Clinical Learning Environments for Postgraduate Medical Education: A Realist Synthesis Anél Wiese Dr. Caroline Kilty Dr. Bridget Maher Dr. Siun O’Flynn Prof. Colm Bergin Prof. Mary Horgan Dr. Deirdre Bennett

Why Realist Review? Looking at postgraduate medical training environments, with the view of producing recommendations of how these can be optimised. What works in workplace learning in PGMET? – how, why, for whom, to what extent, in what circumstances, in what respect and over what duration? Realist review ideal for looking at PG training, takes into account the complexity of these clinical learning environments

Training Early on in this study – upskilled in this method – workshop at ASME - RME London (Trish Greenhalgh and Geoff Wong) Geoff Wong training day at UCC Rameses guidelines Identifying Programme theory Focussing our review Search strategy Study selection criteria Data extraction Data analysis and synthesis Prisma – evidence-based set of items for reporting systematic reviews

Identifying a programme theory for PGMET First step in RR is to determine what the design of the intervention is. What are the assumptions and beliefs underlying the design of PGMET programmes? So coming to an understanding of what the programme theory for PGMET – various sources: Documentation pertaining to training Tools to measure learning environment Literature Stakeholders Substantive theory Socio-cultural perspective Communities of Practice (Lave & Wenger) Workplace Learning Theories (Billett & Teunissen)

Focussing Review It became apparent early on that the topic of our review way to broad, so we had to focus by; Discussions with Dr. Geoff Wong GCM – looking at what’s important in CLE and most important relationship between trainees and senior doctors during patient care

Study Selection - Inclusion Criteria Include full text paper if: Rich enough in relevant information The results provide information of how learning happens: 1) in the clinical learning environment (CLE) 2) during interactions between trainees and senior doctors within clinical environment The study provides information on the context of learning: team structure, EWTD, workload, frequency of supervision, level of trainee. The study provides information on the mechanisms of learning: role modelling, participation in practice, feedback, observation of senior doctors, etc.

Study Selection - Inclusion Criteria quantitative, qualitative and mixed-method studies papers published in English papers published between 1995 and present non-empirical papers including commentaries, letters, editorials and reviews papers related to undergraduate medical education research on simulation or other non-clinical interventions papers related to workplace-based assessment Study Selection - Exclusion Criteria

Search Strategy

Rigour Rigour in realist review twofold, rigour in terms of relevance and rigour in terms of study quality….. Sample review – ensure proper article selection Exploring ways to check quality Quality checks

What’s next… Data extraction Google Forms Coding in Nvivo Thematic Analysis Data synthesis