Evaluation of the educational environment of the Saudi family medicine residency training program

Psychometric properties of the arabic version of PHEEM applied on a sample of medical residents in Syria

BACKGROUND

The clinical learning environment (CLE) plays a crucial role in shaping the learning experiences and professional development of medical professionals. Understanding and optimising this environment is essential for improving doctors' knowledge acquisition, clinical skills, and overall well-being. The development of the Postgraduate Hospital Educational Environment Measure (PHEEM) and its translation to numerous languages has been a milestone in clinical education. Even though PHEEM was recently translated into Arabic, its psychometric properties in this form remain unevaluated. Therefore, this study aims to conduct a comprehensive psychometric analysis of the Arabic version of the PHEEM questionnaire.

METHODS

This is a cross-sectional questionnaire survey validation study. The defined population were medical residents in Damascus, Syria. A paper-based survey as well as an online-based one were conducted using several non-probability sampling methods namely, convenience, river and, snowball sampling between June 15, 2023, and June 21, 2023. Both exploratory (EFA) and confirmatory (CFA) factor analyses were conducted. Several psychometric criteria were applied including scree plot, eigenvalue > 1.5 and the 'proportion of variance accounted for' criterion.

RESULTS

A total of 543 participants completed the questionnaire (56.9% female). Kaiser-Meyer-Olkin measure for sample adequacy was high (0.937) and the P-value for Bartlett's test was < 0.001. EFA revealed five meaningful factors which were labelled: perception of teachers, learner's engagement and social participation, external regulation, work culture, and living conditions. These factors had the following eigenvalues: 12.6, 2.18, 2.03, 1.86, and 1.41 respectively, with a total explained variance of 43.45%. Cronbach's Alpha was 0.938. CFA confirmed the model structure of EFA (SRMR = 0.067 and RMSEA = 0.066). The Average Variance Explained (AVE) value of any given factor was > 0.7.

DISCUSSION

The Arabic PHEEM inventory demonstrated satisfactory psychometric properties. The extracted domains are of theoretical relevance to the psychosocial-material conceptual framework for learning environment. Nonetheless, this validation was performed in the Syrian context; therefore, future studies in other Arabic countries are recommended to support the applicability of Arabic PHEEM in the wide Arab World.

Translation, cultural adaptation and linguistic validation of the postgraduate hospital educational environment measure into Arabic

BACKGROUND

Assessment of the clinical learning environment (CLE) is an essential step that teaching hospitals routinely undertake to ensure the environment is conducive, learning-oriented and supportive of junior doctors' education. The Postgraduate Hospital Educational Environment Measure (PHEEM) is an internationally recognized tool for assessing the CLE with evidence of high reliability and validity. Translation of PHEEM into other languages such as Spanish, Japanese and Persian enabled wider adoption of the instrument in the world. However, in Syria and other Arabic countries, a validated Arabic translation of PHEEM is still not available, making it difficult to adopt it and use it in Arabic contexts. This study aims to translate and culturally adapt the PHEEM from English into Arabic.

METHODS

This study followed the structured translation and validation process guideline proposed by Sousa & Rojjanasrirat 2010. First, the PHEEM went through forward translation by three translators, then reconciled with the aid of a fourth translator. Afterwards, two professional bicultural and bilingual translators conducted back translation into English and compared it with the original version. This formed the Pre-final Version (PFV) which was then pretested for clarity on a sample of medical residents in Damascus, Syria. Following appropriate modifications, the PFV was sent to a panel of experts for a comprehensive review of language clarity and to assess content validity.

RESULTS

A total of thirty-five medical residents were recruited. Ten items with language clarity issues were identified and modified according to the elicited suggestions. Thereafter, the modified PFV was presented to ten subject experts who identified three items in need of revision. The item-content Validity Index (CVI) was over 0.78 for all of the 40 items; the calculated scale-CVI was 0.945.

DISCUSSION

This study provided the first linguistically valid Arabic translation of the widely used PHEEM inventory. The next step is to conduct a full psychometric analysis of the Arabic PHEEM to provide further evidence of validity and reliability.

Factors associated with graduation examination results from standardised residency training in Zhejiang Province, China: a cross-sectional analysis of medical examination results data from 2020

OBJECTIVE

Standardised residency training is an important part of postgraduation medical education in China. The graduation examination tests the effect of residency training and is an important measure to guarantee the quality of residency training. This study aimed to analyse the results and associated factors of the graduation examination of standardised residency training in Zhejiang Province in 2020.

DESIGN

Cross-sectional analysis of examination results data.

SETTING

Medical and health institutions and universities in Zhejiang Province.

PARTICIPANTS

A total of 5555 examinees took the graduation examination of standardised residency training in Zhejiang Province in 2020.

PRIMARY OUTCOMES

Pass rates of the practical skill examination and written examination.

RESULTS

The pass rates for the practical skill examination and written examination were 91.8% and 96.5%, respectively. Examinees aged 30 and above (adjusted OR (AOR)=0.48, 95% CI 0.26 to 0.89), those with 3 years (AOR=0.19, 95% CI 0.09 to 0.43) and 2 years (AOR=0.61, 95% CI 0.40 to 0.96) of training, those who retook the examination (AOR=0.28, 95% CI 0.20 to 0.391) and those from primary healthcare institutions (AOR=0.56, 95% CI 0.40 to 0.77) were less likely to pass the practical skill examination. Examinees with a postgraduate degree and those from colleges and universities had higher pass rates in the written examination (AOR=6.37, 95% CI 1.95 to 23.34; AOR=2.87, 95% CI 1.40 to 6.65, respectively). Examinees aged 30 and above (AOR=0.08, 95% CI 0.01 to 0.30), those aged between 25 and 30 (AOR=0.22, 95% CI 0.03 to 0.80), those who retook the examination (AOR=0.04, 95% CI 0.03 to 0.07), those from second-level hospitals (AOR=0.58, 95% CI 0.39 to 0.87) and those who failed the practical skill examination (AOR=0.17, 95% CI 0.12 to 0.25) were less likely to pass the written examination.

CONCLUSIONS

The pass rate of the graduation examination of standardised residency training was associated with the individual characteristics of the examinees. The results of practical skill examination were related to the results of the written examination.

Assessment of the Educational Environment of Plastic Surgery Training Programs in Iran using the PHEEM Questionnaire: A Cross-sectional Study

Background

Clinical educational environments play a substantial role in the teaching of medical residents and fellows. In order to improve the quality of clinical education, its status should be evaluated. Therefore, we aimed to inquire about the educational environment of Plastic Surgery fellows in two teaching hospitals in Tehran, Iran using the Postgraduate Hospital Educational Environment Measure (PHEEM).

Method

In this descriptive cross-sectional study, Plastic Surgery fellows studying in two teaching hospitals in Tehran, Iran, in 2022 were included. The Persian version of the PHEEM questionnaire was applied for assessing the clinical educational environment. The collected data were analyzed by SPSS software version 22.

Results

Twenty six Plastic Surgery fellows were studied, 15.4% of whom were women (n=4) and 84.6% were men (n=22). The mean total score of the PHEEM questionnaire was 89.68±26.02. The highest mean score was in the teaching dimension (35.08), while the lowest mean score was in the social support dimension (25.42).

Conclusion

Most dissatisfaction among Plastic Surgery fellows were in the field of social support. It is necessary to adopt proper educational policies to improve the supportive resources for Plastic Surgery fellows.

Residents’ Perception of the Educational Program “Family Medicine” in Kazakhstan: A Focus Group Study

Целью данного исследования было: восприятие обучения, мнение резидентов, обучающихся по программе «Семейная медицина», и определение потребности резидентов программы «Семейная медицина».   Методы . В этом качественном исследовании были проведены четыре полуторачасовых фокус-группы с 24 ординаторами, обучаемыми по программе резидентуры по семейной медицине Западно-Казахстанского университета, и результаты были проанализированы с использованием тематического анализа. Результаты. Анализ появления пяти тем и 14 вопросов подтем, которые были классифицированы по областям для обсуждения в фокус-группах: восприятие особенности ФМ, Мотивация доходов, Преимущества и внешний вид категории товаров, Жалобы и проблемы, пожелания по просмотру программ, идеальное значение имеют. Выводы. Это исследование выявления наличия жителей, которые ранее не учитывались в достаточной мере. Компетенции и содержание программы будут изменены в соответствии с назначением резидентов.

Internal Medicine Residents' Perceptions of the Learning Environment of a Residency Training Program in Ethiopia: a Mixed Methods Study

INTRODUCTION

The learning environment is an important determinant of the quality of medical education. Having a good learning climate leads to improved learning process, satisfaction with education, and helps achieve the goals of the curriculum. Assessment of the quality of learning environment helps with the identification of areas that need improvement. The aim of this study was to assess the learning environment of internal medicine training program in Ethiopia.

METHODS

A mixed methods study using a cross-sectional survey using Postgraduate Hospital Educational Environment Measure and a qualitative study using a focus group discussion was done on internal medicine residents from December 2020 to May 2021. Comparison of quantitative data was done using Mann-Whitney U-Test and Kruskal-Wallis H-test. P-value <0.05 was considered statistically significant.

RESULTS

A total of 100 residents participated in the study. The overall total mean score of the responses of the participants was 70.87 (±19.8) with mean perceptions of role autonomy, perceptions of teaching and perceptions of social support of 25.9 (±7.1), 27.1 (10.2) and 17.9 (±5.1), respectively. These values suggest the presence of plenty of problems in the program. Higher mean scores were reported by males and by earlier years of residency. Ten residents participated in the focus group discussion. Four recurring themes that negatively affect learning environment were identified and included excessive workload, inadequate teaching activity, non-conducive hospital physical environment and lack of diagnostic and therapeutic modalities.

CONCLUSION

The internal medicine residency learning environment has many challenges that need immediate attention and follow-up.

Moroccan residents' perception of hospital learning environment measured with French version of the postgraduate hospital educational environment measure

PURPOSE

This study aimed to assess the educational environment of resident in Morocco and to compare the residents' perception depending on their specialties.

METHODS

We applied the French version of the postgraduate hospital educational environment measure (PHEEM) to measure the educational environment in 6 hospitals in Rabat from January to June 2017. Internal reliability of the questionnaire was assessed using Cronbach's alpha coefficient. Principal component analysis was conducted to assess the construct validity of the three subscales of the PHEEM questionnaire. Variance analysis (ANOVA test) was performed to compare means of PHEEM overall, subscale, and each item score among 6 specialties.

RESULTS

The response of 255 resident was included. The 40 items PHEEM questionnaire showed reliability with a Cronbach's alpha of 0.91. Principal component analysis on all 40 items suggested three factors explaining 48% of the variance with better results for the teaching subscale. Moroccan resident perceived their educational environment as more positive than negative. There was a significant difference in the overall and subscales score among the 6 specialties.

CONCLUSION

French version of the PHEEM score is a valid and reliable instrument in Morocco. Moroccan resident perceived their educational environment as more positive than negative but room for improvement of many challenges particularly the poor infrastructure, the suboptimal quality of supervision, and teaching and inadequate work regulation remained.

Evaluating the educational environment in a residency programme in Singapore: can we help reduce burnout rates?

INTRODUCTION

The educational environment (EE) reflects the quality of a residency programme and has an association with burnout. Studying the EE allows for interventions to target specific weaknesses. We aimed to measure the EE of an internal medicine residency programme in Singapore, compare the perceptions between genders, residency grades and levels of work experience, and identify specific areas of weaknesses for intervention in hopes of reducing residency burnout rates in Singapore.

METHODS

This study took place between October and December 2017. We adopted a mixed methods approach, quantitatively using the Postgraduate Hospital Educational Environment Measure (PHEEM), and qualitative exploration using semi-structured focus group discussion.

RESULTS

A total of 136 (88.9%) out of 153 residents responded. Our total PHEEM scores (112.23 ± 16.71), along with the scores for all three subscales, were higher than those of institutions in previous studies. There were no differences in overall PHEEM and subscale scores between genders, residency grades or levels of work experience. However, there were differences for individual questions, which were explored in the focus group discussion. Senior residents juggling heavier workloads, responsibilities and examinations appeared to be most prone to burnout. We identified three recurring themes that contributed to a poor EE in our programme: excessive workload, poor faculty relationships and differing unmet needs.

CONCLUSION

Although our programme had a good EE, there were also areas of weaknesses revealed by specific questions, possibly contributing to burnout. We hope to implement interventions to these areas and subsequently assess for longitudinal changes in EE and burnout rates.

Using the Postgraduate Hospital Educational Environment Measure to Identify Areas for Improvement in a Singaporean Residency Program

BACKGROUND

Attributes of the clinical learning environment (CLE) are a measure of quality in postgraduate medical education, and assessing the CLE is a component of the New Accreditation System being introduced in Singapore by the Accreditation Council for Graduate Medical Education International. There is a dearth of published studies of CLE quality in Singapore.

OBJECTIVE

Our study had 3 aims: (1) to measure the CLE in 1 Singaporean residency program; (2) to compare trainee perceptions by sex, training level, and experience; and (3) to identify areas for improvement.

METHODS

Between October and December 2017, we conducted a mixed assessment of the CLE in an internal medicine program in Singapore, using the Postgraduate Hospital Educational Environment Measure (PHEEM) and qualitative exploration using a focus group.

RESULTS

Of 153 IM residents, 136 (89%) provided PHEEM responses and 8 participated in the focus group. Total PHEEM scores and scores for the 3 subscales were higher than published data on the use of the PHEEM in international settings. Exploration of selected PHEEM responses via a focus group identified attributes associated with negative perceptions of the CLE: excessive workload, inadequate faculty presence in the CLE, and unmet trainee needs. It also suggested senior residents' clinical workloads, greater responsibilities, and pending examinations may contribute to their less positive perceptions of the CLE.

CONCLUSIONS

Our analysis using the PHEEM showed overall positive perceptions of the CLE, along with areas for improvement amenable to interventions. Our approach has relevance to an accreditation model with ongoing evaluation of the CLE.

Learning environment, stress and coping in psychiatry residents within a national training program: a longitudinal study

INTRODUCTION

Perception of one's learning environment is associated with academic performance and well-being of medical students. Yet, few studies have explored learners' perceptions and their correlates within a postgraduate environment. This study examined longitudinal changes in learning environment perception, perceived stress and coping for psychiatry residents in junior and senior years of training. Based on extant social learning theories, we hypothesized that learning environment perceptions will improve with seniority, and be accompanied by lower stress levels and better coping.

METHODS

Eighty-two out of 101 psychiatry residents (81.2%) from our National Psychiatry Residency Program rated their perception of learning environment, perceived stress, and coping strategies from June 2016 to June 2018. Correlations between these variables, and changes across five timepoints were examined.

RESULTS

Senior-year residents reported better perception of learning environment over time, together with increased use of problem-focused coping and lowered perceived stress levels. Junior-year residents reported no changes in learning environment perception and coping strategies, despite rating greater perceived stress levels over time. Perception of learning environment negatively correlated with perceived stress levels and specific coping strategies.

DISCUSSION

Based on these findings, we suggest specific strategies with the emphasis on context, participation, and social interaction within a community of practice to better support residents in training, which are applicable to other similar training programs.

Family medicine residents' educational environment and satisfaction of training program in Riyadh

Background

Improving health outcome indicators worldwide needs well-trained family physicians, and the Kingdom of Saudi Arabia is of no exception from that need.

Objectives

To address the level of satisfaction and assess the educational environment among residents of family medicine (FM) in Riyadh city.

Methodology

A cross-sectional study; the Postgraduate Hospital Educational Environment Measure (PHEEM) was used to assess the educational environment for all FM residents in fully structured training centers that include all levels of residents in Riyadh during 2016.

Results

About 187 surveys were distributed and 140 were collected, with a response rate of 74.87%. Cronbach's alpha scored at 0.917 for overall items. Out of 160 maximum score, the overall score of the PHEEM was 86.73 (standard deviation [SD]: 19.46). The perception of teaching score was 33.11 (SD: 8.80) out of 60, the perception of role autonomy score was 28.60 (SD: 7.35) out of 56, and the perception of social support was 25.02 (SD: 5.43) out of 44.

Conclusion

The educational environment is an important determinant of medical trainees' achievements and success. The results are better than what had been found in the previous studies, but more attention and effort should be done, especially for the poorly rated points in this study. We recommend a continuous evaluation and reconstruction of the Saudi Board of FM program, and such results could be a tool that might help in fostering better and stronger educational program.

Perceptions of emergency medicine residents on the quality of residency training in the United States and Saudi Arabia

BACKGROUND

We compare educational environments (i.e. physical, emotional and intellectual experiences) of emergency medicine (EM) residents training in the United States of America (USA) and Saudi Arabia (SA).

METHODS

A cross-sectional survey study was conducted using an adapted version of the validated Postgraduate Hospital Educational Environment Measure (PHEEM) survey instrument from April 2015 through June 2016 to compare educational environments in all emergency medicine residency programs in SA and three selected programs in the USA with a history of training Saudi physicians. Overall scores were compared across programs, and for subscales (autonomy, teaching, and social Support), using chi-squared, t-tests, and analysis of variance.

RESULTS

A total of 219 surveys were returned for 260 residents across six programs (3 SA, 3 USA), with a response rate of 84%. Program-specific response rates varied from 79%-100%. All six residencies were qualitatively rated as "more positive than negative but room for improvement". Quantitative PHEEM scores for the USA programs were significantly higher: 118.7 compared to 109.9 for SA, P=0.001. In subscales, perceptions of social support were not different between the two countries (P=0.243); however, role autonomy (P<0.001) and teaching (P=0.005) were better in USA programs. There were no significant differences by post-graduate training year.

CONCLUSION

EM residents in all three emergency medicine residency programs in SA and the three USA programs studied perceive their training as high quality in general, but with room for improvements. USA residency programs scored higher in overall quality. This was driven by more favorable perceptions of role autonomy and teaching. Understanding how residents perceive their programs may help drive targeted quality improvement efforts.

Adoption and correlates of Postgraduate Hospital Educational Environment Measure (PHEEM) in the evaluation of learning environments - A systematic review. MEDICAL TEACHER 2016;38:1248-1255. [PMID: 27564848 DOI: 10.1080/0142159x.2016.1210108]

BACKGROUND

The Postgraduate Hospital Educational Environment Measure (PHEEM) is a highly reliable and valid instrument to measure the educational environment during post graduate medical training. This review extends earlier reports by evaluating the extant adoption of PHEEM in various international clinical training sites, and its significant correlations in order to expand our understanding on the use of PHEEM and facilitate future applications and research.

METHOD

A systematic literature review was conducted on all articles between 2005 and October 2015 that adopted and reported data using the PHEEM.

RESULTS

Overall 30 studies were included, encompassing data from 14 countries internationally. Notable differences in the PHEEM scores were found between different levels of training, disciplines, and clinical training sites. Common strengths and weaknesses in learning environments were observed and there were significant correlations between PHEEM scores and In-Training Exam (ITE) performance (positive correlation) and level of burnout (negative correlation), respectively.

CONCLUSIONS

PHEEM is widely adopted in different learning settings, and is a useful tool to identify the strengths and weaknesses of an educational environment. Future research can examine other correlates of PHEEM and longitudinal changes in interventional studies.

New family medicine residency training programme: Residents' perspectives from the University of Botswana

Background

Family Medicine (FM) training is new in Botswana. No previous evaluation of the experiences and opinions of residents of the University of Botswana (UB) Family Medicine training programme has been reported.

Aims

This study explored and assessed residents’ experiences and satisfaction with the FM training programme at the UB and solicited potential strategies for improvement from the residents.

Methods

A descriptive survey using a self-administered questionnaire based on a Likert-type scale and open-ended questions was used to collect data from FM residents at the UB.

Results

Eight out the 14 eligible residents participated to this study. Generally, residents were not satisfied with the FM training programme. Staff shortage, inadequate supervision and poor programme organisation by the faculty were the main reasons for this. However, the residents were satisfied with weekly training schedules and the diversity of patients in the current training sites. Residents’ potential solutions included an increase in staff, the acquisition of equipment at teaching sites and emphasis on FM core topics teachings. They had different views regarding how certain future career paths will be.

Conclusions

Despite the general dissatisfaction among residents because of challenges faced by the training programme, we have learnt that residents are capable of valuable inputs for improvement of their programme when engaged. There is need for the Department of Family Medicine to work with the Ministry of Health to set a clear career pathway for future graduates and to reflect on residents’ input for possible implementation.

Evaluation of the learning environment of urology residency training using the postgraduate hospital educational environment measure inventory

OBJECTIVES

The educational environment plays a crucial role in the learning process. We aimed to evaluate the educational-environment perceptions of Saudi urology residents using the postgraduate hospital educational environment measure (PHEEM) inventory, and to investigate associations of their perception with stages of residency program, regions of Saudi Arabia, and main sectors of the health care system.

METHODS

We used PHEEM to measure the educational environment of Saudi urology residents. Respondents' perception was compared regarding different levels of residency training, regions of Saudi Arabia, and sectors of the health care system. Internal reliability of the inventory was assessed using Cronbach's alpha coefficient.

RESULTS

Out of 72 registered residents, 38 (53%) completed the questionnaire. The residents did not perceive their environment positively (77.7±16.5). No significant differences in perception were found among residents of different program stages or Saudi regions. Residents from different health care sectors differed significantly regarding the total PHEEM score (P=0.024) and the teaching subscale (P=0.017). The inventory showed a high internal consistency with Cronbach's alpha of 0.892.

CONCLUSION

Saudi urology residents perceived the educational environment as less than satisfactory. Perception of the educational environment did not change significantly among different stages of the program or different regions of Saudi Arabia. However, some sectors of the health care system are doing better than others.