Quality improvement of clinical learning environment: An appreciative inquiry approach

Tsai, Jer-Chia (2022) Quality improvement of clinical learning environment: An appreciative inquiry approach. Doctor of Education thesis, University of Liverpool.

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Abstract

Taiwan faces crucial clinical training and healthcare system issues impacting the quality of the clinical learning environment (CLE). Previous studies demonstrated methodology weaknesses and limited scopes of CLE quality. This thesis aims to explore the key elements, impacts, and action plans informing and improving the CLE quality in Taiwan. Research questions include (1) What are key elements that would construct the quality of the CLE from trainees’ and teachers’ viewpoints? (2) Why are these elements crucial in forming a quality CLE in the Taiwanese sociocultural context? (3) What are the action plans that could be implemented to improve the quality of CLE and inform medical education practice? This thesis employed social constructivism as a theoretical framework and appreciative inquiry approach to design qualitative research using individual interviews with 12 medical trainees and 12 clinical teachers. Thematic analysis identified five themes as key elements: (1) Setting a learning community: creating a sense of belonging and opportunities for patient care practice. (2) Fostering learning goals and medical competencies on patient-centred care, clinical management, and interprofessional learning and practice. (3) Learning facilitation with supervision and autonomy, assessment and feedback in aligning with trainees’ levels and psycho-sociocultural factors. (4) Role modelling and professional development: teachers’ roles as facilitators, coaches, and mentors beyond knowledge providers. (5) Organisational culture, systemic regulation, and educational resources: a collaborative and non-blaming organisational culture for psychological safety; dual effects of duty-hour regulation on job stress and training course arrangement; simulation medicine training model for patient safety. Action plans included (1) The bottom-up Teacher Development Learning Community; (2) Longitudinal Integrated Clerkship model to ensure the “continuity” of clinical education, patient care, and supervision; (3) Empowerment and assessment system in aligning with patients’ complexities and trainees’ capabilities. Study limitations included a single researcher, predominant male participants, and inherent features of qualitative design. In conclusion, this study reveals the enabling and hindering factors in shaping the CLE quality and highlights psycho-sociocultural factors in mediating mutual engagement among medical teams and organisation. Collaborative action plans improve the CLE quality in the local institute and advance better educational practice in Taiwanese medical society.

Item Type:	Thesis (Doctor of Education)
Uncontrolled Keywords:	Clinical learning environment; quality improvement; appreciative inquiry; qualitative research; Taiwan
Divisions:	Faculty of Humanities and Social Sciences > School of Histories, Languages and Cultures
Depositing User:	Symplectic Admin
Date Deposited:	09 Feb 2022 14:38
Last Modified:	18 Jan 2023 21:16
DOI:	10.17638/03146745
Supervisors:	Wang, Ruolan Willis, Ian
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3146745