No Environment, No Education: Honoring the Clinical Learning Environment as the Engine of Competency-Based Education – A Call to Action
Abstract
Competency-Based Health Professions Education (CBHPE) has transformed health professions training by emphasizing demonstrated competence over time-based progression. Yet the clinical learning environment (CLE), the social, cultural, and organizational ecosystem in which learning occurs, has not evolved in parallel. Persistent hierarchies, workload pressures, and inadequate faculty development limit CBHPE’s full potential. Thus, the authors sought to identify priorities for CLE reform. A structured consensus process was conducted at the International Competency-Based Education Collaborators Summit in February 2025, where interdisciplinary health professions educators identified CLE reform priorities. Findings were refined through virtual meetings over three months. Five interdependent priorities were identified as essential for transforming the CLE: Psychological safety: enabling vulnerability, feedback, coaching, and growth through faculty and learner development Teaching environment: prioritizing faculty well-being, recognition, and sustainable teaching capacity Desirable difficulty and productive struggle: balancing challenge and safety to promote adaptive expertise and resilience Interdependence and collectivism: reframing education from individual performance to team-based competence and shared accountability Partner alignment: integrating educational and healthcare system goals to advance patient care and workforce well-being Together, these domains outline the CLE as both a developmental and operational engine for CBHPE. Realizing the promise of CBHPE depends on transforming the CLE into a psychologically safe, appropriately challenging, interdependent, and system-aligned ecosystem. Reform demands cultural change that values coaching, feedback, vulnerability, and collective responsibility as professional imperatives. By aligning structures and empowering adaptive educators, the CLE can evolve from a passive setting to an active driver of successful competency-based transformation.