Development and analysis of D-RECT, an instrument measuring residents' learning climate

Background: Measurement of learning climates can serve as an indicator of a department's educational functioning. Aim: This article describes the development and psychometric qualities of an instrument to measure learning climates in postgraduate specialist training: the Dutch Residency Educational Climate Test (D-RECT). Method: A preliminary questionnaire was evaluated in a modified Delphi procedure. Simultaneously, all residents in the Netherlands were invited to fill out the preliminary questionnaire. We used exploratory factor analysis to analyze the outcomes and construct the definitive D-RECT. Confirmatory factor analysis tested the questionnaire's goodness of fit. Generalizability studies tested the number of residents needed for a reliable outcome. Results: In two rounds, the Delphi panel reached consensus. In addition, 1278 residents representing 26 specialties completed the questionnaire. The Delphi panel's input in combination with the exploratory factor analysis of 600 completed surveys led to the definitive D-RECT, consisting of 50 items and 11 subscales (e. g., feedback, supervision, patient handover and professional relations between attendings). Confirmatory factor analyses of the remaining surveys confirmed the construct. The results showed that a feasible number of residents is needed for a reliable outcome. Conclusion: D-RECT appears to be a valid, reliable and feasible tool to measure the quality of clinical learning climates.