No Environment, No Education: Honoring the Clinical Learning Environment as the Engine of Competency-Based Education – A Call to Action

Integrate vulnerability and adaptability coaching into faculty and learner development (storytelling, uncertainty-simulation).

Provide protected time/incentives for peer observation focused on safety behaviors.

Embed learner-reported psychological safety metrics into program dashboards, linking results to recognition and support.

Explicitly teach and model growth mindset principles, pairing them with feedback literacy.

Recognize, support and value clinical teachers as essential system assets.

Address workload strain and protect time for teaching.

Mitigate misuse of evaluation systems and promote trust through clear feedback norms.

Apply Quality Improvement (QI) approaches that integrate patient care and teaching priorities.

Educate learners on the science of productive struggle and desirable difficulty and set expectations for training.

Dispel myths that psychological safety equals comfort or conflict avoidance.

Incorporate evidence-based strategies (retrieval practice, spaced repetition, interleaving) into clinical teaching.

Train supervisors to coach through challenge rather than avoid it, maintaining accountability without punitive overtones.

Reward followership, shared leadership, and collaborative achievements alongside individual excellence.

Embed team-based assessment and feedback into training, emphasizing reciprocal growth.

Foster interdisciplinary debriefing and after-action reviews modeled on high-reliability teams.

Use vulnerability as a lever for building trust and collective accountability.

Build formal partnerships between education leaders and health system leadership to align goals.

Measure and monetize the value of strong CLEs (e.g., recruitment/retention, patient outcomes).

Engage learners directly in health systems improvement projects.

Apply familiar organizational improvement frameworks (e.g., Learning Health System, Deliberately Developmental Organization) to embed continuous learning.