1. 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

2. 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

3. 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

4. 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)

5. 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

6. 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.

7. 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

8. Search Strategy

10. 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

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