# Evaluating the Clinical Learning Environment for Competency-based Postgraduate Education in a Low-Middle income Country: Trainee Perceptions using PHEEM Inventory

## TL;DR

This study evaluates trainees' perceptions of their clinical learning environment in a low-middle income country to support competency-based postgraduate medical education.

## Contribution

The study provides insights into the strengths and weaknesses of the clinical learning environment for competency-based education in a specific regional context.

## Key findings

- Trainees generally perceive the clinical learning environment favorably, with room for improvement.
- Residency programs and years show significant variation in perceived quality of the clinical learning environment.
- The PHEEM inventory effectively identifies areas needing enhancement for competency-based education.

## Abstract

The clinical learning environment (CLE) is an important element of competency-based postgraduate medical education (CBME). Trainee perceptions of their CLE serve as a quality indicator of the teaching and learning taking place at the workplace. This study aimed to investigate the trainees’ perceptions regarding their CLE and identify strengths and weaknesses to support CBME.

A universal sampling was employed for this cross-sectional survey. The electronic version of the Postgraduate Hospital Educational Environment Measure (PHEEM) inventory was sent via email to all the trainees who were enrolled in all 35 residency programs at our university and consented to participate in the study.

A total of 347 (69.4%) residents responded; of them, 65.7% were females. The overall mean score was 107 (66.8%), suggesting a generally favorable opinion of the workplace, with room for improvement. Mean scores for the subscales of Autonomy, Teaching, and Social Support were 33.42±7.24 (more positive), 42±8.9 (moving in the right direction), and 27.9±6.2 (more pros than cons), respectively. There was no difference in the CLE perceptions based on gender. Overall and subscale scores differed significantly across residency programs, with the highest in Radiology (122.3±13.5) and the lowest in Surgical disciplines (95.47±19.0); and year of residency, with the highest in the first year (111.3±17.8) and the lowest in the final year (81.5±34.3).

Evaluating the EE offers valuable insights into enhancing training quality by identifying both strengths and weaknesses, and prioritizing areas in any planned enhancements. The EE for the postgraduate training appears to be prepared for implementing CBME, with certain areas warranting improvement.