Creating a learning environment to produce competent residents: the roles of culture and context.

Six core competencies have been developed for use by residency programs in assessing individual resident training outcomes. The authors propose that it is important to consider the role of residency culture and work context in helping residents achieve the required competencies. Specifically, the development of a learning-oriented culture and favorable work conditions that facilitate the presence of that culture should be a high priority for residency programs and the organizations (e.g., hospitals) in which they are housed. This places formal accountability at the doorstep of these programs and organizations in helping to create a "competent" resident. Using ideas from management theory, the authors identify specific attitudes, behaviors, and interactions that define a learning culture and show their usefulness when applied to residents' achievement of the competencies. They assert that current features of everyday resident work life decrease the chances that such attitudes, behaviors, and interactions will occur. Identifying and prioritizing the components of desired work environments for promoting a learning-oriented culture, in addition to assessing the presence or absence of both the components and learning best practices within residency programs, should become normal activities that complement the process of assessing competencies.