From classroom to clinic: the role of the clinical learning environment in shaping medical students’ psychological capital

BACKGROUND: The transition from classroom to clinical practice poses psychological challenges for medical students. This study examines how the clinical learning environment (CLE) shapes psychological capital (PsyCap) among Chinese medical interns. METHODS: A total of 2,589 medical students from 18 universities completed the Dundee Ready Education Environment Measure (DREEM) and Psychological Capital Scale (PCS). Confirmatory factor analysis validated both instruments. Structural equation modeling assessed CLE-PsyCap relationships, controlling for gender and university type. RESULTS: Both instruments showed excellent psychometric properties (DREEM: α = 0.91, CFI = 0.92; PCS: α = 0.93, CFI = 0.96). Students' Social Self-Perceptions was the strongest positive predictor of PsyCap (β = 0.33-0.46, all p < 0.0001), whereas Students' Perceptions of Teachers consistently showed negative effects (β = -0.10 to -0.32, all p < 0.001). Students' Academic Self-Perceptions positively predicted resilience (β = 0.19, p = 0.0007) but not hope or optimism. Key university students reported higher CLE and PsyCap scores than provincial peers (both p < 0.0001). Females perceived more favorable CLE than males (p < 0.0001), with no overall PsyCap difference. CONCLUSIONS: The CLE significantly influences medical students' PsyCap. The adverse impact of teacher perceptions may reflect hierarchical training culture in Chinese medical education. Enhancing social support and learning atmosphere, particularly in under-resourced institutions, is critical for fostering psychological well-being and professional readiness.