title: Protocol for a realist review of workplace learning in postgraduate medical education and training.
abstract: Postgraduate medical education and training (PGMET) is a complex social process which happens predominantly during the delivery of patient care. The clinical learning environment (CLE), the context for PGMET, shapes the development of the doctors who learn and work within it, ultimately impacting the quality and safety of patient care. Clinical workplaces are complex, dynamic systems in which learning emerges from non-linear interactions within a network of related factors and activities. Those tasked with the design and delivery of postgraduate medical education and training need to understand the relationship between the processes of medical workplace learning and these contextual elements in order to optimise conditions for learning. We propose to conduct a realist synthesis of the literature to address the overarching questions; how, why and in what circumstances do doctors learn in clinical environments? This review is part of a funded projected with the overall aim of producing guidelines and recommendations for the design of high quality clinical learning environments for postgraduate medical education and training.
  
  
  
  We have chosen realist synthesis as a methodology because of its suitability for researching complexity and producing answers useful to policymakers and practitioners. This realist synthesis will follow the steps and procedures outlined by Wong et al. in the RAMESES Publication Standards for Realist Synthesis and the Realist Synthesis RAMESES Training Materials. The core research team is a multi-disciplinary group of researchers, clinicians and health professions educators. The wider research group includes experts in organisational behaviour and human resources management as well as the key stakeholders; doctors in training, patient representatives and providers of PGMET.
  
  
  
  This study will draw from the published literature and programme, and substantive, theories of workplace learning, to describe context, mechanism and outcome configurations for PGMET. This information will be useful to policymakers and practitioners in PGMET, who will be able to apply our findings within their own contexts. Improving the quality of clinical learning environments can improve the performance, humanism and wellbeing of learners and improve the quality and safety of patient care.
  
  
  
  The review is not registered with the PROSPERO International Prospective Register of Systematic Reviews as the review objectives relate solely to education outcomes.
authors.affiliation: Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland.
authors.forename: Anel
authors.initials: A
authors.lastname: Wiese
authors.affiliation: Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland.
authors.forename: Caroline
authors.initials: C
authors.lastname: Kilty
authors.affiliation: Trinity College Dublin, Dublin, Ireland.
authors.forename: Colm
authors.initials: C
authors.lastname: Bergin
authors.affiliation: Dublin City University Business School, Dublin, Ireland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Flood
authors.affiliation: Trinity College Dublin Business School, Dublin, Ireland.
authors.forename: Na
authors.initials: N
authors.lastname: Fu
authors.affiliation: Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Horgan
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
authors.forename: Agnes
authors.initials: A
authors.lastname: Higgins
authors.affiliation: Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland.
authors.forename: Bridget
authors.initials: B
authors.lastname: Maher
authors.affiliation: Royal College of Physicians of Ireland, Dublin, Ireland.
authors.forename: Grainne
authors.initials: G
authors.lastname: O'Kane
authors.affiliation: Royal College of Physicians of Ireland, Dublin, Ireland.
authors.forename: Lucia
authors.initials: L
authors.lastname: Prihodova
authors.affiliation: Children's University Hospital, Temple St., Dublin, Ireland.
authors.forename: Dubhfeasa
authors.initials: D
authors.lastname: Slattery
authors.affiliation: Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland. d.bennett@ucc.ie.
authors.forename: Deirdre
authors.identifier: 0000-0002-4469-9138
authors.initials: D
authors.lastname: Bennett
mesh_terms: D004503:Education, Medical, Graduate; D006801:Humans; D007858:Learning; D012107:Research Design; D000078202:Systematic Reviews as Topic; D017132:Workplace
keywords: Clinical learning environment; Graduate medical education; Postgraduate medical education; Realist review; Realist synthesis; Workplace learning