title: Clinical learning environment measurement for medical trainees at transitions: relations with socio-cultural factors and mental distress.
abstract: BACKGROUND
  Measuring clinical learning environment is crucial for the quality improvement of medical education, especially for medical trainees at transition stages. Medical education in Taiwan is shaped by multiple socio-cultural influences. The aims of this study were to construct an instrument for measuring clinical learning environment in alignment with the local socio-cultural factors and medical training settings, and further investigate the relationship between the quality of the clinical learning environment and the status of mental distress among medical trainees.
  
  
  METHODS
  Participants consisted of 189 medical trainees (62 interns, 52 postgraduate year one (PGY1) residents, and 75 senior residents). Instruments included a designed 40-item Clinical Learning Environment Questionnaire (CLENQ) and a five-item Brief Symptoms Rating Scale (BSRS-5) for evaluating mental distress. Constructs of CLENQ were examined using factor analysis. Correlations were calculated between BSRS-5 and CLENQ across the three levels of medical trainees.
  
  
  RESULTS
  Factor analysis of CLENQ yielded five factors- I: Teaching (13 items), II: Workload (7 items), III: Relationship pressure (9 items), IV: Organisational support (4 items) and V: Mutual trust (6 items). Intern trainees reported the lower total CLENQ scores in comparison to PGY1 and senior resident trainees. Mental distress using BSRS-5 was negatively correlated with total CLENQ scores and several key factors in all three groups.
  
  
  CONCLUSIONS
  Our study using CLENQ has identified five major factors of clinical learning environment that are closely linked with our local socio-cultural factors and medical training settings. Medical trainee's mental distress status was negatively correlated with the quality of CLENQ. These findings have socio-cultural relevance and medical contextual significance and might be applicable to other countries. It warrants further study to investigate the impact of clinical learning environment improvement on the medical trainee's mental distress and performance.
authors.forename: Jer-Chia
authors.initials: JC
authors.lastname: Tsai
authors.forename: Cheng-Sheng
authors.initials: CS
authors.lastname: Chen
authors.forename: I-Feng
authors.initials: IF
authors.lastname: Sun
authors.forename: Keh-Min
authors.initials: KM
authors.lastname: Liu
authors.affiliation: Department of Surgery, Kaohsiung Medical University Hospital, School of Medicine, College of Medicine, Kaohsiung Medical University, No, 100, Tz-You First Road, San-Ming District, Kaohsiung 80708, Taiwan. chshla@kmu.edu.tw.
authors.forename: Chung-Sheng
authors.initials: CS
authors.lastname: Lai
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003431:Cross-Cultural Comparison; D003466:Cultural Characteristics; D004503:Education, Medical, Graduate / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D011594:Psychometrics; D058996:Quality Improvement / Q000458:organization & administration*; D012931:Social Environment; D012944:Social Support; D013223:Statistics as Topic; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology*; D011795:Surveys and Questionnaires; D013624:Taiwan; D035502:Trust; D016526:Workload / Q000523:psychology*