Assessing the Culture of Residency Using the C - Change Resident Survey: Validity Evidence in 34 U.S. Residency Programs.
BACKGROUND
A practical instrument is needed to reliably measure the clinical learning environment and professionalism for residents.


OBJECTIVE
To develop and present evidence of validity of an instrument to assess the culture of residency programs and the clinical learning environment.


METHODS
During 2014-2015, we surveyed residents using the C - Change Resident Survey to assess residents' perceptions of the culture in their programs.


METHODS
Residents in all years of training in 34 programs in internal medicine, pediatrics, and general surgery in 14 geographically diverse public and private academic health systems.


METHODS
The C - Change Resident Survey assessed residents' perceptions of 13 dimensions of the culture: Vitality, Self-Efficacy, Institutional Support, Relationships/Inclusion, Values Alignment, Ethical/Moral Distress, Respect, Mentoring, Work-Life Integration, Gender Equity, Racial/Ethnic Minority Equity, and self-assessed Competencies. We measured the internal reliability of each of the 13 dimensions and evaluated response process, content validity, and construct-related evidence validity by assessing relationships predicted by our conceptual model and prior research. We also assessed whether the measurements were sensitive to differences in specialty and across institutions.


RESULTS
A total of 1708 residents completed the survey [internal medicine: n = 956, pediatrics: n = 411, general surgery: n = 311 (51% women; 16% underrepresented in medicine minority)], with a response rate of 70% (range across programs, 51-87%). Internal consistency of each dimension was high (Cronbach α: 0.73-0.90). The instrument was able to detect significant differences in the learning environment across programs and sites. Evidence of validity was supported by a good response process and the demonstration of several relationships predicted by our conceptual model.


CONCLUSIONS
The C - Change Resident Survey assesses the clinical learning environment for residents, and we encourage further study of validity in different contexts. Results could be used to facilitate and monitor improvements in the clinical learning environment and resident well-being.
National Initiative on Gender, Culture and Leadership in Medicine: C - Change, Brandeis Women's Studies Research Center, Brandeis University, Mailstop 079, 415 South Street, Waltham, MA, 02453, USA. lpololi@brandeis.edu.
Linda H
LH
Pololi
Hospital Medicine, Weill Cornell Medical College, New York, NY, USA.
Arthur T
AT
Evans
Brandeis Women's Studies Research Center, Brandeis University, Waltham, MA, USA.
Janet T
JT
Civian
Committee of Interns and Residents, New York, NY, USA.
Sandy
S
Shea
Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA.
Robert T
RT
Brennan
D003466:Cultural Characteristics; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000639:trends*; D008297:Male; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
clinical learning environment; culture of medicine; quantitative survey; resident well-being; residents