We then highlight how to apply the 5 core principles of CBME to equip learners across the continuum to address health inequities. We provide specific examples including 1) how CBME can inform teaching, assessment and professional development activities to promote equitable pediatric health outcomes via enturstable professional activities, 2) competency-focused instruction that address racism and inequities, 3) multimodal learning approaches to facilitate the acquisition of the desired competencies to address health inequities, 4) sequenced learning approaches across the continuum of practicing pediatricians, and 5) tools and resources for programmatic assessment of trainee and program performance in addressing pediatric health inequities.

Exploring Undergraduate Nursing Students' Perceptions on Clinical Learning Environment in the UAE: A Focus on Perceived Benefits and Challenges.

Introduction: Establishing a supportive clinical environment is paramount for enhancing nursing students' engagement in clinical practice, their clinical proficiencies, and satisfaction. The increase in nursing student enrollment at the Nursing College, driven by the collaborative efforts between Abu Dhabi Health Services Company (SEHA) and universities, has given rise to concerns regarding the quality of education and clinical instruction. These concerns are primarily due to the increased student-to-instructor ratio. Furthermore, the unsupportive clinical settings and learning tensions underscore the need to understand students' learning experiences and address research gaps within the field of clinical learning in the United Arab Emirates (UAE). Objectives: The purpose of this study is to investigate the undergraduate nursing students' perceptions of their clinical learning environment, with a focus on perceived benefits and challenges. Methods: This study used a cross-sectional survey design. The researchers administered a five-point Likert scale questionnaire, which had been adapted and contextualized, to a convenience sample of 217 third and fourth-year nursing students who willingly participated in this study. Results: Despite the presence of positive aspects, such as diverse clinical experiences and strong support from both clinical instructors and peers, several challenges affect the students' clinical learning. These challenges encompass disparate perceptions of supervision among staff nurses, learning tensions related to student academic workload, insufficient clinical supervision, and difficulties in finding assistance when needed. Conclusion: There is a clear need to enhance the overall ward learning environment to optimize students' academic motivation and clinical skills. Several measures can be taken to achieve this goal, including incentivizing and reducing the workload of staff nurses, investing in the professional development of clinical instructors, promoting peer interactions and group learning, and adopting a block pattern of education in years three and four for better clinical knowledge assimilation and reduced theoretical workload.

Addressing unprofessional behaviors in the clinical learning environment: lessons from a multi-year virtual, intergenerational, interdisciplinary workshop.

INTRODUCTION: Optimizing the clinical learning environment (CLE) is a medical education priority nationwide. MATERIALS AND METHODS: We developed a virtual, one-hour workshop engaging students, housestaff and faculty in small-group discussions of five case scenarios adapted from reported unprofessional behaviors in the CLE, plus didactics regarding mistreatment, microaggressions and bystander interventions. RESULTS: Over two sessions (2021-2022), we engaged 340 students and 73 faculty/housestaff facilitators. Post-session surveys showed significant improvement in participants' ability to recognize and respond to challenges in the CLE. DISCUSSION: Our innovative workshop, including scenarios derived from institutional reports of unprofessional behaviors, advanced participants' knowledge and commitment to improve the CLE.

Teaming in Graduate Medical Education: Ward Rounds and Beyond.

Teamwork in graduate medical education (GME) is often hindered in clinical learning environments where discontinuity among residents, supervisors, and other health care professionals is typical. Teaming is a conceptual approach to teamwork in dynamic environments with constantly changing team members and goals. Teaming is built on principles of project management and team leadership, which together provide an attractive strategy for addressing teamwork challenges in GME. Indeed, teaming is now a requirement of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program. However, many clinician-educators and leaders may be unfamiliar with teaming and how to integrate it into their GME programs. In this article, the teaming framework is described with a specific example of how it can be applied to improve hospital ward rounds, a common setting of teamwork breakdown. The goal of this article is to educate and encourage GME leaders as they learn new ways to implement teaming to improve patient care and education in their programs.

Modifiable factors contributing to belongingness of undergraduate nursing students in the clinical learning environment: An exploratory study.

BACKGROUND: Belongingness has been tied to positive personal and educational outcomes in undergraduate nursing students in the clinical learning environment, but there is limited literature on specific factors that promote these important feelings of acceptance and value alignment. OBJECTIVES: This study aimed to assess demographic characteristics, program/clinical structure factors, and modifiable clinical setting factors that may impact feelings of belongingness in U.S. undergraduate nursing students in the clinical learning environment. DESIGN: A cross-sectional survey design was used to assess the relationship between demographics, program/clinical structure factors, and modifiable clinical setting factors and levels of belongingness using the U.S. version of the Belongingness Scale - Clinical Placement Experience. SETTING: A national study was conducted via the National Student Nurses Association database from December 2022 to January 2023. PARTICIPANTS: 759 volunteer undergraduate nursing students in the U.S. who had completed at least one clinical course. METHODS: An online survey was disseminated to assess demographic factors, program/clinical structure factors, students' perceptions on the frequency of occurrence and perceived value of modifiable clinical setting factors (including clinical format, clinical site, relationship and interpersonal, and miscellaneous factors), and to measure levels of belongingness experienced. RESULTS: Bivariate analyses revealed one statistically significant program/clinical structure factor (p <.001) and 10 statistically significant modifiable clinical setting factors (p <.001) that contribute to belongingness. The findings also support the use of the U.S. version of the BES-CPE as a reliable and valid instrument. CONCLUSIONS: Results demonstrate the importance of fostering belongingness in undergraduate nursing students in the clinical learning environment and, for the first time, extrapolate qualitative findings from the literature into the identification of factors that contribute to these critical feelings of inclusion. There are immediate implications for nursing educators and a rich foundation for future intervention research is proposed.

Exploring the Experiences of Undergraduate Medical Students on Surgical Placement - A Qualitative Study.

OBJECTIVE: Multiple elements in the clinical learning environment have been found to influence medical students' learning experiences. A rich area of research, many factors are already known to influence students' experiences of learning which go on to impact later training choices. However, there is a knowledge gap specifically related to undergraduate medical students' experiences of surgical placement. This study aims to explore the lived experiences of medical students in their surgery rotation(s). DESIGN: A phenomenological study using semistructured interviews was conducted. Transcribed interview recordings were thematically analyzed using an iterative approach. SETTING: Participants were studying in a large medical school in the north of England. PARTICIPANTS: Fitting with the method, 6 undergraduate medical students, with at least 1 surgery placement took part in the study. RESULTS: Participants described issues including knowing the details of clinical opportunities, the clinical environment, and the portfolio; having a sense of involvement and previous surgical experiences; teaching and assessments; observation; and interactions. These experiences were also found to influence later career aspirations. CONCLUSIONS: The findings suggest that undergraduate surgical learning experiences can be influenced by various themes: knowing the details of progression, the clinical environment, having a sense of involvement and previous experiences, constructive alignment of teaching and assessment, and professional identity formation. Future studies can explore methods such as personalized learning outcomes to enhance the overall learning experience of medical students.

The second victim phenomenon: A qualitative study among bachelor's degree nursing students within the clinical learning environment.

AIM: This study explores and describes the second victim phenomenon in nursing students in association with the characteristics of the clinical learning environment and the clinical supervision process. DESIGN: Qualitative design using conventional content analysis and summative content analysis approaches. METHODS: From September 2022 to July 2023, in-depth semi-structured individual interviews were conducted with a purposive sample of 10 undergraduate nursing students. RESULTS: Six main themes were developed: 'defining the physical and psychological responses after the most significant patient safety incident', 'analyzing the characteristics of patient safety incidents', 'creating a safe learning environment to provide the best care for patients', 'developing mentorship capabilities and qualities for an ideal follow up of students as a second victim', 'providing resources and integrating support structures to second victim nursing students during their clinical learning', and 'considering the cooperation and coordination between the health institution and the higher education institutions.' CONCLUSION: Nursing students become second victims during their clinical placement. The clinical learning environment and mentoring characteristics influence the second victim experience.

Assessment of the psychometric properties of the italian version of the midwifery student evaluation of practice (MIDSTEP-IT): A validity and reliability study.

BACKGROUND: Clinical learning is a crucial component of the midwifery education program, necessary to support the acquisition of professional abilities through the integration of theoretical and practical learning experiences. Evaluating Bachelor of Midwifery students' perception of their clinical learning experiences is important to improve midwifery educational programs. AIM: the objective of this study was the translation, cultural adaptation, and validation of the Midwifery Student Evaluation of Practice (MidSTEP) in a group of Italian midwives' students. METHODS: "Translation and Cultural Adaptation of Patient Reported Outcomes Measures - Principles of Good Practice" guidelines were adopted to achieve the MidSTEP Italian version. Exploratory Factor Analysis was performed. Internal consistency for reliability was assessed using Cronbach's alpha reliability coefficient (α) and Omega coefficient (ω), while Intraclass Correlation Coefficients (ICC) were used to determine if the tool was stable over time. FINDINGS: The Italian version of MidSTEP (MidSTEP-IT) has good internal consistency: considering the Clinical Learning Environment Scale, Cronbach's α was 0.839 (for the "Skill Development" subscale α was equal to 0.739 and for the "Philosophy of Midwifery Practice" subscale α was equal to 0.825) while considering the Midwifery Preceptor Scale, Cronbach's α was 0.920. Factor analysis does not fully reflect the factorial analysis of the original version. CONCLUSION: The MidSTEP-IT had been proven to be a valid and reliable tool, easy and fast to administer, that could be effectively helpful for investigating and measuring the Italian midwifery students' perception of their clinical learning experiences, according to the setting and impact of mentors on their professional growth. It is an innovative tool, valuable in both clinical practice and research to highlight the importance of encouraging a supportive clinical learning environment and an efficient preceptorship.

Psychological safety and perceived organizational support in emergency medicine residencies.

Background: The clinical learning environment (CLE) is a key focus of the Accreditation Council of Graduate Medical Education. It impacts knowledge acquisition and professional development. A previous single-center study evaluated the psychological safety and perceived organizational support of the CLE across different specialties. Building on this work, we explored and evaluated psychological safety and perceived organizational support across multiple heterogeneous emergency medicine (EM) residencies to identify trends and factors affecting perceptions of the CLE. Methods: Using the Psychological Safety Scale (PSS) and Survey of Perceived Organizational Support (SPOS), residents from seven U.S. EM residencies were surveyed using REDCap software from September through November 2021, with 300 potential respondents. As an adjunct to these surveys, three open-ended questions were included regarding features of their learning environments. Results: A total of 137 out of 300 residents completed the survey. The overall response rate was 45.7%. There was a variable response rate across programs (26.0%-96.7%). Pooled results demonstrate an overall positive perception of CLEs, based on positive mean responses (i.e., "Members of my department are able to bring up problems and tough issue" had a mean of 4.2 on a 5-point Likert scale). Open responses identified teaching, collegiality, and support from program leadership as supportive features of the CLE. Confrontational interdisciplinary communication, a sense of being devalued, and off-service rotations were identified as threats or areas for improvement to the CLE. Conclusions: PSS and SPOS scores were generally positive in this multi-institution study, consistent with the prior single-institution study indicating that EM is often considered psychologically safe and supportive. EM training programs can consider using the PSS/SPOS to audit their own programs to identify areas for improvement and foster supportive features already in place.