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The Educational Climate Inventory: Measuring Students’ Perceptions of the Preclerkship and Clerkship Settings

Krupat, Edward PhD; Borges, Nicole J. PhD; Brower, Richard D. MD; Haidet, Paul M. MD, MPH; Schroth, W. Scott MD, MPH; Fleenor, Thomas J. Jr MEd; Uijtdehaage, Sebastian PhD

doi: 10.1097/ACM.0000000000001730
Research Reports

Purpose To develop an instrument to assess educational climate, a critical aspect of the medical school learning environment that previous tools have not explored in depth.

Method Fifty items were written, capturing aspects of Dweck’s performance–learning distinction, to distinguish students’ perceptions of the educational climate as learning/mastery oriented (where the goal is growth and development) versus performance oriented (where the goal is appearance of competence). These items were included in a 2014 survey of first-, second-, and third-year students at six diverse medical schools. Students rated their preclerkship or clerkship experiences and provided demographic and other data. The final Educational Climate Inventory (ECI) was determined via exploratory and confirmatory factor analysis. Relationships between scale scores and other variables were calculated.

Results Responses were received from 1,441/2,590 students (56%). The 20-item ECI resulted, with three factors: centrality of learning and mutual respect; competitiveness and stress; and passive learning and memorization. Clerkship students’ ratings of their learning climate were more performance oriented than preclerkship students’ ratings (P < .001). Among preclerkship students, ECI scores were more performance oriented in schools with grading versus pass–fail systems (P < .04). Students who viewed their climate as more performance oriented were less satisfied with their medical school (P < .001) and choice of medicine as a career (P < .001).

Conclusions The ECI allows educators to assess students’ perceptions of the learning climate. It has potential as an evaluation instrument to determine the efficacy of attempts to move health professions education toward learning and mastery.

Supplemental Digital Content is available in the text.

E. Krupat is associate professor of psychology, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts. At the time of the research, the author was also director, Center for Evaluation, Harvard Medical School, Boston, Massachusetts.

N.J. Borges is assistant dean, Medical Education Research and Scholarship, and professor, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi. At the time of the research, the author was on the faculty of Wright State University Boonshoft School of Medicine, Dayton, Ohio.

R.D. Brower is associate dean for medical education, associate professor of medical education, and clinical associate professor of neurology, Paul L. Foster School of Medicine at Texas Tech University Health Sciences Center, El Paso, Texas.

P.M. Haidet is professor of medicine, humanities, and public health sciences and director of medical education research, Penn State College of Medicine, Hershey, Pennsylvania.

W.S. Schroth was associate dean for administration, George Washington University School of Medicine and Health Sciences, Washington, DC, at the time of the research.

T.J. Fleenor Jr is project manager, Office of Educational Quality Improvement, Harvard Medical School, Boston, Massachusetts.

S. Uijtdehaage is professor of medicine and associate director, graduate programs in health professions education, Uniformed Services University of the Health Sciences, Bethesda, Maryland. At the time of the research, the author was on the faculty of the David Geffen School of Medicine at the University of California, Los Angeles, California.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: This study was reviewed and approved individually at each of the participating schools, with the exception of the George Washington University School of Medicine and Health Sciences, which ceded review to Harvard Medical School, the site of the principal investigator (E.K.).

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Correspondence should be addressed to Edward Krupat; e-mail:

Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.

© 2017 by the Association of American Medical Colleges