Educational climate of a pathology residency program at a tertiary care hospital

Views about patient sign-out are essential as a variable because residents’ perceptions could improve with an upgraded patient sign-out system. This consideration sparked because of high scores for patients signing out (4.22±0.535) among residents (100%), like the positive scores (3.82 +/- 0.46) during a shift change in a study in the Netherlands that included resi- dents from multiple specialty training programs [15]. Nevertheless, scores in the current study were higher, indicating a positive impact on our patient sign-out system. Despite consistent positive findings in the literature about patient sign-out, negative perception has also been reported (3.50±1.15) when patient sign-out across multiple specialties was done and could reduce the representative size from each specialty [20]. These differential findings provide evi- dence for further improvement of patient-sign-out systems in specific settings. Overall, a positive perception (>3.6) about EC Subscales of the D-RECT questionnaire was found in almost all the PGRs working in the four departments (histopathology, chemical pathology, immunology, hematology) of the pathology residency program. A positive percep- tion regarding the overall EC score (4.39+0.385) was observed, which corresponded to the overall positive score for clinical learning (3.85 +/- 0.29) in Filipino medical residents [25]. However, a negative perception regarding EC (3.16±0.92) has also been reported in a study of Moroccan residents where a French translation of the D-RECT scale was used for psychomet-

ric analysis of the tool’s French version [26]. Despite the positive score for EC, score variations by years of training p�0.05 were observed; it is supposed that they reflected changing percep- tions of PGRs about the attributes of EC due to the transition of PGRs into senior years. In var- ious years of training, different challenges and milestones may influence perceptions about experiences regarding LC. In senior years (from third to fifth), residents may feel added responsibility with low time availability for each commitment, relatively less supervised task performances, and the increased complexity of competencies that need to be mastered during the residency training [27]. Therefore, the observed differences in EC scores by years of train- ing may reflect that in the earlier years of residency, i.e., first year and second year, residents might be more enthusiastic about their professional futures and invest consistent time com- mitments for training milestones and adjust corresponding to relatively simple competencies to be mastered. Additionally, significant differences in means of EC scores by years of training in our study contradict the assessed differences in scores by years of training in an emergency department [23]. However, there are methodological differences in how the differences were calculated. In a study in the emergency department [23], scores were determined individually for each con- struct on the D-RECT and then compared by years of training. In addition, emergency resi-

dency training is only for four years. In our study, we calculated the average mean score for the overall D-RECT and then compared the scores by each year. Furthermore, in our study, the pathology residency program lasts five years. We condensed these years of training into three groups. We conducted ANOVA to assess if any significant differences could be identified in addition to a post-hoc analysis through multiple comparisons to see where differences were located, as identifying differences in perceptions about EC scores reflects a need to devise mechanisms to address these differences. A limitation of our study is that it included a smaller sample size. Enrolling any new PGRs for the study was impossible as these were the maximum PGRs during the study, and even though the study participants provided voluntary informed consent to participate, the response rate was 100%. To address the limitation of sampling size, this study may be consid- ered a pilot study and, in the future, may be replicated in the same setting but with a different study design, i.e., longitudinal study design. Our study’s strength is that it focuses on the pathology residency program. Considering the diverse needs of EC in each unique setting, it was essential to assess the needs within our EC. To achieve this milestone, a research study was PLOS ONE Educational climate of a pathology residency program PLOS ONE | https://doi.org/10.1371/journal.pone.0303534 May 23, 2024 7 / 10