The Association Between Learning Climate and Adverse Obstetrical Outcomes in 16 Nontertiary Obstetrics-Gynecology Departments in the Netherlands

Acad Med. 2017 Dec;92(12):1740-1748. doi: 10.1097/ACM.0000000000001964.


Purpose: To investigate the association between learning climate and adverse perinatal and maternal outcomes in obstetrics-gynecology departments.

Method: The authors analyzed 23,629 births and 103 learning climate evaluations from 16 nontertiary obstetrics-gynecology departments in the Netherlands in 2013. Multilevel logistic regressions were used to calculate the odds of adverse perinatal and maternal outcomes, by learning climate score tertile, adjusting for maternal and department characteristics. Adverse perinatal outcomes included fetal or early neonatal mortality, five-minute Apgar score < 7, or neonatal intensive care unit admission for ≥ 24 hours. Adverse maternal outcomes included postpartum hemorrhage and/or transfusion, death, uterine rupture, or third- or fourth-degree perineal laceration. Bias analyses were conducted to quantify the sensitivity of the results to uncontrolled confounding and selection bias.

Results: Learning climate scores were significantly associated with increased odds of adverse perinatal outcomes (aOR 2.06, 95% CI 1.14-3.72). Compared with the lowest tertile, departments in the middle tertile had 46% greater odds of adverse perinatal outcomes (aOR 1.46, 95% CI 1.09-1.94); departments in the highest tertile had 69% greater odds (aOR 1.69, 95% CI 1.24-2.30). Learning climate was not associated with adverse maternal outcomes (middle vs. lowest tertile: OR 1.04, 95% CI 0.93-1.16; highest vs. lowest tertile: OR 0.98, 95% CI 0.88-1.10).

Conclusions: Learning climate was associated with significantly increased odds of adverse perinatal, but not maternal, outcomes. Research in similar clinical contexts is needed to replicate these findings and explore potential mechanisms behind these associations.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Education, Medical, Graduate*
  • Female
  • Gynecology / education*
  • Hospital Departments* / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Lacerations / epidemiology
  • Learning*
  • Maternal Mortality
  • Netherlands / epidemiology
  • Obstetrics / education*
  • Perinatal Mortality
  • Postpartum Hemorrhage / epidemiology
  • Pre-Eclampsia / epidemiology
  • Pregnancy
  • Pregnancy Complications* / epidemiology
  • Retrospective Studies
  • Surveys and Questionnaires
  • Uterine Rupture / epidemiology