Intern doctors' perceptions of their hospital learning environment in Uganda: a multi center study

Abstract

BACKGROUND: Globally, internship training occurs in a learning/working environment in which there is a rift with regards to setting an equilibrium between the education and clinical services arm and hence the need for regular monitoring of this environment. In Uganda internship training has been faced with a rampant strikes amidst reports of declining quality of doctors. In this same regard, the internship training in Uganda‘s context, doesn‘t have a documented learning environment monitoring and evaluation initiative and hence the need to evaluate the perceptions intern doctors about their learning environment.

Objectives: To assess the perceptions of intern doctors about their hospital learning environment at three National Referral Hospitals using the Postgraduate Hospital Education Environment Measure (PHEEM). To compare the perceptions of the learning environment between different departments at the three National Referral Hospitals using the PHEEM

Methods: This was a cross-sectional study done at three national referral hospitals of Mulago, Kawempe and Kiruddu among medical intern doctors. 200medical intern doctors were consecutively enrolled into the study and their perceptions of the hospital learning environment assessed using the PHEEM questionnaire. Institutional Review Board clearance was granted from the school of medicine and all participants provided informed consent.

Results: The overall perception of the learning environment was scored at 93.27(maximum score 160) and with subscale sores of 31.35(maximum 56), 37.37(maximum 60) and 23.65(maximum 44) for perception of autonomy, perception of teaching and social support respectively. In comparison using analysis of variance, there were significant differences in perception according to the clinical rotation: pediatrics and internal medicine Obs and Gyn and Surgery (p-0.015 and 0.05 respectively) there was no statistically significant difference in perception between internal medicine and pediatrics and between surgery and Obs and Gyn. The tool had an overall Cronbach‘s alpha reliability of 0.913 after exploratory factor analysis.

Conclusion: The hospital learning environment among the three hospitals is in the more positive than negative classification although weaknesses exist especially with regards to social support and role autonomy. There were significant departmental differences in perception