title: Evaluating the Clinical Learning Environment: Resident and Fellow Perceptions of Patient Safety Culture.
abstract: BACKGROUND
  The Accreditation Council for Graduate Medical Education has begun to evaluate teaching institutions' learning environments with Clinical Learning Environment Review visits, including trainee involvement in institutions' patient safety and quality improvement efforts.
  
  
  OBJECTIVE
  We sought to address the dearth of metrics that assess trainee patient safety perceptions of the clinical environment.
  
  
  METHODS
  Using the Hospital Survey on Patient Safety Culture (HSOPSC), we measured resident and fellow perceptions of patient safety culture in 50 graduate medical education programs at 10 hospitals within an integrated health system. As institution-specific physician scores were not available, resident and fellow scores on the HSOPSC were compared with national data from 29 162 practicing providers at 543 hospitals.
  
  
  RESULTS
  Of the 1337 residents and fellows surveyed, 955 (71.4%) responded. Compared with national practicing providers, trainees had lower perceptions of patient safety culture in 6 of 12 domains, including teamwork within units, organizational learning, management support for patient safety, overall perceptions of patient safety, feedback and communication about error, and communication openness. Higher perceptions were observed for manager/supervisor actions promoting patient safety and for staffing. Perceptions equaled national norms in 4 domains. Perceptions of patient safety culture did not improve with advancing postgraduate year.
  
  
  CONCLUSIONS
  Trainees in a large integrated health system have variable perceptions of patient safety culture, as compared with national norms for some practicing providers. Administration of the HSOPSC was feasible and acceptable to trainees, and may be used to track perceptions over time.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Bump
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Calabria
authors.forename: Gabriella
authors.initials: G
authors.lastname: Gosman
authors.forename: Catherine
authors.initials: C
authors.lastname: Eckart
authors.forename: David G
authors.initials: DG
authors.lastname: Metro
authors.forename: Harish
authors.initials: H
authors.lastname: Jasti
authors.forename: Julie B
authors.initials: JB
authors.lastname: McCausland
authors.forename: Jason N
authors.initials: JN
authors.lastname: Itri
authors.forename: Rita M
authors.initials: RM
authors.lastname: Patel
authors.forename: Andrew
authors.initials: A
authors.lastname: Buchert
mesh_terms: D001291:Attitude of Health Personnel; D004503:Education, Medical, Graduate; D005257:Fellowships and Scholarships; D006272:Health Facility Environment; D006801:Humans; D007396:Internship and Residency; D007858:Learning; D015279:Organizational Culture; D061214:Patient Safety; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires