Journal of General Internal Medicine

, Volume 32, Issue 7, pp 783–789

Assessing the Culture of Residency Using the C - Change Resident Survey: Validity Evidence in 34 U.S. Residency Programs

  • Linda H. Pololi
  • Arthur T. Evans
  • Janet T. Civian
  • Sandy Shea
  • Robert T. Brennan
Original Research



A practical instrument is needed to reliably measure the clinical learning environment and professionalism for residents.


To develop and present evidence of validity of an instrument to assess the culture of residency programs and the clinical learning environment.


During 2014–2015, we surveyed residents using the C - Change Resident Survey to assess residents’ perceptions of the culture in their programs.


Residents in all years of training in 34 programs in internal medicine, pediatrics, and general surgery in 14 geographically diverse public and private academic health systems.

Main Measures

The C - Change Resident Survey assessed residents’ perceptions of 13 dimensions of the culture: Vitality, Self-Efficacy, Institutional Support, Relationships/Inclusion, Values Alignment, Ethical/Moral Distress, Respect, Mentoring, Work–Life Integration, Gender Equity, Racial/Ethnic Minority Equity, and self-assessed Competencies. We measured the internal reliability of each of the 13 dimensions and evaluated response process, content validity, and construct-related evidence validity by assessing relationships predicted by our conceptual model and prior research. We also assessed whether the measurements were sensitive to differences in specialty and across institutions.

Key Results

A total of 1708 residents completed the survey [internal medicine: n = 956, pediatrics: n = 411, general surgery: n = 311 (51% women; 16% underrepresented in medicine minority)], with a response rate of 70% (range across programs, 51–87%). Internal consistency of each dimension was high (Cronbach α: 0.73–0.90). The instrument was able to detect significant differences in the learning environment across programs and sites. Evidence of validity was supported by a good response process and the demonstration of several relationships predicted by our conceptual model.


The C - Change Resident Survey assesses the clinical learning environment for residents, and we encourage further study of validity in different contexts. Results could be used to facilitate and monitor improvements in the clinical learning environment and resident well-being.


residents culture of medicine clinical learning environment quantitative survey resident well-being 

Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  • Linda H. Pololi
    • 1
  • Arthur T. Evans
    • 2
  • Janet T. Civian
    • 3
  • Sandy Shea
    • 4
  • Robert T. Brennan
    • 5
  1. 1.National Initiative on Gender, Culture and Leadership in Medicine: C - Change, Brandeis Women’s Studies Research CenterBrandeis UniversityWalthamUSA
  2. 2.Hospital MedicineWeill Cornell Medical CollegeNew YorkUSA
  3. 3.Brandeis Women’s Studies Research CenterBrandeis UniversityWalthamUSA
  4. 4.Committee of Interns and ResidentsNew YorkUSA
  5. 5.Harvard T. H. Chan School of Public HealthHarvard UniversityBostonUSA

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