The Association Between Residency Learning Climate and Inpatient Care Experience in Clinical Teaching Departments in the Netherlands

Acad Med. 2019 Mar;94(3):419-426. doi: 10.1097/ACM.0000000000002494.


Purpose: To examine the association between residency learning climate and inpatient care experience.

Method: The authors analyzed 1,201 evaluations of the residency learning climate (using the Dutch Residency Educational Climate Test questionnaire) and 6,689 evaluations of inpatient care experience (using the Consumer Quality Index Inpatient Hospital Care questionnaire) from 86 departments across 15 specialties in 18 hospitals in the Netherlands between 2013 and 2014. The authors used linear hierarchical panel analyses to study the associations between departments' overall and subscale learning climate scores and inpatient care experience global ratings and subscale scores, controlling for respondent- and department-level characteristics and correcting for multiple testing.

Results: Overall learning climate was not associated with global department ratings (b = 0.03; 95% confidence interval -0.17 to 0.23) but was positively associated with specific inpatient care experience domains, including communication with doctors (b = 0.11; 0.02 to 0.20) and feeling of safety (b = 0.09; 0.01 to 0.17). Coaching and assessment was positively associated with communication with doctors (b = 0.22; 0.08 to 0.37) and explanation of treatment (b = 0.22; 0.08 to 0.36). Formal education was negatively associated with pain management (b = -0.16; -0.26 to -0.05), while peer collaboration was positively associated with pain management (b = 0.14; 0.03 to 0.24).

Conclusions: Optimizing the clinical learning environment is an important step toward ensuring high-quality residency training and patient care. These findings could help clinical teaching departments address those aspects of the learning environment that directly affect patient care.

MeSH terms

  • Clinical Competence*
  • Hospitals, Teaching
  • Humans
  • Inpatients
  • Internship and Residency*
  • Netherlands
  • Students, Medical