Core components of clinical education: a qualitative study with attending physicians and their residents.
BACKGROUND
In medical education, particularly in residency courses, most of the training occurs in real clinical environments. Workplace-based learning profoundly affects students' knowledge, attitudes, and practice; therefore, it should be properly planned.  Due to the extensiveness   of the clinical   environment   and   its   importance in training residents, investigating how residents learn in these environments and detecting factors that influence effectiveness will help curriculum designers to promote residents' learning by improving their learning environment.  Therefore, our qualitative content analysis study, aimed  to  examine  the experiences and perspectives of internal and surgical residents and their attending physicians about learning in clinical settings.


METHODS
This qualitative content analysis study was conducted through purposeful sampling.  Semi-structured interviews were conducted with 15 internal and surgical residents and 15 of their attending physicians at educational hospitals of Tehran University of Medical Sciences.


RESULTS
The main categories explored in this study were hidden curriculum, learning resources, and learning conditions. In the context of clinical environment and under its individual culture, residents learn professionalism and learn to improve their communication skills with patients and colleagues. Because of clinical obligations such as priority of treating the patients for education or workload of the attending physicians, residents acquire most of their practical knowledge from colleagues, fellows, or follow-up patients in different learning conditions (such as: educational rounds, morning reports and outpatient clinics). They see some of their attending physicians as role models.


CONCLUSIONS
Changing cultural and contextual factors is of prime importance to promote a learning-oriented environment in a clinical setting. The present findings will help curriculum planners and attending physicians to improve residents' learning by means of appropriate workplace planning and by considering the components involved in clinical learning.
Department of Internal Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran;
Alireza
A
Esteghamati
Department of Medical Education, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran;
Hamidreza
H
Baradaran
Department of Philosophy of Science, Institute for Humanities and Cultural Studies, Tehran, Iran;
Alireza
A
Monajemi
Department of Health in Emergency and Disaster, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; ; Department of Clinical Science and education, Karolinska Institute, Stockholm, Sweden;
Hamid Reza
HR
Khankeh
Department of Medical Education, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran;
Mehrnaz
M
Geranmayeh
Curriculum; Learning; Medical students; Teaching hospitals; Workplace