title: Focus on Quality: Investigating Residents' Learning Climate Perceptions.
abstract: BACKGROUND
  A department's learning climate is known to contribute to the quality of postgraduate medical education and, as such, to the quality of patient care provided by residents. However, it is unclear how the learning climate is perceived over time.
  
  
  OBJECTIVE
  This study investigated whether the learning climate perceptions of residents changed over time.
  
  
  METHODS
  The context for this study was residency training in the Netherlands. Between January 2012 and December 2014, residents from 223 training programs in 39 hospitals filled out the web-based Dutch Residency Educational Climate Test (D-RECT) to evaluate their clinical department's learning climate. Residents had to fill out 35 validated questions using a five point Likert-scale. We analyzed data using generalized linear mixed (growth) models.
  
  
  RESULTS
  Overall, 3982 D-RECT evaluations were available to investigate our aim. The overall mean D-RECT score was 3.9 (SD = 0.3). The growth model showed an increase in D-RECT scores over time (b = 0.03; 95% CI: 0.01-0.06; p < 0.05).
  
  
  CONCLUSIONS
  The observed increase in D-RECT scores implied that residents perceived an improvement in the learning climate over time. Future research could focus on factors that facilitate or hinder learning climate improvement, and investigate the roles that hospital governing committees play in safeguarding and improving the learning climate.
authors.affiliation: Professional Performance Research group, Center for Evidence-Based Education, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Milou E W M
authors.initials: ME
authors.lastname: Silkens
authors.affiliation: Professional Performance Research group, Center for Evidence-Based Education, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.|Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California, United States of America.|UCLA Center for Health Policy Research, Los Angeles, California, United States of America.
authors.forename: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
authors.affiliation: Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands.
authors.forename: Albert J J A
authors.initials: AJ
authors.lastname: Scherpbier
authors.affiliation: Professional Performance Research group, Center for Evidence-Based Education, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Maas Jan
authors.initials: MJ
authors.lastname: Heineman
authors.affiliation: Professional Performance Research group, Center for Evidence-Based Education, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Kiki M J M H
authors.initials: KM
authors.lastname: Lombarts
mesh_terms: D004503:Education, Medical, Graduate / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D007858:Learning; D009426:Netherlands; D011787:Quality of Health Care; D012938:Social Perception; D013997:Time Factors