Measuring the educational environment in ambulatory settings

Background and objectives: Students’ perceptions of their educational environment (EE) have been studied in undergraduate and postgraduate curricula. The Ambulatory Care Learning Educational Environment Measure (ACLEEM) is an inventory that was recently developed to measure the EE in postgraduate ambulatory settings. The aim of this study was to assess the psychometric properties of the inventory. Methods: A mixed methodology was used to develop the ACLEEM including: Grounded theory (8 focus groups); a two-round Delphi technique to identify consensus; and a pilot study. The inventory was refined to 50-items after the pilot study and it was prospectively administered to a large cohort of clerks and residents in Chile during 2010-2011. Psychometric measurements included factor analysis followed by Varimax rotation for construct validity,Cronbach’s alpha coefficients for internal consistency and Generalizability theory for test reliability. Results: Four-hundred and eleven students responded: 151 clerks (83.9% of the target population) and 260 residents (74% of the target population) from 31 postgraduate programs. The factor analyses showed an eight factor instrument. ACLEEM was found highly reliable with a Cronbach’s alpha of 0.94 and D-study revealed a reliable outcome for residency programs with at least 15 respondents with a G coefficient of 0.831. The EE perceived by residents and clerks was positive without differences between groups: 152.52 ± 23.36 (76.26%) and 150.61 ± 24.62 (75.30%),respectively (p=0.761). Conclusions: The 50-item ACLEEM inventory is a multidimensional and valid instrument requiring only 15 respondents for reliable results. We recommend using it to measure the EE in the ambulatory postgraduate Spanish-speaking programs.