Development of an instrument to measure the clinical learning environment in health sciences
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Date
2020-11
Authors
Jordaan, Hanlie
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
A positive and stimulating clinical learning environment (CLE) is key to health professional students’ as it increases their opportunities to transfer learning and become competent professionals. The evaluation of the CLE is crucial to determine the quality of the students’ clinical experience and learning opportunities, as well as to promote a supportive CLE for students. The CLE has received ample attention from researchers over the past three decades. From the literature, four major aspects are identified to contribute to a positive CLE, including the atmosphere of the clinical settings; teamwork; staff and student workloads; and learning opportunities offered by clinical settings to students to practice people-centred care. An instrument that is used to measure the CLE is expected to address these aspects to promote a positive CLE. An overview of existing CLE measuring instruments, however, revealed that the instruments failed to address all four of these major aspects. Failing to address those aspects in the measuring instrument may lead to the failure to identify weaknesses in current systems, or to measure new CLEs in terms of its potential contribution to work-integrated learning (WIL). Ultimately it may have a negative impact on the clinical learning of students. Therefore, a more comprehensive, valid and reliable instrument is needed to measure the complex characteristics of CLEs, and to determine whether they provide the essential learning opportunities for professional students. Therefore this research aimed to develop an instrument that measures the clinical learning environments of students in health sciences, addressing all major aspects associated with a positive CLE. This study was conducted in two phases. The first phase included the development of an instrument that measures the CLE based on pre-existing instruments and literature. Nineteen instruments, consisting of 454 items, were identified. The items were thematically analysed and refined to develop the first version of the instrument. The first version instrument consisted of 66 items. The second phase included a Delphi study to determine the face and content validity of the first version instrument. A consensus Delphi technique, with an agreement rate of 70% was used to validate the inclusion of items for the final instrument. An expert panel of qualified healthcare professionals proved to be most suitable to obtain the face and content validity of the items. The panel members included diverse expert healthcare professionals from various African countries and healthcare facilities. Of the 54 experts initially invited, 36 indicated an interest to participate. During the first round, 22 panel members responded to the instrument while 16 panel members responded during round two. Ten panel members took part in the third and final round. A possibility for professional attrition may be that all healthcare practitioners were called to the frontline during the CoVID-19 pandemic. Based on the results of the Delphi-study, four of the original 66 items were eliminated due to a lack of consensus. The remaining 62 items were judged to have face and content validity and were included in the final instrument. The 62 items in the second version of the instrument address all major aspects that contribute to a positive CLE. The instrument developed in this research can benefit a range of role-players involved in the WIL of students in the healthcare profession. It could be used as an evaluation instrument for new CLEs, and to measure its potential contribution to WIL; it could assist in identifying inherent weak areas in the system that need strengthening; professional governing bodies could use it to accredit clinical settings for placements of health professional students. It is recommended that the construct validity and reliability of the instrument be tested in future research.
Description
Keywords
Dissertation (M.Soc.Sc. (Nursing))--University of the Free State, 2020, Clinical learning environment, Develop, Health science, Health professions students, Instrument, Validity