What is the learning environment?

We can read the curriculum documents, we can inspect the expected learning outcomes, and we can experience a wide range of teaching approaches, but we may know little about the student’s experience in the education programme. Key to this, suggests Genn (2001), is the atmosphere or climate experienced by the student in the school – what is valued, what is recognised and what is encouraged. As Genn describes, the education climate is the soul and heart of the medical school. It is the education environment that determines the students’ behaviour, their achievements and their satisfaction. McAleer et al (2009) likened it to the climate or environment in the meteorological context and suggested that we cannot hope to maximise the education output if we do not foster a nurturing climate.

Contributing to the learning environment in a medical school or a postgraduate programme and influencing the students’ or trainees’ learning, positively or negatively, are:

The education climate is important

The establishment of an appropriate climate is almost certainly the most important single task for a medical teacher. Genn and others have highlighted that while the education climate may seem rather intangible, unreal and insubstantial, its effects are pervasive, substantial, very real and influential. The climate, it has been suggested, is like a mist – you cannot stay long in the mist before being thoroughly soaked. The climate includes the type of things that are rewarded, encouraged and emphasised, and the style of life that is valued in the school or training programme. A study of the learning environment can help to answer questions such as these:

Without an examination of the education environment these questions go unanswered. Genn (2001) suggests “If we wish to describe, assess, or otherwise ‘get a handle on’ the curriculum in a medical school, we need to consider the environment, educational and organisational, associated with the curriculum and the medical school”.

In postgraduate training particular concerns have related to poor supervision, variable and unpredictable teaching, lack of continuity, the provision of feedback that is not constructive, and an emphasis on service requirements rather than educational requirements. These can all be related to the established education environment.

Suggestions that students become more cynical and less empathetic as they progress through the medical curriculum are a cause of concern. The problem may rest, at least in part, with the education environment. Too often this is task orientated with the emphasis on the presentation by an expert scientist or clinician who knows the answers and procedures while the social– emotional orientation concerning the development of a caring helper of sick people is neglected. An appropriate education environment should encourage the development of abilities to empathise and identify with patients and their predicaments.

The need for a fundamental review of medical education was proposed by the Global Independent Commission on Education of Health Professionals for the 21st Century published in The Lancet in December 2010. The recommendations proposed far-reaching changes to learning outcomes and to methods of teaching, learning and assessment and addressed issues relating to teamwork, inter-professional collaboration, international dimensions and individualised learning. One could argue that key to the implementation of these changes is the development of a supportive education environment.

Aspects of the education environment

The medical education environment is extraordinarily complex. The different dimensions are sometimes referred to as orientations. Some aspects or orientations of the environment that merit consideration are listed here. The list is not comprehensive but it provides examples of the various orientations.