More Information

The Clinical Learning Environment

• Total D-RECT score provides a global, composite measure of trainee views of the clinical learning environment. D-RECT scores can range from 50 to 250 with a higher score indicating a more positive view of the clinical environment.
• The mean total D-RECT score across all trainees in Ireland in 2015 was 172.4. This is an increase of 2 points on 2014 score (170.8).
• In 2015, there was wide variation in trainees' experience of the clinical learning environments: 25% reported scores lower than 151 and 25% reported scores higher than 194.
• Despite the increase in D-RECT score in 2015, there is still some distance between the trainee experience and that envisioned by experts.

Different Attributes of the Clinical Learning Environment

• The D-RECT model allows trainee views of the overall clinical learning environment under 11 specific attributes. A higher score indicates more positive view of that attribute.
• There was no change in order of how trainees ranked attributes between 2014 and 2015.
• Feedback (2.64/2.70) was considered the lowest ranking attribute in both years respectively, while peer collaboration (3.87/3.95) was the highest ranking attribute for both years.
• However, there was a slight decrease in trainees' scores regarding 'formal education' (3.46/3.44) and 'consultant's role' (3.78/3.77).  
• Age was considered a factor in trainees' views of their learning environment. Generally, the older the trainee, the higher they valued their learning environment.
• Trainees who took direct entry routes into medical school rated their learning environments significantly higher than graduate entry trainees. 
• Trainees that graduated in an Irish medical school gave significantly lower scores (m=169) than trainees who qualified elsewhere (m=189).
• Trainees in smaller (m=163) and larger hospitals (m=170) rated their clinical learning environment lower than trainees in GP Practices (m=200). 

Induction to Clinical Learning Environment

• 22% of trainees said they were not offered an induction and a further 9% said that they were offered a programme but could not get released to attend.
• Trainees' experience of induction did not improve within the last year and falls short of comparable information from the UK.
• Trainees' induction experience was strongly associated with their stage of training. Trainees on intern training programmes were less likely to receive all the information they needed about their workplace before commencing their post.
• Trainees in larger and smaller hospital were less likely to have their roles and responsibilities explained to them, than trainees in GP practices or mental health services.
• Trainees that attended induction programmes considered their learning environment to be significantly higher in quality than trainees who did not, these results reconfirm the link made in 2014.

Preparedness for Transition

• 83% of trainees who were about to complete specialist training agreed they were well prepared for the next stage of their career. This is compared to the 87% of trainees who felt prepared for their next role in 2014.
• 53% of interns agreed that their previous medical education and training had prepared them well for the jobs to be undertaken as an intern, compared to 48% in 2014.
• 30% of trainees felt their previous training and education did not prepared them for their undertaking as an intern, compared to 34% in 2014.
• Of the interns who disagreed that their previous medical education and training had prepared them for their next role, 36% reported it was a minor problem, 55% said the problem was medium sized and a further 9% indicated the problem was serious.
• The majority of interns agreed that they were well prepared for their intern roles in terms of clinical knowledge (78%) and interpersonal skills (71%). However, only a minority of interns agreed they were well prepared for clinical procedures (43%), physical, emotional and mental demands (28%) and administrative tasks (18%) of the intern year.
• There was no significant association with trainee preparedness and gender, age, routes to medical school, or the medical schools in which they graduated.

Bullying and Undermining Behaviour

• 35% of trainees have experienced bullying and harassment in their post, compared to 33.7% in 2014.
• The prevalence of bullying was significantly higher among interns (48%), and lower among trainees in higher specialist training (28%) and GP training programmes (23%).
• Doctors were identified by trainees as the largest source of bullying (49%) in training environments. While, nurses and midwives were perceived as the 2nd largest source of bullying (36%).
• The data suggest that sources of bullying vary for trainees at different stages of training. For example, consultants/GPs accounted for 24% of all trainee bullying, yet for trainees in run-through training programmes this source accounted for 48% of bullying.
• Almost 7- in- 10 who experienced bullying did not report their experience to someone in authority.  Of the trainees who did report to someone in authority, almost 40% perceived nothing to have happened about it.
• Trainees who experienced frequent (m=148) or infrequent (m=163) bullying reported lower total D-RECT scores than trainees who were never bullied.  
• There was no significant association between the prevalence of bullying experienced by trainees and gender, the region in which they obtained their basic medical qualification, or entry routes taken by trainees to medical school.

Safety and Quality of Clinical Sites

• 83% of trainees agreed that they felt physically safe within their clinical learning environment, this is a 3% decrease from 2014.
• Trainees in GP training programmes (89%) were less likely than other trainees (94%) to agree that they felt physically safe at their clinical site.
• Trainees who were never bullied were more likely, than trainees who were bullied, to agree that they felt safe at their clinical site.
• There was no significant association with feeling safe in the learning environment and trainees age, gender, entry routes to medical school, region of qualification or type of site in which the trainee was located.
• 86% rated the quality of care provided to patients as 'good or very good', a marginal increase compared to 2014 (85%).
• Trainees who rated the quality of care to patients as 'good or very good' had more positive views of clinical learning environments.
• Trainees in larger (12.5%) and smaller (26.2%) hospitals were significantly more likely, than trainees in GP practices (45%) and Mental Health Services (7%), to rate the quality of care provided to patients as 'less good'.
• There was no significant variations in trainees views on quality of care provided at clinical sites due to gender or entry routes to medical school.

View Previous Your Training Counts Reports

• Your Training Counts 2014 Report
• Your Training Counts - health and wellbeing 
• Your Training Counts- Career and Retention Intentions

• Follow the survey on Twitter.
• Find out more about what changes have been made since the 2014 survey.