Research Article
BibTex RIS Cite

Assessment of hospital educational environment perceptions of obstetrics and gynecology residents in specialty and subspecialty training

Year 2020, Volume: 19 Issue: 57, 64 - 75, 30.04.2020
https://doi.org/10.25282/ted.593420

Abstract

Background: Data on educational hospital environment perceptions of obstetrics and gynecology residents in Turkey are limited. The present study aims to evaluate the educational environment perceptions of residents in (sub)specialty training in an obstetrics and gynecology department

Methods: Postgraduate Hospital Educational Environment Measure (PHEEM) was administered to all residents (n=19) in specialty and subspecialty training at an obstetrics and gynecology department of a single university hospital. Item and subscale scores of gender and postgraduate experience groups were compared using student’s t-test. The participants were classified into two groups regarding postgraduate experience as “novice” (postgraduate year 1 and 2) and “experienced” (postgraduate year 3 and above). Cronbach’s alpha coefficient was calculated to estimate score reliability.

Results: The overall Cronbach’s alpha coefficient and mean cumulative score was 0.938 and 85.8 ± 24.8 (more positive than negative, but room for improvement), respectively. Mean subscale scores were 28.3 ± 8.2 for role of autonomy (negative view), 33.4 ± 11.0 for teaching (moving in the right direction), and 24.1 ± 6.8 for social support (more pros than cons). Cumulative and category scores did not differ regarding gender (p > 0.05 for all). Experienced group had similar mean cumulative (p=0.06), but increased social perception scores (p=0.03) compared to novice group. Mean scores of three items were extremely low (<1): (i) an informative junior doctor’s handbook is available, (ii) this hospital has good accommodation facilities for junior doctors, especially when on call, and (iii) my working hours comply with legal requirements.     

Conclusions: Hospital educational environment perceptions of physicians in (sub)specialty training are generally positive independent of gender in the reviewed department, while there is room for improvement of various role autonomy and social support components such as doctor’s handbook, on call accommodation, and working hours. PHEEM seems to be a relatively practical, convenient, and reliable tool to evaluate and improve postgraduate medical training.  

References

  • 1. Al-Ayed IH, Sheik SA. Assessment of the educational environment at the College of Medicine of King Saud University, Riyadh. East Mediterr Heal J. 2008;14(4):953–9.
  • 2. Roff S, McAleer S. What is educational climate? Med Teach. 2001;23(4):333–4.
  • 3. Farnan JM, Petty LA, Georgitis E, Martin S, Chiu E, Prochaska M, ve ark. A systematic review: The effect of clinical supervision on patient and residency education outcomes. Acad Med. 2012;87(4):428–42.
  • 4. Smirnova A, Arah OA, Stalmeijer RE, Lombarts KMJMH, Van Der Vleuten CPM. The association between residency learning climate and inpatient care experience in clinical teaching departments in the netherlands. Acad Med. 2019;94(3):419–26.
  • 5. Yılmaz D. Mezuniyet Sonrası Tıp eğitiminde öğrenme ortamı ve öğrenme iklimi. Türkiye Klin Med Educ Spec Top. 2016;1(2):1–7.
  • 6. Roff S, McAleer S, Skinner A. Development and validation of an instrument to measure the postgraduate clinical learning and teaching educational environment for hospital-based junior doctors in the UK. Med Teach. 2005;27(4):326–31.
  • 7. Wall D, Clapham M, Riquelme A, Vieira J, Cartmill R, Aspegren K, ve ark. Is PHEEM a multi-dimensional instrument An international perspective. Med Teach. 2009;31(11): e521-7.
  • 8. Balcıoğlu H. Tıpta Uzmanlık Öğrencilerinin Eğitim Ortamı Algılamaları ve Buna Etkili Faktörlerin Değerlendirilmesi [Doktota Tezi]. Ankara Üniversitesi; 2008.
  • 9. Piek J, Bossart M, Boor K, Halaska M, Haidopoulos D, Zapardiel I, ve ark. The work place educational climate in gynecological oncology fellowships across Europe: the impact of accreditation. Int J Gynecol Cancer. 2015;25(1):180–90.
  • 10. Blazek BA, Zollinger TW, Look KY. Obstetrics-gynecology resident satisfaction. Am J Obstet Gynecol. 2005;193(5):1798–803.
  • 11. Smirnova A, Ravelli ACJ, Stalmeijer RE, Arah OA, Heineman MJ, Van Der Vleuten CPM, ve ark. The association between learning climate and adverse obstetrical outcomes in 16 nontertiary obstetrics-gynecology departments in the Netherlands. Acad Med. 2017;92(12):1740–8.
  • 12. Rahimi M, Haghani F, Kohan S, Shirani M. The clinical learning environment of a maternity ward: A qualitative study. Women and Birth. 2019 [Baskıda].
  • 13. Atılgan S, Teker G, Sezer B, Yeşiltepe M, Odabaşı O. Tıpta Uzmanlık Öğrencilerinin Klinik Eğitim Ortamlarına İlişkin Algılarının Değerlendirilmesi. Ulusal Tıp Eğitmim Sempozyumu; 10-12 Nisan 2019; Eskişehir Türkiye [Özet bildiri].
  • 14. Boor K, Scheele F, Van Der Vleuten CPM, Teunissen PW, Den Breejen EME, Scherpbier AJJA. How undergraduate clinical learning climates differ: A multi-method case study. Med Educ. 2008;42(10):1029–36.
  • 15. Cate OT. Medical education in the Netherlands. Med Teach. 2007;29(8):752–7.
  • 16. Byrne JM, Loo LK, Giang D. Monitoring and improving resident work environment across affiliated hospitals: A call for a national resident survey. Acad Med. 2009;84(2):199–205.
  • 17. Bourgain A, Ivorra-Deleuze D. Using the resident’s log-book. Gynecol Obs Fertil. 2009;37(9):764.
  • 18. Huri G, Cabuk YS, Gursoy S, Akkaya M, Ozkan S, Oztuna V, ve ark. Evaluation of the orthopaedics and traumatology resident education in Turkey: A descriptive study. Acta Orthop Traumatol Turc.2016;50(5):567–71.
  • 19. Mateo-Sierra O, Delgado P, Cancela P, Fernández-Carballal C. Surgical activity by Spanish Residents in Neurosurgery under the Training Programme in place since 1984 and changes to be implemented under the New Training Programme. Acta Neurochir. 2005;147(4):449–56.
  • 20. Aksay E, Sahin H, Kiyan S, Ersel M. Current status of emergency residency training programs in Turkey: After 14 years of experience. Eur J Emerg Med. 2009;16(1):4–10.
  • 21. Dokuzlar U, Miman MC, Ilter Denizoglu I, Egrilmez M. Opinions of otorhinolaryngology residents about their education process. Turkish Arch Otolaryngol. 2015;53(3):100–7.
  • 22. Morton JM, Baker CC, Farrell TM, Yohe ME, Kimple RJ, Herman DC, ve ark. What do surgery residents do on their call nights? Am J Surg. 2004;188(3):225–9.
  • 23. Vieira JE. The postgraduate hospital educational environment measure (PHEEM) questionnaire identifies quality of instruction as a key factor predicting academic achievement. Clinics. 2008;63(6):741–6.
  • 24. Goldin SB, Wahi MM, Farooq OS, Borgman HA, Carpenter HL, Wiegand LR, ve ark. Student Quality-of-Life Declines During Third Year Surgical Clerkship. J Surg Res. 2007;143(1):151–7.
  • 25. Türk Tabipler Birliği 20. Tıpta Uzmanlık Eğitimi Kurultayı Uzmanlık Öğrencisi ve Genç Uzman Toplantısı Sonuç Bildirgesi; 13 Aralık 2014; Ankara. [https://www.toraks.org.tr/userfiles/file/TTBTUEK2014.pdf].
  • 26. Avan BI, Syed AR, Khokhar S, Awan F, Sohail N, Rashid S, Hamza H. Residents’ perceptions of work environment during their postgraduate medical training in Pakistan. J Postgr Med. 20066;52(1):11–6.
  • 27. Holt KD, Miller RS, Philibert I, Heard JK, Nasca TJ. Residents’ perspectives on the learning environment: Data from the accreditation council for graduate medical education resident survey. Acad Med. 2010;85(3):512–8.
  • 28. Immerman I, Kubiak E, Zuckerman J. Resident work-hour rules: a survey of residents’ and program directors’ opinions and attitudes. Am J Orthop. 2007;36(12):E172-9.
  • 29. Swide CE, Kirsch JR. Duty hours restriction and their effect on resident education and academic departments: The American perspective. Curr Opin Anaesthesiol. 2007;20(6):580–4.
  • 30. Philibert I. What Is Known: Examining the Empirical Literature in Resident Work Hours Using 30 Influential Articles. J Grad Med Educ. 2016;8(5):795–805.
  • 31. Weiss P, Kryger M, Knauert M. Impact of extended duty hours on medical trainees. Sleep Heal. 2016;2(4):309–15.
  • 32. Sandefur BJ, Shewmaker DM, Lohse CM, Rose SH, Colletti JE. Perceptions of the 2011 ACGME duty hour requirements among residents in all core programs at a large academic medical center. BMC Med Educ. 2017;17(1):1–9.
  • 33. Camargo A, Liu L, Yousem DM. Sexual Harassment in Radiology. J Am Coll Radiol. 2017;14(8):1094–9.
  • 34. Chrysafi P, Simou E, Makris M, Malietzis G, Makris GC. Bullying and sexual discrimination in the Greek health care system. J Surg Educ. 2017;74(4):690–7.
  • 35. Kerr H, Armstrong L, Cade J. Barriers to becoming a female surgeon and the influence of female surgical role models. Postgr Med J. 2016;92(1092):576–80.
  • 36. Young-Shumate L, Kramer T, Beresin E. Pregnancy during graduate medical training. Acad Med. 1993;68(10):792–9.
  • 37. Garrison CB. The Lonely Only: Physician Reflections on Race, Bias, and Residency Program Leadership. Fam Med. 2019;51(1):59–60.

Kadın Hastalıkları ve Doğum Uzmanlık ve Yan Dal Uzmanlık Öğrencilerinin Hastane Eğitim Ortamı Algılarının Değerlendirilmesi

Year 2020, Volume: 19 Issue: 57, 64 - 75, 30.04.2020
https://doi.org/10.25282/ted.593420

Abstract

Giriş: Türkiye’de kadın hastalıkları ve doğum uzmanlık öğrencilerinin hastane içi eğitim ortamı algılarına dair kısıtlı veri mevcuttur. Mevcut araştırmada, Mezuniyet Sonrası Hastane Eğitim Ortamı Ölçeğinin (MESHEÖ), bir kadın hastalıkları ve doğum kliniğindeki asistan hekimlere uygulanarak eğitim ortamı algılarının saptanması amaçlanmıştır.

Gereç ve Yöntem: Tek bir kadın hastalıkları ve doğum anabilim dalındaki uzmanlık ve yan dal uzmanlık öğrencilerinin tümüne (n=19) MESHEÖ uygulandı. Maddeler ve alt başlıklar için dağılım ve skorlar hesaplandı. Cinsiyet ve kıdem (ilk 2 yıl kıdemsiz, 2 yıldan sonra kıdemli) açısından student’s t-test kullanılarak skorlar karşılaştırıldı. Ölçüm güvenirliği kestirimi için Cronbach’ın alfa katsayısı hesaplandı.

Bulgular: Cronbach’ın alfa katsayısı 0.938 ve ortalama toplam skor 85.8 ± 24.8 (olumlu ancak geliştirilmesi gereken eğitim ortamı) olarak hesaplandı. Mesleki özerklik, eğitim niteliği ve sosyal destek algılarına dair alt grup ortalama skorları ise sırasıyla 28.3 ± 8.2 (yetersiz), 33.4 ± 11.0 (nitelikli) ve 24.1 ± 6.8 (olumlu özellikleri daha baskın) idi. Kadın ve erkeklerin toplam ve alt grup ortalama skorları benzerdi (tüm karşılaştırmalar için p > 0.05). Kıdemli olanlarda, ilk 2 yılın içindekilere göre ortalama skor benzerken (p = 0.06), sosyal destek ortalama skoru daha yüksekti (p = 0.03). Üç adet maddenin ortalama skoru 1 ve altındaydı: (i) Bilgilendirici bir asistan el kitabı vardır, (ii) Bu hastanede asistanlar için yeterli ve uygun asistan odası (özellikle de nöbet odası) vardır, (iii) Çalışma saatlerim haftalık yasal çalışma süresi ile uyumludur.

Sonuç: Ölçeğin uygulandığı klinikte uzmanlık eğitimi alan hekimlerin hastane içi eğitime dair algıları cinsiyetten bağımsız olarak genelde olumlu gözükmekle birlikte asistan el kitabı, nöbet odası, çalışma saatleri başta gelmek üzere birçok mesleki özerklik ve sosyal destek unsurunda iyileştirmelere ihtiyaç duyulmaktadır. MESHEÖ nispeten kolay uygulanabilir, kullanışlı ve güvenilir bir araç olarak mezuniyet sonrası eğitim programlarını değerlendirme ve iyileştirme amaçlı kullanılabilir.

References

  • 1. Al-Ayed IH, Sheik SA. Assessment of the educational environment at the College of Medicine of King Saud University, Riyadh. East Mediterr Heal J. 2008;14(4):953–9.
  • 2. Roff S, McAleer S. What is educational climate? Med Teach. 2001;23(4):333–4.
  • 3. Farnan JM, Petty LA, Georgitis E, Martin S, Chiu E, Prochaska M, ve ark. A systematic review: The effect of clinical supervision on patient and residency education outcomes. Acad Med. 2012;87(4):428–42.
  • 4. Smirnova A, Arah OA, Stalmeijer RE, Lombarts KMJMH, Van Der Vleuten CPM. The association between residency learning climate and inpatient care experience in clinical teaching departments in the netherlands. Acad Med. 2019;94(3):419–26.
  • 5. Yılmaz D. Mezuniyet Sonrası Tıp eğitiminde öğrenme ortamı ve öğrenme iklimi. Türkiye Klin Med Educ Spec Top. 2016;1(2):1–7.
  • 6. Roff S, McAleer S, Skinner A. Development and validation of an instrument to measure the postgraduate clinical learning and teaching educational environment for hospital-based junior doctors in the UK. Med Teach. 2005;27(4):326–31.
  • 7. Wall D, Clapham M, Riquelme A, Vieira J, Cartmill R, Aspegren K, ve ark. Is PHEEM a multi-dimensional instrument An international perspective. Med Teach. 2009;31(11): e521-7.
  • 8. Balcıoğlu H. Tıpta Uzmanlık Öğrencilerinin Eğitim Ortamı Algılamaları ve Buna Etkili Faktörlerin Değerlendirilmesi [Doktota Tezi]. Ankara Üniversitesi; 2008.
  • 9. Piek J, Bossart M, Boor K, Halaska M, Haidopoulos D, Zapardiel I, ve ark. The work place educational climate in gynecological oncology fellowships across Europe: the impact of accreditation. Int J Gynecol Cancer. 2015;25(1):180–90.
  • 10. Blazek BA, Zollinger TW, Look KY. Obstetrics-gynecology resident satisfaction. Am J Obstet Gynecol. 2005;193(5):1798–803.
  • 11. Smirnova A, Ravelli ACJ, Stalmeijer RE, Arah OA, Heineman MJ, Van Der Vleuten CPM, ve ark. The association between learning climate and adverse obstetrical outcomes in 16 nontertiary obstetrics-gynecology departments in the Netherlands. Acad Med. 2017;92(12):1740–8.
  • 12. Rahimi M, Haghani F, Kohan S, Shirani M. The clinical learning environment of a maternity ward: A qualitative study. Women and Birth. 2019 [Baskıda].
  • 13. Atılgan S, Teker G, Sezer B, Yeşiltepe M, Odabaşı O. Tıpta Uzmanlık Öğrencilerinin Klinik Eğitim Ortamlarına İlişkin Algılarının Değerlendirilmesi. Ulusal Tıp Eğitmim Sempozyumu; 10-12 Nisan 2019; Eskişehir Türkiye [Özet bildiri].
  • 14. Boor K, Scheele F, Van Der Vleuten CPM, Teunissen PW, Den Breejen EME, Scherpbier AJJA. How undergraduate clinical learning climates differ: A multi-method case study. Med Educ. 2008;42(10):1029–36.
  • 15. Cate OT. Medical education in the Netherlands. Med Teach. 2007;29(8):752–7.
  • 16. Byrne JM, Loo LK, Giang D. Monitoring and improving resident work environment across affiliated hospitals: A call for a national resident survey. Acad Med. 2009;84(2):199–205.
  • 17. Bourgain A, Ivorra-Deleuze D. Using the resident’s log-book. Gynecol Obs Fertil. 2009;37(9):764.
  • 18. Huri G, Cabuk YS, Gursoy S, Akkaya M, Ozkan S, Oztuna V, ve ark. Evaluation of the orthopaedics and traumatology resident education in Turkey: A descriptive study. Acta Orthop Traumatol Turc.2016;50(5):567–71.
  • 19. Mateo-Sierra O, Delgado P, Cancela P, Fernández-Carballal C. Surgical activity by Spanish Residents in Neurosurgery under the Training Programme in place since 1984 and changes to be implemented under the New Training Programme. Acta Neurochir. 2005;147(4):449–56.
  • 20. Aksay E, Sahin H, Kiyan S, Ersel M. Current status of emergency residency training programs in Turkey: After 14 years of experience. Eur J Emerg Med. 2009;16(1):4–10.
  • 21. Dokuzlar U, Miman MC, Ilter Denizoglu I, Egrilmez M. Opinions of otorhinolaryngology residents about their education process. Turkish Arch Otolaryngol. 2015;53(3):100–7.
  • 22. Morton JM, Baker CC, Farrell TM, Yohe ME, Kimple RJ, Herman DC, ve ark. What do surgery residents do on their call nights? Am J Surg. 2004;188(3):225–9.
  • 23. Vieira JE. The postgraduate hospital educational environment measure (PHEEM) questionnaire identifies quality of instruction as a key factor predicting academic achievement. Clinics. 2008;63(6):741–6.
  • 24. Goldin SB, Wahi MM, Farooq OS, Borgman HA, Carpenter HL, Wiegand LR, ve ark. Student Quality-of-Life Declines During Third Year Surgical Clerkship. J Surg Res. 2007;143(1):151–7.
  • 25. Türk Tabipler Birliği 20. Tıpta Uzmanlık Eğitimi Kurultayı Uzmanlık Öğrencisi ve Genç Uzman Toplantısı Sonuç Bildirgesi; 13 Aralık 2014; Ankara. [https://www.toraks.org.tr/userfiles/file/TTBTUEK2014.pdf].
  • 26. Avan BI, Syed AR, Khokhar S, Awan F, Sohail N, Rashid S, Hamza H. Residents’ perceptions of work environment during their postgraduate medical training in Pakistan. J Postgr Med. 20066;52(1):11–6.
  • 27. Holt KD, Miller RS, Philibert I, Heard JK, Nasca TJ. Residents’ perspectives on the learning environment: Data from the accreditation council for graduate medical education resident survey. Acad Med. 2010;85(3):512–8.
  • 28. Immerman I, Kubiak E, Zuckerman J. Resident work-hour rules: a survey of residents’ and program directors’ opinions and attitudes. Am J Orthop. 2007;36(12):E172-9.
  • 29. Swide CE, Kirsch JR. Duty hours restriction and their effect on resident education and academic departments: The American perspective. Curr Opin Anaesthesiol. 2007;20(6):580–4.
  • 30. Philibert I. What Is Known: Examining the Empirical Literature in Resident Work Hours Using 30 Influential Articles. J Grad Med Educ. 2016;8(5):795–805.
  • 31. Weiss P, Kryger M, Knauert M. Impact of extended duty hours on medical trainees. Sleep Heal. 2016;2(4):309–15.
  • 32. Sandefur BJ, Shewmaker DM, Lohse CM, Rose SH, Colletti JE. Perceptions of the 2011 ACGME duty hour requirements among residents in all core programs at a large academic medical center. BMC Med Educ. 2017;17(1):1–9.
  • 33. Camargo A, Liu L, Yousem DM. Sexual Harassment in Radiology. J Am Coll Radiol. 2017;14(8):1094–9.
  • 34. Chrysafi P, Simou E, Makris M, Malietzis G, Makris GC. Bullying and sexual discrimination in the Greek health care system. J Surg Educ. 2017;74(4):690–7.
  • 35. Kerr H, Armstrong L, Cade J. Barriers to becoming a female surgeon and the influence of female surgical role models. Postgr Med J. 2016;92(1092):576–80.
  • 36. Young-Shumate L, Kramer T, Beresin E. Pregnancy during graduate medical training. Acad Med. 1993;68(10):792–9.
  • 37. Garrison CB. The Lonely Only: Physician Reflections on Race, Bias, and Residency Program Leadership. Fam Med. 2019;51(1):59–60.
There are 37 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Mekin Sezik 0000-0002-6989-081X

Mehtap Savran 0000-0002-7933-0453

Cüneyt Orhan Kara 0000-0003-2219-4283

Mustafa Kemal Alimoğlu 0000-0002-0587-1177

Publication Date April 30, 2020
Submission Date July 17, 2019
Published in Issue Year 2020 Volume: 19 Issue: 57

Cite

Vancouver Sezik M, Savran M, Kara CO, Alimoğlu MK. Assessment of hospital educational environment perceptions of obstetrics and gynecology residents in specialty and subspecialty training. TED. 2020;19(57):64-75.