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Research Article | Volume 15 Issue 1 (Jan - Feb, 2025) | Pages 177 - 181
A Study to assess the perception of Educational Environment in Critical Care Units amongst Anaesthesiology Post Graduate students by using Healthcare Education Micro-Learning Environment Measure (HEMLEM) Questionnaire
 ,
 ,
1
Associate Professor, Department of Anaesthesiology and Critical Care, Pt. B.D Sharma PGIMS, Rohtak
2
Assistant Professor, Department of Pharmacology, CMC Ludhiana
Under a Creative Commons license
Open Access
Received
Nov. 20, 2024
Revised
Dec. 3, 2024
Accepted
Dec. 24, 2024
Published
Jan. 15, 2025
Abstract

Introduction: Educational micro learning environment is a small dynamic placement. A positive and inclusive environment helps in achieving learning objectives. Assessment of this is important for constructive modification. Methods: This is a prospective cross-sectional study done in tertiary care institute as end posting feedback in critical care units. Thirty-five second year post graduate trainees were enrolled and HEMLEM Questionnaire was circulated after valid consent. Data analysis was done using SPSS software version 22. Results: The study population consisted of 54.29% males and 45.71% females. Regarding staff attitude and behaviour, most of the students agreed that the environment was welcoming and they felt free to ask questions. Equal number of students strongly agreed (22.86%) and strongly disagreed (22.86%) to enthusiasm in faculty about teaching. Most students (54.13%) agreed to faculty’s interest in student’s learning. Most of the trainees agreed that student’s inputs were valued and 31.43% strongly agreed to that. Nearly fifty percent (54.29%) trainees felt neutral to providing with regular and supportive feedback during their postings. Regarding Quality of teaching, there was encouraging feedback and most of the students strongly agreed that the quality was well maintained. More than fifty percent (51.43%) strongly agreed that they had an opportunity to apply their previous knowledge in this posting. There was enhancement in knowledge and skills of more than fifty percent students. More than ninety percent found the posting helpful for practical application of theory. Hundred percent students achieved their learning objectives during this posting. Most of them had an opportunity to deal with patients under supervision. Conclusion: Healthcare Education Micro-Learning Environment Measure scale serves as important tool to assess learning environment in a small and dynamic placement. It is a handy and easy to use tool to obtain feedback and modify the learning environment constructively.

Keywords
INTRODUCTION

Educational environment is an academic, social, physical and psychological environment which is provided by an educational institute to the trainees. This environment in medical schools is governed by tangible factors like technology, infrastructure, and resources and intangible elements like attitudes of educators and peers, institutional culture, and interpersonal interactions.(1,2) Both the factors equally influence learning and outcomes of education. A supportive and inclusive environment plays a key role in fostering motivation, engagement, and skill development, which directly impacts clinical competency, critical thinking, and professional growth.(3) Environments that provide ample feedback promote reflection and personal growth, while those characterized by stress or competition can impede learning outcomes. A positive environment not only improves academic performance but also supports long-term professional development, personal well-being, and effective behaviour. On the other hand, negative environments can lead to burnout and reduced effectiveness. Medical education demands a setting that fosters cognitive, psychomotor, and emotional learning, encouraging active engagement, critical thinking, and the practical application of theory. Optimizing the educational environment is crucial for producing competent, compassionate physicians who are dedicated to lifelong learning and delivering high-quality patient care.(4,5)

 

To assess and enhance the learning environment, various scales are used specially for post graduates like Post Graduate Hospital Education Environment Measure (PHEEM),

Dutch Residency Educational Climate Test (D-RECT),

Operating room educational environment measure (OREEM),

Surgical theatre educational environment measure (STEEM),

Anaesthetic theatre educational environment measure (ATEEM), etc.(6,7)  These scales are used to study the educational environment in detail and the time taken to implement them can be a prohibiting factor to use these scales routinely Healthcare Education Micro-Learning Environment Measure Questionnaire (HEMLEM) was designed to analyse micro learning environment like brief rotatory posting. It is easy to use and can be applied as end posting feedback in different rotations. (8,9)

 

Anaesthesiology post graduates have a frequent rotation in critical care units as apart of their curriculum. Intensive care units (ICU) offer a great learning environment for various procedures, protocols, crisis management and communication. At the same time there are many barriers which are dealt with daily by the post graduate trainees at their level.(10) These barriers should be recognised and addressed to create an ambient learning environment.(11) Regular assessment and feedback on the same helps modifying it and making it optimum for learning.

MATERIALS AND METHODS

This is a prospective cross-sectional study in which both qualitative and quantitative methodology was adopted. It was conducted in a tertiary care centre after receiving approval from Institutional Ethics Committee. Purposive sampling was done and 35 second year Anaesthesiology Post Graduate Trainees posted in critical care units were included in the study after obtaining consent. Data was collected at the end of posting by online survey using google forms. The participation in the study was voluntary and students had a choice of opting out of the study at any point. HEMLEM Questionnaire developed by Isba et al was used which is a pre validated tool to assess micro learning environment which can be dynamic and small. HEMLEM Questionnaire involves 12 questions related to Staff attitude and behaviours and quality of teaching. The questions related to staff attitude consist of assessing atmosphere, culture, faculty’s enthusiasm, value of student’s input and supportive feedback within the placement. The questions like development of skill, knowledge, practical applications, achieving learning objectives, dealing with patients and tasks related to training were included in quality of teaching(9,12). The google questionnaire was circulated at the end of critical care posting of subsequent months for a period of 5 months. A reminder was sent after 7 days. All the responses were recorded in Microsoft excel sheet.

Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency and proportion for categorical variables. Non normally distributed quantitative variables were summarized by median and interquartile range (IQR).

All Quantitative variables were checked for normal distribution within each category of explanatory variable by using visual inspection of histograms and normality Q-Q plots. Shapiro- wilk test was also conducted to assess normal distribution. Shapiro wilk test p value of >0.05 was considered as normal distribution. For normally distributed Quantitative parameters the mean values were compared between study groups using Independent sample t-test (2 groups). P value < 0.05 was considered statistically significant. Data was analyzed by using SPSS software, V.22.

 

RESULTS

A total of 35 subjects were included in the final analysis.

Table 1: Descriptive analysis of gender in the study population (N=35)

Gender

Frequency

Percentages

Male

19

54.29%

Female

16

45.71%

 

Table 2: Students’ evaluation of learning environment of Critical Care Unit

 

Strongly

Disagree

Disagree

Neutral

Agree

Strongly

Agree

This place has a welcoming, friendly and open atmosphere.

4

(11.43%)

4

(11.43%)

11

(31.43%)

10

(28.57%)

6

(17.14%)

There is a culture where I felt free to ask questions or make comments on this placement

0 (0%)

7

(20.00%)

8

(22.86%)

15

(42.86%)

5

(14.29%)

Faculty on this placement is enthusiastic about teaching

8

(22.86%)

7

(20.00%)

3

(8.57%)

9

(25.71%)

8

(22.86%)

Faculty shows an interest in student's learning

5

(14.29%)

6

(17.14%)

6

(17.14%)

14

(40.00%)

4

(11.43%)

Student's input is valued in this placement

0 (0%)

0 (0%)

8

(22.86%)

16

(45.71%)

11

(31.43%)

I am provided with regular useful and supportive feedback during this placement

0 (0%)

0 (0%)

19

(54.29%)

9

(25.71%)

7

(20.00%)

I have an opportunity to apply my previous knowledge in this placement

0 (0%)

4

(11.43%)

1

(2.86%)

12

(34.29%)

18

(51.43%)

My knowledge and skills develop during this placement

0 (0%)

5

(14.29%)

9

(25.71%)

10

(28.57%)

11

(31.43%)

This placement helps me put theory into practice

0 (0%)

2

(5.71%)

0 (0%)

15

(42.86%)

18

(51.43%)

I was able to meet my learning objectives in this placement

0 (0%)

0 (0%)

13

(37.14%)

14

(40.00%)

8

(22.86%)

I have the opportunity to deal with the patient as whole on this placement

0 (0%)

6

(17.14%)

8

(22.86%)

12

(34.29%)

9

(25.71%)

I am given tasks suitable for my stage of training on this placement

0 (0%)

0 (0%)

0 (0%)

19

(54.29%)

16

(45.71%)

 

Table 3: Gender-wise comparison of students’ responses

Parameter

 Gender (Mean± SD)

P value

Male (N=19)

Female (N=16)

This place has a welcoming, Friendly and open

atmosphere.

3.32 ± 1.42

3.25 ± 1

0.877

There is a culture where I felt free to ask

questions or make comments on this placement

3.63 ± 1.01

3.38 ± 0.96

0.449

Faculty on this placement is enthusiastic about teaching

2.89 ± 1.63

3.25 ± 1.44

0.503

Faculty shows an interest in student's learning

3 ± 1.33

3.38 ± 1.2

0.393

Student's input is valued in this placement

4.37 ± 0.68

3.75 ± 0.68

0.012

I am provided with regular useful and supportive feedback during this placement

3.74 ± 0.81

3.56 ± 0.81

0.530

I have an opportunity to apply my previous

knowledge in this placement

4 ± 1.15

4.56 ± 0.63

0.091

My knowledge and skills develop during this placement

3.37 ± 1.12

4.25 ± 0.77

0.012

This placement helps me put theory into practice

4.16 ± 0.9

4.69 ± 0.48

0.042

I was able to meet my learning objectives in

this placement

3.84 ± 0.76

3.88 ± 0.81

0.902

I have the opportunity to deal with the patient as

whole on this placement

3.58 ± 1.17

3.81 ± 0.91

0.521

I am given tasks suitable for my stage of

training on this placement

4.47 ± 0.51

4.44 ± 0.51

0.837

DISCUSSION

This study assessed the learning environment in the critical care unit of a tertiary care institute. Second year post graduate trainees rated their overall learning experience as per HEMLEM questionnaire at the end of their one month posting in critical care.(13,14)

 

The study population consisted of 54.29% males and 45.71% females. Regarding staff attitude and behaviour, most of the students agreed that the environment was welcoming and they felt free to ask questions. Equal number of students strongly agreed and strongly disagreed to enthusiasm in faculty about teaching. Most students agreed to faculty’s interest in student’s learning. Most of the trainees agreed that student’s inputs were valued and 31.43% strongly agreed to that. Nearly fifty percent trainees felt that they were provided with regular and supportive feedback during their postings. Regarding Quality of teaching, there was encouraging feedback and most of the students strongly agreed that the quality was well maintained. More than fifty percent had an opportunity to apply their previous knowledge in this posting. There was enhancement in knowledge and skills of more than fifty percent students. More than ninety percent found the posting helpful for practical application of theory. Hundred percent students achieved their learning objectives during this posting. Most of them had an opportunity to deal with patients under supervision. Also, hundred percent of them felt that they were given tasks suitable for their stage of learning. (15,16,17)

 

There are many factors which determine quality of medical education that can be provided in a micro environment like postings of short duration (Figure 1). To provide a good learning environment focus should be on clinical skill development, professionalism and ethics, access to technology and resources and good mentorship.(18,19) Peer interaction, assessment and feedback are equally important in a teaching learning environment.(20,21)

Figure 1: Factors determining Quality of Medical Education in Micro learning     environment

 

Micro learning environment is different as there are small groups and short duration postings. The results from this study can be extrapolated as the assessment of learning environment is dynamic and sequential. HEMLEM tool is a very useful tool to obtain feedback on a micro learning environment at the end of posting. The constructive feedback can be immediately incorporated to improve the teaching and learning practices for the benefit of subsequent batches. A learner-centered and supportive environment nurtures empathy, communication, and resilience, whereas a toxic or punitive atmosphere can jeopardize both student well-being and patient safety.(22,23) Learning in critical care involves clinical reasoning, practicing procedures, communication and stress management. For optimum learning conditions the environment should be stress free and there should be two-way interaction between the trainee and facilitator. The working hours in critical care units is hectic and stress management plays an important role in maintain a cordial learning environment. The optimistic outlook of the students is an encouraging factor for the teachers to further enhance the learning environment in future. The teamwork, non-technical skills, clinical reasoning and empathy were all built up seamlessly.(24) The engaging nature of learning environment was preferred by all students as facilitating factor. Learning by doing under supervision was helpful in building up the confidence. Since trainees are adult learners, providing learning environment overcoming the barrier of hierarchy helped the learners to express themselves and clear their queries.(25,26)

CONCLUSION

Healthcare Education Micro-Learning Environment Measure scale serves as important tool to assess learning environment in a small and dynamic placements. It is a handy tool to obtain feedback and modify the learning environment constructively.

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