# Evaluating the Hospital Learning Environment for Medical Interns in Uganda: a Crossectional Study at Three National Referral Hospitals

## TL;DR

This study evaluates the hospital learning environment for medical interns in three Ugandan hospitals, finding that perceptions vary by clinical department.

## Contribution

The study provides the first formal evaluation of intern doctors' perceptions of their clinical learning environments in Ugandan hospitals.

## Key findings

- The overall learning environment score was 93.27 out of 160, indicating a generally positive but suboptimal environment.
- Medical disciplines like Pediatrics and Internal Medicine scored higher than surgical disciplines like Surgery and Obstetrics/Gynecology.
- Deficiencies were noted in social support and role autonomy across all departments.

## Abstract

Background
Medical internship is a crucial phase where theoretical knowledge is translated into practical skills through supervised patient care. Globally, this training is grounded in work-based learning, but balancing educational objectives with service delivery often creates challenges. In developed settings, learning environments are integral to accreditation standards, while in Uganda, issues such as poor supervision, inadequate resources, and dissatisfaction among interns remain prevalent. Structural changes to internship rotations and frequent strikes further highlight the need for systematic evaluation. Despite these challenges, no formal feedback mechanisms exist to capture intern doctors' perspectives on their clinical learning environments. We sought to evaluate intern doctors' perceptions of their hospital learning environment and compare these perceptions across clinical departments in three National Referral Hospitals.
Methods
We conducted a cross-sectional study at Mulago, Kawempe, and Kiruddu National Referral Hospitals, enrolling 200 medical interns. Interns' perceptions were assessed using the Postgraduate Hospital Education Environment Measure (PHEEM) questionnaire. Institutional Review Board approval was obtained, and all participants provided informed consent.
Results
The meanlearning environment score for the three hospitals was 93.27 (maximum 160), with subscale scores of 31.35 (maximum 56) for autonomy, 37.37 (maximum 60) for teaching, and 23.65 (maximum 44) for social support. Analysis of variance of the mean scores revealed significant differences in perception of the learning environment regarding clinical rotation with the medical disciplines scoring higher than the surgical disciplines: Pediatrics ( p = 0.015) Internal medicine (p=0.05) compared to Obstetrics/Gynecology and Surgery. However, there were no significant differences between internal medicine and pediatrics or between surgery and obstetrics/gynecology.
Conclusion
The hospital learning environment across the three hospitals was rated as more positive than negative, though deficiencies were noted, particularly in social support and role autonomy. Medical disciplines of: Internal medicine and Pediatrics had better-rated learning environments than the surgical disciplines of: Surgery and Obstetrics and Gynecology.
Clinical trial number: Not applicable.