Nested Domains: A Global Conceptual Model for Optimizing the Clinical Learning and Working Environment

The learning and working environment (LWE), where educational objectives intersect with direct patient care, falls under the purview of a range of professional, educational, and clinical organizations.1–4 National trends including resident duty hour restrictions, decreased patient length of stay, rapid throughput, observation status, and increased inpatient medical acuity all threaten the quality of hospital-based medical training. Workload pressures stemming from patient volume, fee for service compensation, and documentation requirements have the same effect upon ambulatory-based training.