Relation between perceptions of residents about educational environment and years of residency education

Date of Award


Document Type


Degree Name

Master of Health Professions Education (MPHE)


Educational Development


To assess residents' perception of educational environment in obstetrics and gynaecology (OBGYN) programme at Services Hospital Lahore (SHL) and to study the variation in perception of residents in different years of OBGYN training in SHL. Further, to identify the areas of strength and possible improvements in the learning environment. Subjects and Methods The study is conducted by using a mixed-method, explanatory sequential study design. The quantitative, phase I, employs the cross-sectional design as it involves a survey using the Postgraduate Hospital Educational Environment Measure (PHEEM) instrument. A total of sixty-six residents participated in the study. Five forms which were filled incompletely were removed so the final sample size was sixty-one. Scores equal to or below 70 and above or equal to 130 were considered as extreme scores. Extreme scores were analyzed with respect to the year of residency education. One-Way Analysis of Variance (ANOVA) was used to measure the statistical significance between the different years of residency programmes. R1 (first year in residency training) through R4 (fourth year in residency training). Statistical significance was tested at the level of p<0.05. Initially, the plan was to take in-depth interviews from those residents who scored highest and lowest scores on results of phase I however, it was realised that extreme scores were coming from similar units, so in order to avoid selection bias, interviewees (residents) in different residency years, and those from different units with extreme scores were selected. Thematic analysis was done which was triangulated with frequencies of responses using quasi-statistical approach. Result The mean overall scores of postgraduate educational environments as reported by OBGYN residents at SHL was 109.78, indicating a 60.98% satisfaction level with more positive than negative, but there is still a room for improvement in educational environment. Mean cumulative scores in each domain of PHEEM reported were 30.5(61.18%), 45.71(60.94%) and 33.48(60.87%) for autonomy, social support and teaching respectively. After analyzing in-depth interviews, strenuous working hours and a strained relationship with the seniors was observed as a major negative perception. Insufficient remuneration, lack of a structured training programme, unsupportive hospital administration, inappropriate task delegation, poor logistics, inadequate research support, insufficient security measures and favoritism were other factors reported as the root causes of low morale and decreased productivity. Conclusion: No significant correlation was observed between the PHEEM scores and years of residency. However, in-depth interviews revealed that the first and fourth year residents were more vocal and were significantly dissatisfied with their educational environment. The areas of improvement identified by residents included the need to enhance hospital's role in clinical learning, curriculum improvement, better remuneration, better logistics, equitable training environment and reduction in workload.

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