Abstract
Background
Educational climate within medical schools and various departments is an important part of
the curriculum, which has reportedly been associated with students' satisfaction and learning
outcomes. Assessing residents’ perceptions of the learning environment could be beneficial
to inform targets in the improvement of curriculum, teaching programs or medical schools.
However, limited evidence exists to describe residents' perceptions of the learning
environment in training institutions across Thailand. Previous studies were small or focused
on a single specialist, with no formal comparison in residents’ educational climate across
different specialties and training institutions.
Objectives
1. To develop and validate a Thai version of the residency educational climate
assessment tool (Thai Residency Educational Climate Test: T-RECT)
2. To assess the educational climate of residents in medical schools and training
institutions in Thailand
Methods
This was a cross-sectional multi-center online survey to assess the learning environment and
climate among residents and physicians undergoing specialized training in training institutions
across Thailand. In Phase 1 we developed and validated the residency educational climate
assessment tool through literature review, modified Delphi technique and factor analysis. In
Phase 2, an online questionnaire was sent to residents in major specialties, including Internal
Medicine, Surgery, Pediatrics, Obstetrics and Gynecology, Orthopedics, Family Medicine, as
well as other specialties in primary training institutions, which include medical schools and
those under the Ministry of Public Health. Mean (standard deviation) educational climate
scores were described, overall and by characteristics of residents and training institutions.
Comparisons of the educational climate scores across different training years, specialties,
and types of training institutions were made using independent t-tests and ANOVA.
Results
In Phase 1, a new educational climate assessment tool was developed and it contains 49
questions across 7 categories with high reliability (Cronbach’s alpha = 0.80-0.95). In Phase 2,
756 residents from major specialties and others responded to the online questionnaire.
Three-quarters of all respondents were from training institutions affiliated with the Ministry
of Public Health. Residents reported relatively high scores for their learning environment and
atmosphere, with an average score of 173.34 out of 245 points. Specifically, Subscale
"teachers" received the highest scores, while Subscales "academic activities, curriculum
organization, and student support systems" and "physical environment, facilities, libraries,
and study resources" received the lowest scores, underscoring opportunities for
improvement. Educational climate scores varied across training years, specialties, and types
of training institutions. Notably, orthopedic residents reported the highest scores for the
learning environment and atmosphere, whereas those in internal medicine reported the
lowest scores. Residents training in medical schools/ Medical Services Department reported
higher scores in Subscales “academic activities, curriculum and learner support system” and
“physical environment, accomodations, library and resources foe literature search” than
those from training institutions within the Office of Permanent Secretary, Ministry of Public
Health (P<0.05). However, those from training institutions within the Office of Permanent
Secretary reported higher scores in Subscale “colleagues and care team” and “patients and
learning opportunities from patients" than their medical school counterpart (P<0.05).
Implications
1) As assessment of residents’ learning environment and climate would help inform many
WFME standards, Royal Colleges, medical schools and training institutions should promote
regular assessment of educational climate to identify opportunities for improvement of
curricula and teaching methods for residency programs. Assessment of educational climate
should be integrated into monitoring and evaluation processes of any curriculum
development. Additionally, training institutions under the Ministry of Public Health can
leverage this information to align with the SAP (Service-Academic-Premium/Professional)
developmental framework.
2) The Ministry of Public Health should allocate adequate budgets to support residency
training in affiliated institutions.
3) A responsible agency should be established within the Ministry of Public Health to
develop and oversee policy decision and implementation in production and professional
development of physicians.
