{"id":72424,"date":"2024-03-25T11:13:23","date_gmt":"2024-03-25T03:13:23","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=72424"},"modified":"2024-07-02T10:15:00","modified_gmt":"2024-07-02T02:15:00","slug":"perceptions-of-the-learning-environment-in-ophthalmology-residency-training-a-mixed-method-study","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/perceptions-of-the-learning-environment-in-ophthalmology-residency-training-a-mixed-method-study\/","title":{"rendered":"Perceptions of the learning environment in ophthalmology residency training: A mixed method study"},"content":{"rendered":"<p>Submitted: 1 July 2023<br \/>\r\nAccepted: 24 October 2023<br \/>\r\nPublished online: 2 April, TAPS 2024, 9(2), 39-50<br \/>\r\n<a href=\"https:\/\/doi.org\/10.29060\/TAPS.2024-9-2\/OA3074\">https:\/\/doi.org\/10.29060\/TAPS.2024-9-2\/OA3074<\/a><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Muhammad Irfan Kamaruddin<sup>1,2<\/sup>, Andi Alfian Zainuddin<sup>1,3<\/sup>, Berti Nelwan<sup>1,4<\/sup>, Sri Asriyani<sup>1,5<\/sup>, Firdaus Hamid<sup>1,6<\/sup>, Tenri Esa<sup>1,7<\/sup> &amp; Irawan Yusuf<sup>1,8<\/sup><\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><sup><span lang=\"EN-GB\">1<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Department of Medical Education, Faculty of Medicine, Hasanuddin University, Indonesia; <sup>2<\/sup>Department of Ophthalmology, Faculty of Medicine, Hasanuddin University, Indonesia; <sup>3<\/sup>Department of Public Health, Faculty of Medicine, Hasanuddin University, Indonesia; <sup>4<\/sup>Department of Pathology Anatomy, Faculty of Medicine, Hasanuddin University, Indonesia; <sup>5<\/sup>Department of Radiology, Faculty of Medicine, Hasanuddin University, Indonesia; <sup>6<\/sup>Department of Microbiology, Faculty of Medicine, Hasanuddin University, Indonesia; <sup>7<\/sup>Department of Clinical Pathology, Faculty of Medicine, Hasanuddin University, Indonesia; <sup>8<\/sup>Department of Physiology, Faculty of Medicine, Hasanuddin University, Indonesia<\/span><\/i><\/p>\r\n<p style=\"text-align: center;\"><b><span lang=\"EN-GB\">Abstract <\/span><\/b><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Introduction:<\/span><\/b><span lang=\"EN-GB\"> A good learning environment (LE) will affect the quality and standard of the learning process, student performance, and the outcome of the curriculum as well as predictor of the quality of health services. Our study aims to assess residents\u2019 perception of the LE in Ophthalmology training programs for future improvement.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Methods:<\/span><\/b><span lang=\"EN-GB\"> Mixed method with an explanatory sequential design was implemented in this study using the Post-graduate Hospital Educational Environment Measure (PHEEM) as a quantitative approach and open-ended questions collaborated with focus group discussion (FGD) as a qualitative measurement. A comparison of the quantitative data was made using parametric and non-parametric analyses. Thematic analyses were performed for qualitative data. Integration of quantitative and qualitative data was done by connecting both data.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Results:<\/span><\/b><span lang=\"EN-GB\"> Fifty-three residents participated in this survey. The mean age was 30.96\u00b12.18 years old, 64.15% were female and 77.36% are at the internship stage. The mean score of overall PHEEM was 123.40 \u00b112.35, indicated an excellent LE, while the mean score of perceptions of role autonomy, perceptions of teaching, and perceptions of social support were 42.57\u00b14.62, 47.75\u00b14.84 and 33.08\u00b14.15, respectively. There is no significant difference between gender and study period with the perception of LE. Thematic analysis from qualitative data reveals six positive and five negative perception themes. All discovered themes confirmed concordance with the result of LE perception.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Conclusion:<\/span><\/b><span lang=\"EN-GB\"> Learning environment perception in the ophthalmology residency program was excellent and essential for the student&#8217;s skills and performance quality. Some specific areas still need improvement strategies for institutional development.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Keywords<\/span><\/b><b><span lang=\"EN-GB\">:<\/span><\/b><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><i><span lang=\"EN-GB\">Learning Environment, PHEEM, Ophthalmology, Residency, Mixed Method<\/span><\/i><span lang=\"EN-GB\"> <b><\/b><\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Practice Highlights<\/span><\/strong><\/p>\r\n<ul>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Ophthalmology resident has an excellent learning environment. <\/span><span lang=\"EN-GB\"><\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Good teacher, learning system and social life will give positive perception on learning environment. <\/span><span lang=\"EN-GB\"><\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-GB\"> <\/span><span lang=\"EN-GB\">Lack of learning opportunity, less mentoring time, and suboptimum facilities influence students negative perception of learning environment.<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">I. INTRODUCTION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span><span lang=\"EN-US\">A<\/span><\/span><span lang=\"EN-US\"> <span>good<\/span> learning <span>environment<\/span> (LE) <span>will<\/span> <span>affect<\/span> the <span>learning<\/span> <span>process<\/span> and <span>student<\/span> <span>behavior<\/span> <span>and<\/span> <span>determine<\/span> the <span>outcome<\/span> <span>of<\/span> <span>the<\/span> <span>curriculum<\/span> <\/span><span lang=\"EN-US\">(Al-Shiekh et al., 2014; Bari et al., 2018; Binsaleh et al., 2015; Ong et al., 2019; Ong et al., 2020)<\/span><span><span lang=\"EN-US\">.<\/span><\/span><span lang=\"EN-US\"> <span>Learners<\/span> <span>who<\/span> <span>experience a<\/span>n excellent <span>LE<\/span> <span>will<\/span> <span>actively<\/span> <span>participate<\/span> <span>in<\/span> <span>the<\/span> <span>learning<\/span> <span>process <\/span><\/span><span><span lang=\"EN-US\">(Clapham et al., 2007)<\/span><\/span><span><span lang=\"EN-US\">.<\/span><\/span><span lang=\"EN-US\"> <span>With<\/span> <span>an id<\/span>eal LE, learners <span>can<\/span> <span>achieve<\/span> <span>better<\/span> <span>academic<\/span> <span>success<\/span> <span>than<\/span> <span>learners<\/span> <span>who<\/span> <span>perceive<\/span> <span>the<\/span> <span>LE<\/span> <span>negatively <\/span><\/span><span><span lang=\"EN-US\">(<\/span><\/span><span lang=\"EN-US\">Ong et al., 2019; Ong et al., 2020<span>)<\/span><\/span><span><span lang=\"EN-US\">.<\/span><\/span><\/p>\r\n<p style=\"text-align: justify;\"><span><span lang=\"EN-US\">The<\/span><\/span><span lang=\"EN-US\"> <span>clinical<\/span> <span>LE<\/span> <span>is<\/span> <span>an<\/span> essential <span>factor<\/span> <span>influencing<\/span> <span>the<\/span> <span>quality<\/span> <span>of<\/span> <span>medical<\/span> <span>education<\/span> <span>in<\/span> <span>residency<\/span> <span>programs <\/span><\/span><span><span lang=\"EN-US\">(Sandhu et al., 2018)<\/span><\/span><span><span lang=\"EN-US\">.<\/span><\/span><span lang=\"EN-US\"> The <span>resident<\/span> <span>LE<\/span>, which mostly took place at the hospital, <span>differ<\/span>s <span>from<\/span> <span>that<\/span> of <span>medical<\/span> <span>students<\/span>. <span>This<\/span> <span>environment<\/span> <span>has<\/span> <span>many<\/span> destructive <span>factors<\/span> <span>that impact<\/span> <span>resident<\/span>s&#8217; <span>performance and mentality<\/span> <span>and<\/span> <span>can<\/span> <span>result<\/span> <span>in<\/span> <span>residents<\/span> <span>experiencing<\/span> <span>symptoms<\/span> of <span>burnout<\/span> <\/span><span lang=\"EN-US\">(Prins et al., 2010; Ripp et al., 2017)<\/span><span><span lang=\"EN-US\">. Suboptimal<\/span><\/span><span lang=\"EN-US\"> <span>clinical<\/span> LE <span>have<\/span> <span>been<\/span> <span>associated<\/span> <span>with<\/span> <span>poor<\/span> <span>patient<\/span> <span>care<\/span> <span>and<\/span> <span>learning<\/span> <span>outcomes<\/span> (General Medical Council, 2016)<span>.<\/span> <span>Therefore<\/span>, <span>efforts<\/span> <span>to<\/span> <span>improve<\/span> the <span>quality<\/span> of the <span>LE<\/span> <span>not<\/span> <span>only<\/span> <span>positive<\/span>ly <span>impact<\/span> the <span>environment<\/span> <span>in<\/span> <span>which<\/span> <span>learners<\/span> <span>learn<\/span> <span>and<\/span> <span>participate<\/span> in <span>patient<\/span> <span>care<\/span> <span>but<\/span> <span>also<\/span> <span>affect<\/span> the <span>practice<\/span> <span>of<\/span> <span>graduate<\/span> <span>doctors<\/span> <span>in<\/span> <span>the<\/span> <span>future.<\/span><\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">This study aims to determine the residents\u2019 perception of LE in the ophthalmology training program. Based on current data, there is still no study about ophthalmology residents&#8217; perception of LE and its associated factors. This study is a pioneer and pilot study of LE in Ophthalmology training programs, especially in Indonesia.<\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">II. METHODS<\/span><\/strong><\/p>\r\n<p><i><span lang=\"EN-US\">A. Study Design and Subjects<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">This mixed methods study was conducted with explanatory sequential design with both quantitative and qualitative measurements that were performed from January to May 2023 at two main teaching hospitals for the ophthalmology specialist program (OSP) Faculty of Medicine, Hasanuddin University in Makassar, Indonesia.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The study consists of two phases; the first is an offline survey comprising The PHEEM questionnaire and open questions data collection. The second phase of the study was focus group discussion (FGD).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Total sampling was used to determine the sample for the study&#8217;s first phase. Our inclusion criteria for the first phase were ophthalmology residents who have experience training in both main teaching hospitals and have attended a minimum of 6 months of ophthalmology residency training. Sixty residents met the inclusion criterion, and seven were excluded because they could not participate in the offline survey due to personal reasons. Fifty-three residents were included in the first phase of the study.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">On the other hand, purposive sampling was employed to decide on phase two study participants. The PHEEM score, open-ended questions responses, and representation for each year of residency training were used <\/span><span lang=\"EN-US\">to ensure heterogeneity of participants for different perspectives. Residents with high and low PHEEM scores and with exciting and evoking responses to open-ended questions were selected as respondents while considering resident representation for each year of training. Twenty residents were included in phase 2 of the study. The residents were divided into two groups consisting of 10 residents to attend FGD.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">B. Study Instruments and Procedure<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">A cross-sectional survey that included a paper based PHEEM questionnaire, open-ended questions, and sociodemographic data, including age, gender, and year of residency, was distributed to all study subjects. The survey was conducted by single-trained data collector which was not part of the study program. Before administration, the study background, including its purposes and potential impacts, was explained to the residents and the written consent of each resident was obtained. Resident confidentiality and anonymity were also guaranteed.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The PHEEM consists of 40 items regarding LE subdivided into three subscales, each assessing perception of role of autonomy, perceptions of teaching, and perceptions of social support. It is scored on a 5-point Likert scale ranging from &#8220;strongly disagree&#8221; (0) to &#8220;strongly agree&#8221; (4), with a maximum score of 160. The findings were interpreted according to the original study shown in Supplement Table 1 <\/span><span lang=\"EN-US\">(Roff et al., 2005)<\/span><span lang=\"EN-US\">. Four negative questions (questions 7, 8, 11, 13) were scored in reverse. PHEEM has been validated to assess the post-graduate clinical learning environment after the original study, including after translation to different languages, including the Bahasa Indonesia version <\/span><span lang=\"EN-US\">(Raharjanti &amp; Ramadianto, 2016; Roff et al., 2005)<\/span><span lang=\"EN-US\">. Multiple subsequent studies have shown good internal reliability <\/span><span lang=\"EN-US\">(Bari et al., 2018; Clapham et al., 2007; Ong et al., 2019)<\/span><span lang=\"EN-US\">. The Bahasa Indonesia version of the PHEEM questionnaire was used to suit the local context. Bahasa Indonesia version of the PHEEM Questionnaire shows good validity and reliability <\/span><span lang=\"EN-US\">(Raharjanti &amp; Ramadianto, 2016)<\/span><span lang=\"EN-US\">. Eight open questions were added to the questionnaire. The questions were related to 3 subscales on the PHEEM questionnaire. Validation of the open-ended questions was done by expert judgment from two experts. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">A semi-structured focus group session was conducted among the selected group of residents to supplement the PHEEM results. Two FGD session was done with a group size of ten. The FGD questions focused on exploring supporting and barrier factors that influence a good LE. The session lasted 60-90 minutes and was guided by a single-trained facilitator experienced in qualitative research methodology. FGD was conducted until new insights were no longer attained, reaching saturation.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Both quantitative and qualitative demographic data were coded by the trained data collector for maintaining the anonymity of the data. The response from both anonymous data were stored securely by the author for further analyses.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">C. Statistical Analyses<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Quantitative data were analysed using IBM Statistical Package for Social Sciences (SPSS) version 25. Descriptive statistics were presented using percentages, means, and standard deviation (SD). Internal reliability was assessed using Cronbach\u2019s alpha coefficient. Comparison of quantitative data was made using Independent T-Test, Mann\u2013Whitney U-Test, One-way ANOVA, and Kruskal\u2013Wallis H-test. A p-value &lt;0.05 was considered statistically significant.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">For qualitative analyses, transcriptions of the open-ended questions answers and the audio and video recording of FGD were made by an independent data collector, and its accuracy was confirmed by the first author and the FGD facilitator. For open-ended questions, participants were coded with \u201cP(Participant Code)-OEQ\u201d (e.g. participant 1:P1-OEQ) while for FGD participants were coded with \u201cP(Participant Code)-FGD(Group)\u201d (e.g. participant 1 in FGD 2: P1-FGD2). The transcripts were coded into common themes independently by two investigators and discussed using thematic analysis using QDA Miner Version 5.0 for open questions and MAXQDA Analytics Pro 2020 for FGD.<\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">III. RESULTS<\/span><\/strong><\/p>\r\n<p><i><span lang=\"EN-ID\">A. Quantitative Data<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">Fifty-three ophthalmology residents were included in this mixed-method study, with the majority being female (64.15%). The mean age of residents was 30.96<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">2.18 years old. <\/span><span lang=\"EN\">The largest age group is aged 30-34 (67.93%). 77.36% of respondents are at the internship stage or in the year 1 to 3 period of study, where respondents in year 3 have the most significant number of residents (32.08%). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN\">Internal reliability of the PHEEM score was good, with Cronbach&#8217;s alpha coefficient of 0.872. No significant change with the removal of any of the 40 questions, proving its good internal reliability. Data in the perception of the role of autonomy was not normally distributed (P&lt;0.05), but in the perception of teaching (P=0.200), perception of social support (P=0.200), also overall PHEEM score (P=0.200), the data were distributed normally.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN\">As shown in Table 1, the mean score (SD) of the overall PHEEM score was 123.40\u00b112.35, which is categorised as an excellent learning environment (LE) (&gt;120). The mean perceptions for each subscale were <\/span><span lang=\"EN-ID\">42.57<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">4.62 for perceptions of the role of autonomy classified as \u201cmore positive than negative\u201d; 47.75<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">4.84 for perceptions of teaching classified as \u201cmodel teachers\u201d; 33.08<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">4.15 for perceptions of social support classified as \u201cmore pros than cons.\u201d<\/span><\/p>\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"516\" class=\" aligncenter\" style=\"width: 49.5316%;\">\r\n<tbody>\r\n<tr>\r\n<td width=\"33\" valign=\"top\" style=\"width: 6.4833%;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">No<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"163\" valign=\"top\" style=\"width: 29.0766%;\">\r\n<p align=\"center\"><b><i><span lang=\"EN-US\">PHEEM Subscales<\/span><\/i><\/b><b><span lang=\"EN-US\"><\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"96\" valign=\"top\" style=\"width: 19.2534%;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Mean (SD)<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"143\" valign=\"top\" style=\"width: 27.5049%;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Interpretation<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"81\" valign=\"top\" style=\"width: 74.0668%;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Maximum Score<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"33\" style=\"width: 6.4833%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1<\/span><\/p>\r\n<\/td>\r\n<td width=\"163\" style=\"width: 29.0766%;\">\r\n<p><span lang=\"EN-US\">Perceptions of role of autonomy<\/span><\/p>\r\n<\/td>\r\n<td width=\"96\" style=\"width: 19.2534%;\">\r\n<p><span lang=\"EN-US\">42.57<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">4.62<\/span><\/p>\r\n<\/td>\r\n<td width=\"143\" style=\"width: 27.5049%;\">\r\n<p><span lang=\"EN-US\">more positive than negative<\/span><\/p>\r\n<\/td>\r\n<td width=\"81\" style=\"width: 74.0668%;\">\r\n<p align=\"center\"><span lang=\"SV\">56<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"33\" style=\"width: 6.4833%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2<\/span><\/p>\r\n<\/td>\r\n<td width=\"163\" style=\"width: 29.0766%;\">\r\n<p><span lang=\"EN-US\">Perceptions of teaching<\/span><\/p>\r\n<\/td>\r\n<td width=\"96\" style=\"width: 19.2534%;\">\r\n<p><span lang=\"EN-US\">47.75<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">4.84<\/span><\/p>\r\n<\/td>\r\n<td width=\"143\" style=\"width: 27.5049%;\">\r\n<p><span lang=\"EN-US\">model teachers<\/span><\/p>\r\n<\/td>\r\n<td width=\"81\" style=\"width: 74.0668%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">60<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"33\" style=\"width: 6.4833%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3<\/span><\/p>\r\n<\/td>\r\n<td width=\"163\" style=\"width: 29.0766%;\">\r\n<p><span lang=\"EN-US\">Perceptions of social support<\/span><\/p>\r\n<\/td>\r\n<td width=\"96\" style=\"width: 19.2534%;\">\r\n<p><span lang=\"EN-US\">33.08<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">4.15<\/span><\/p>\r\n<\/td>\r\n<td width=\"143\" style=\"width: 27.5049%;\">\r\n<p><span lang=\"EN-US\">more pros than cons<\/span><\/p>\r\n<\/td>\r\n<td width=\"81\" style=\"width: 74.0668%;\">\r\n<p align=\"center\"><span lang=\"SV\">44<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"33\" style=\"width: 6.4833%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4<\/span><\/p>\r\n<\/td>\r\n<td width=\"163\" style=\"width: 29.0766%;\">\r\n<p><span lang=\"EN-US\">Overall PHEEM<\/span><\/p>\r\n<\/td>\r\n<td width=\"96\" style=\"width: 19.2534%;\">\r\n<p><span lang=\"EN-US\">123.40<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">12.35<\/span><\/p>\r\n<\/td>\r\n<td width=\"143\" style=\"width: 27.5049%;\">\r\n<p><span lang=\"EN-US\">Excellent<\/span><\/p>\r\n<\/td>\r\n<td width=\"81\" style=\"width: 74.0668%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">160<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-US\">Table 1.<\/span><span lang=\"EN-US\"> The PHEEM scores<\/span><\/p>\r\n<p><span lang=\"EN-US\">Abbreviation<\/span><span lang=\"EN-US\">: <i>PHEEM, Postgraduate Hospital Environment Measure<\/i>; SD, Standard Deviation.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN\">From the overall PHEEM item, there are 28 items with an average score &gt;3, nine items in the perception of the role of autonomy, twelve items in teaching perception, and seven items in the perception of social support (Table 2). Only one item has a score &gt;3.5 or is classified as real positive points; that is <\/span><span lang=\"EN-US\">item number 3 (I have protected educational time in this post) for the perception of teaching<\/span><span lang=\"EN\">. The highest score <\/span><span lang=\"EN-US\">for the perception of the role of autonomy<\/span><span lang=\"EN\"> was item 34 (<\/span><span lang=\"EN-US\">The training in this post makes me feel ready to be a consultant) and item 24 (I feel physically safe within the hospital environment) in the perception of social support.<\/span><\/p>\r\n<div>\r\n<p style=\"text-align: justify;\"><span lang=\"EN\">Only one item with an average score of &lt;2, indicated as a problem area which is item number 26 (There are adequate catering facilities when I am on call) in the perception of social support (Table 2). In the perception of the role of autonomy, item 8 (<\/span><span lang=\"EN-US\">I must perform inappropriate tasks*) <\/span><span lang=\"EN\">have the lowest score, while item 31 (<\/span><span lang=\"EN-US\">My clinical teachers are accessible) <\/span><span lang=\"EN\">has the lowest score under the perception of teaching (Table 2).<\/span><\/p>\r\n<\/div>\r\n<div>\r\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"520\" class=\"aligncenter\" style=\"width: 31.5974%;\">\r\n<tbody>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"top\" style=\"width: 8.38095%;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Code<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" valign=\"top\" style=\"width: 144.571%;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Item<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"2\" valign=\"top\" style=\"width: 17.1285%;\">\r\n<p align=\"center\"><b><span lang=\"EN-US\">Mean<\/span><\/b><span lang=\"EN\">\u00b1<\/span><b><span lang=\"EN-US\">SD<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"520\" nowrap=\"nowrap\" colspan=\"4\" valign=\"top\" style=\"width: 170.08%;\">\r\n<p><b><span lang=\"EN-US\">Perception of role of autonomy<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">34<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">The training in this post makes me feel ready to be a consultant<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"2\" style=\"width: 17.1285%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.40<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.53<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">40<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">My clinical teachers promote an atmosphere of mutual respect<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"2\" style=\"width: 17.1285%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.34<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.48<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">30<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I have opportunities to acquire the appropriate practical procedures for my residency<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"2\" style=\"width: 17.1285%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.32<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.51<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">29<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I feel part of a team working here<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"2\" style=\"width: 17.1285%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.21<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.49<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">5<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I have the appropriate level of responsibility in this post<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"2\" style=\"width: 17.1285%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.19<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.56<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">18<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I have the opportunity to provide continuity of care<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"2\" style=\"width: 17.1285%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.19<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.44<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">1<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I have an employment contract that provides information about hours of work<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"2\" style=\"width: 17.1285%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.15<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.72<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">32<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">My workload in this job is fine<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"2\" style=\"width: 17.1285%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.02<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.50<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">4<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I had an informative induction program<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"2\" style=\"width: 17.1285%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.00<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.59<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">14<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">There are clear clinical protocols in this post<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"2\" style=\"width: 17.1285%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.98<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.64<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">17<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">My work hours are in accordance to the national limits of working hours per day and week for physicians<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"2\" style=\"width: 17.1285%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.74<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.79<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">9<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">There is an informative Junior Doctors Handbook<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"2\" style=\"width: 17.1285%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.70<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.72<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">11*<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I am bleeped (called) inappropriately*<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"2\" style=\"width: 17.1285%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.68<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.89<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">8*<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I have to perform inappropriate tasks*<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"2\" style=\"width: 17.1285%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.66<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.88<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"520\" nowrap=\"nowrap\" colspan=\"4\" valign=\"top\" style=\"width: 170.08%;\">\r\n<p><b><span lang=\"EN-US\">Perception of teaching<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">3<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I have protected educational time in this post<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.51<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.58<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">2<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">My clinical teachers set clear expectation<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.47<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.54<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">37<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">My clinical teachers encourage me to be an independent learner<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.40<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.49<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">28<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">My clinical teachers have good teaching skills<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.38<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.49<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">12<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I am able to participate actively in educational events<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.28<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.53<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">10<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">My clinical teachers have good communication skills<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.25<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.55<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">27<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I have enough clinical learning opportunities for my needs<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.23<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.42<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">15<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">My clinical teachers are enthusiastic<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.15<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.57<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">21<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">There is access to an educational program relevant to my needs<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.15<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.53<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">23<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">My clinical teachers are well organised<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.15<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.53<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">6<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I have good clinical supervision at all times<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.06<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.66<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">33<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">Senior staff utilise learning opportunities effectively<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.06<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.41<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">39<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">The clinical teachers provide me with good feedback on my strengths and weaknesses<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.98<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.57<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">22<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I get regular feedback from seniors<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.92<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.70<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">31<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">My clinical teachers are accessible<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.77<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.61<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"520\" nowrap=\"nowrap\" colspan=\"3\" valign=\"top\" style=\"width: 168.19%;\">\r\n<p><b><span lang=\"EN-US\">Perception of Social Support<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"top\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">24<\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I feel physically safe within the hospital environment<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.36<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.59<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"top\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">13*<\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">There is sex discrimination in this post*<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.30<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.99<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"top\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">7*<\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">There is racism in this post*<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.28<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.84<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"top\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">35<\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">My clinical teachers have good mentoring skills<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.28<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.53<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"top\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">16<\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I have good collaboration with other doctors in my residency<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.25<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.52<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"top\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">36<\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I get a lot of enjoyment out of my present job<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.15<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.53<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"top\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">20<\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">This hospital has good quality accommodation for junior doctors, especially when on call<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.04<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.71<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"top\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">38<\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">There are good counselling opportunities for junior doctors who fail to complete their training satisfactorily<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.98<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.66<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"top\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">19<\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">I have suitable access to careers advice<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.94<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.66<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"top\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">25<\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">There is a no-blame culture in this post<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.53<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">0.93<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"top\" style=\"width: 8.38095%;\">\r\n<p><span lang=\"EN-US\">26<\/span><\/p>\r\n<\/td>\r\n<td width=\"331\" nowrap=\"nowrap\" style=\"width: 144.571%;\">\r\n<p><span lang=\"EN-US\">There are adequate catering facilities when I am on call<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" style=\"width: 15.2381%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.96<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-US\">1.02<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"0\" style=\"width: 1.89036%;\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\" style=\"text-align: center;\"><span lang=\"EN-US\">Table 2.<\/span><span lang=\"EN-US\"> Mean score in each item on the PHEEM questionnaire<\/span><\/p>\r\n<p><span lang=\"EN-US\">Notes<\/span><span lang=\"EN-US\">: Ordered by highest score in each subscale; *negative statement. <\/span><\/p>\r\n<p><span lang=\"EN-US\">Abbreviation<\/span><span lang=\"EN-US\">: SD, Standard Deviation.<\/span><\/p>\r\n<\/div>\r\n<div>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">In Table 3, an analysis of the relationship between student perception and gender from total PHEEM score showed no significant difference (P= 0.863). The mean scores of females were higher than males for the perception of teaching and social support, although not significantly different (P= 0.209 &amp; P= 0.869). Conversely, in the perception of autonomy, the mean scores of females were lower than males but also not statistically significant (P= 0.212). The biggest difference between male and female perceptions is the perception of teaching.<\/span><\/p>\r\n<\/div>\r\n<div>\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"663\" class=\" aligncenter\">\r\n<tbody>\r\n<tr>\r\n<td width=\"113\" nowrap=\"nowrap\" rowspan=\"2\">\r\n<p align=\"center\"><span lang=\"EN-ID\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-ID\">Sample\u2019s<\/span><\/b><\/p>\r\n<p align=\"center\"><b><span lang=\"EN-ID\">Characteristics<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"151\" nowrap=\"nowrap\" colspan=\"2\">\r\n<p align=\"center\"><b><span lang=\"EN-ID\">Total <i>PHEEM Scores<\/i><\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"133\" nowrap=\"nowrap\" colspan=\"3\">\r\n<p align=\"center\"><b><span lang=\"EN-ID\">Perception of Role of Autonomy<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"134\" nowrap=\"nowrap\" colspan=\"3\">\r\n<p align=\"center\"><b><span lang=\"EN-ID\">Perception of Teaching<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"132\" nowrap=\"nowrap\" colspan=\"3\">\r\n<p align=\"center\"><b><span lang=\"EN-ID\">Perception of Social Support<\/span><\/b><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"95\" nowrap=\"nowrap\">\r\n<p align=\"center\"><span lang=\"EN-ID\">Mean<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">SD<\/span><\/p>\r\n<\/td>\r\n<td width=\"56\" nowrap=\"nowrap\">\r\n<p align=\"center\"><span lang=\"EN-ID\">p<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\">\r\n<p align=\"center\"><span lang=\"EN-ID\">Mean<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">SD<\/span><\/p>\r\n<\/td>\r\n<td width=\"55\" nowrap=\"nowrap\">\r\n<p align=\"center\"><span lang=\"EN-ID\">p<\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" nowrap=\"nowrap\" colspan=\"2\">\r\n<p align=\"center\"><span lang=\"EN-ID\">Mean<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">SD<\/span><\/p>\r\n<\/td>\r\n<td width=\"57\" nowrap=\"nowrap\">\r\n<p align=\"center\"><span lang=\"EN-ID\">p<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" colspan=\"2\">\r\n<p align=\"center\"><span lang=\"EN-ID\">Mean<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">SD<\/span><\/p>\r\n<\/td>\r\n<td width=\"57\" nowrap=\"nowrap\">\r\n<p align=\"center\"><span lang=\"EN-ID\">p<\/span><\/p>\r\n<\/td>\r\n<td width=\"2\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"113\" nowrap=\"nowrap\">\r\n<p><b><span lang=\"EN-ID\">Gender<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"95\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"56\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"55\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<td width=\"2\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"113\" nowrap=\"nowrap\">\r\n<p><span lang=\"EN-ID\">Male<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">123.00<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">13.24<\/span><\/p>\r\n<\/td>\r\n<td width=\"56\" nowrap=\"nowrap\" rowspan=\"2\">\r\n<p align=\"center\"><span lang=\"EN-ID\">0.863<sup>a<\/sup><\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">43.42<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">5.00<\/span><\/p>\r\n<\/td>\r\n<td width=\"55\" nowrap=\"nowrap\" rowspan=\"2\">\r\n<p align=\"center\"><span lang=\"EN-ID\">0.212<sup>b<\/sup><\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">46.63<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">5.20<\/span><\/p>\r\n<\/td>\r\n<td width=\"57\" nowrap=\"nowrap\" rowspan=\"2\">\r\n<p align=\"center\"><span lang=\"EN-ID\">0.209<sup>a<\/sup><\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">32.95<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">4.44<\/span><\/p>\r\n<\/td>\r\n<td width=\"57\" nowrap=\"nowrap\" rowspan=\"2\">\r\n<p align=\"center\"><span lang=\"EN-ID\">0.869<sup>a<\/sup><\/span><\/p>\r\n<\/td>\r\n<td width=\"2\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"113\" nowrap=\"nowrap\">\r\n<p><span lang=\"EN-ID\">Female<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">123.62<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">12.03)<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">42.09<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">4.40<\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">48.38<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">4.58<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">33.15<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">4.05<\/span><\/p>\r\n<\/td>\r\n<td width=\"2\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"113\" nowrap=\"nowrap\">\r\n<p><b><span lang=\"EN-ID\">Years of Study<\/span><\/b><\/p>\r\n<\/td>\r\n<td width=\"95\" nowrap=\"nowrap\" valign=\"bottom\"><\/td>\r\n<td width=\"56\" nowrap=\"nowrap\" valign=\"bottom\"><\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" valign=\"bottom\"><\/td>\r\n<td width=\"55\" nowrap=\"nowrap\" valign=\"bottom\"><\/td>\r\n<td width=\"77\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\"><\/td>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"bottom\"><\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\"><\/td>\r\n<td width=\"57\" nowrap=\"nowrap\" valign=\"bottom\"><\/td>\r\n<td width=\"2\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"113\" nowrap=\"nowrap\">\r\n<p><span lang=\"EN-ID\">Year 1<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">123.9<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">9.39<\/span><\/p>\r\n<\/td>\r\n<td width=\"56\" nowrap=\"nowrap\" rowspan=\"5\">\r\n<p align=\"center\"><span lang=\"EN-ID\">0.273<sup>c<\/sup><\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">42.40<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">4.40<\/span><\/p>\r\n<\/td>\r\n<td width=\"55\" nowrap=\"nowrap\" rowspan=\"5\">\r\n<p align=\"center\"><span lang=\"EN-ID\">0.163<sup>d<\/sup><\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">48.40<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">3.60<\/span><\/p>\r\n<\/td>\r\n<td width=\"57\" nowrap=\"nowrap\" rowspan=\"5\">\r\n<p align=\"center\"><span lang=\"EN-ID\">0.363<sup>c<\/sup><\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">33.10<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">2.81<\/span><\/p>\r\n<\/td>\r\n<td width=\"57\" nowrap=\"nowrap\" rowspan=\"5\">\r\n<p align=\"center\"><span lang=\"EN-ID\">0.444<sup>c<\/sup><\/span><\/p>\r\n<\/td>\r\n<td width=\"2\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"113\" nowrap=\"nowrap\">\r\n<p><span lang=\"EN-ID\">Year 2<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">126.2<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">12.49<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">43.57<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">5.32<\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">48.43<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">4.89<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">34.21<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">3.49<\/span><\/p>\r\n<\/td>\r\n<td width=\"2\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"113\" nowrap=\"nowrap\">\r\n<p><span lang=\"EN-ID\">Year 3<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">122.7<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">13.87<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">42.65<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">4.24<\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">47.71<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">5.52<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">32.35<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">5.50<\/span><\/p>\r\n<\/td>\r\n<td width=\"2\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"113\" nowrap=\"nowrap\">\r\n<p><span lang=\"EN-ID\">Year 4<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">115.7<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">6.14<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">39.50<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">2.56<\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">44.75<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">3.28<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">31.50<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">1.85<\/span><\/p>\r\n<\/td>\r\n<td width=\"2\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"113\" nowrap=\"nowrap\">\r\n<p><span lang=\"EN-ID\">Year 5 or more<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">130.50<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">18.08<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">45.25<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">6.24<\/span><\/p>\r\n<\/td>\r\n<td width=\"77\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">50.00<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">6.38<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" nowrap=\"nowrap\" colspan=\"2\" valign=\"bottom\">\r\n<p align=\"center\"><span lang=\"EN-ID\">35.25<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">5.62<\/span><\/p>\r\n<\/td>\r\n<td width=\"2\">\r\n<p>&nbsp;<\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr height=\"0\">\r\n<td width=\"142\"><\/td>\r\n<td width=\"118\"><\/td>\r\n<td width=\"71\"><\/td>\r\n<td width=\"95\"><\/td>\r\n<td width=\"69\"><\/td>\r\n<td width=\"2\"><\/td>\r\n<td width=\"94\"><\/td>\r\n<td width=\"71\"><\/td>\r\n<td width=\"2\"><\/td>\r\n<td width=\"92\"><\/td>\r\n<td width=\"71\"><\/td>\r\n<td width=\"3\"><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\" style=\"text-align: center;\"><span lang=\"EN-US\">Table 3. Correlation between sample\u2019s characteristics and perception<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Abbreviation<\/span><span lang=\"EN-US\">: <i>PHEEM, Postgraduate Hospital Environment Measure<\/i>; SD, Standard Deviation.<\/span><\/p>\r\n<p style=\"text-align: left;\"><sup><span lang=\"EN-US\">a<\/span><\/sup><span lang=\"EN-US\">independent sample t-test; <sup>b<\/sup>Mann-Whitney test; <sup>c<\/sup>One Way ANOVA test; <sup>d<\/sup>Kruskall-Wallis test<\/span><\/p>\r\n<\/div>\r\n<div>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">No significant differences were found for a mean of total PHEEM scores among years of the study group (P= 0.273), as well as in perceptions of the role of autonomy (P= 0.163), perceptions of teaching (P= 0.363) and perceptions of social support (P= 0.444). However, there are similar trends in both total PHEEM scores and perceptions of autonomy, teaching, and social support, in which the score of year 2 was higher than that of year 1, the lowest score in the year four student group, and the highest score in the 5th year student group or above. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The data supporting the quantitative findings of this study are openly available in Figshare at <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.6084\/m9.figshare.23606157\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.6084\/m9.figshare.23606157<\/span><\/a><\/span><span lang=\"EN-GB\"> (Kamaruddin et al., 2023).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><span lang=\"EN-ID\">B. Qualitative Data<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">Six open-ended questions were administered along with the PHEEM questionnaire. Thematic analyses revealed 12 themes in which residents have a positive perception of their LE and 10 themes that could be a barrier because residents have a negative perception of their LE (Appendix 1). Two FGDs were conducted with 10 participants in each group. Eleven participants were from year one and two, and the rest was from year three or more. Eight males and 12 females participated. From FGD results, we could also classify residents&#8217; perceptions into 8 positive and 11 negative perception themes (Appendix 1). <\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">Based on the themes found in both open-ended questions and FGD, we transform and formulate the final theme by connecting and merging themes that occurred from both methods. The final theme&#8217;s transformation and formulation are presented in Appendix 1. Even though the number of themes was not significantly different from positive and negative perceptions, we can see from the data transformation (based on % code and count) that the propensity of the theme was towards the positive perception.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">There is a total of 11 final themes, of which six themes were positive and five were negative perceptions.<\/span><\/p>\r\n<\/div>\r\n<div>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">The themes along with supporting statements are as follows:<\/span><\/p>\r\n<div align=\"center\">\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" style=\"width: 85.502%;\">\r\n<tbody>\r\n<tr>\r\n<td width=\"216\" valign=\"top\" style=\"width: 43.6964%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">Positive perception themes<\/span><\/p>\r\n<\/td>\r\n<td width=\"433\" valign=\"top\" style=\"width: 280.115%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">Supporting Statements<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"216\" valign=\"top\" style=\"width: 43.6964%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">1. A good clinical teacher<\/span><\/p>\r\n<\/td>\r\n<td width=\"433\" valign=\"top\" style=\"width: 280.115%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">\u201cClinical teachers in Ophthalmology Study Program are very competent, highly dedicated, and respect us as students.&#8221; &#8211; P52-OEQ<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"216\" valign=\"top\" style=\"width: 43.6964%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">2. Conducive learning atmosphere<\/span><\/p>\r\n<\/td>\r\n<td width=\"433\" valign=\"top\" style=\"width: 280.115%; text-align: left;\">\r\n<p><span lang=\"EN-US\">&#8220;<\/span><span lang=\"EN\">The learning atmosphere is very conducive<\/span><span lang=\"EN-US\">.&#8221; &#8211; P6-FGD1<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"216\" valign=\"top\" style=\"width: 43.6964%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">3. <\/span><span lang=\"EN-US\">Well-organised learning system<\/span><span lang=\"EN-ID\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"433\" valign=\"top\" style=\"width: 280.115%; text-align: left;\">\r\n<p><span lang=\"EN\">&#8220;The schedule is in order; everything has been arranged, so it all depends on whether residents want to finish on time or not.&#8221; &#8211; P6-FGD2<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"216\" valign=\"top\" style=\"width: 43.6964%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">4. <\/span><span lang=\"EN-US\">Friendly social environment<\/span><span lang=\"EN-ID\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"433\" valign=\"top\" style=\"width: 280.115%; text-align: left;\">\r\n<p><span lang=\"EN-US\">\u201c<\/span><span lang=\"EN\">I feel that the working environment or colleagues here are very good; the sense of family is felt even though I am not originally from this city.\u201d &#8211; P29-OEQ<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"216\" valign=\"top\" style=\"width: 43.6964%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">5. <\/span><span lang=\"EN-US\">Supporting colleague<\/span><span lang=\"EN-ID\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"433\" valign=\"top\" style=\"width: 280.115%; text-align: left;\">\r\n<p><span lang=\"EN-US\">&#8220;Everything was safe here, delightful; we support each other.&#8221; &#8211; P5-FGD1<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"216\" valign=\"top\" style=\"width: 43.6964%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">6. <\/span><span lang=\"EN-US\">Well-established facilities<\/span><span lang=\"EN-ID\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"433\" valign=\"top\" style=\"width: 280.115%; text-align: left;\">\r\n<p><span lang=\"EN\">&#8220;The facilities is good, all equipment is available and easy to access in the hospital.&#8221; &#8211; <\/span><span lang=\"EN-US\">P15-OEQ<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"216\" valign=\"top\" style=\"width: 43.6964%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">Negative perception themes<\/span><\/p>\r\n<\/td>\r\n<td width=\"433\" valign=\"top\" style=\"width: 280.115%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">Supporting Statements<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"216\" valign=\"top\" style=\"width: 43.6964%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">1. <\/span><span lang=\"EN-US\">Suboptimal facilities<\/span><span lang=\"EN-ID\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"433\" valign=\"top\" style=\"width: 280.115%; text-align: left;\">\r\n<p><span lang=\"EN\">\u201cThings that still need improvement are the facilities and infrastructure; the study program should be provided special rooms such as study rooms with libraries and computers to support us to complete our tasks.\u201d &#8211; P50-OEQ<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"216\" valign=\"top\" style=\"width: 43.6964%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">2. <\/span><span lang=\"EN-US\">Inadequate learning opportunities <\/span><\/p>\r\n<p><span lang=\"EN-US\">(discrimination issue)<\/span><span lang=\"EN-ID\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"433\" valign=\"top\" style=\"width: 280.115%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">\u201cThere are still teachers who seem to discriminate between residents.\u201d &#8211; P46-OEQ<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"216\" valign=\"top\" style=\"width: 43.6964%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">3. <\/span><span lang=\"EN-US\">Inappropriate tasks<\/span><span lang=\"EN-ID\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"433\" valign=\"top\" style=\"width: 280.115%; text-align: left;\">\r\n<p><span lang=\"EN-US\">&#8220;all administrative tasks be imposed on the resident, and everything must be sorted out in our hands; the nurse is just left to take care of everything that has been done.&#8221; &#8211; P8-FGD2<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"216\" valign=\"top\" style=\"width: 43.6964%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">4. <\/span><span lang=\"EN-US\">Less mentoring time<\/span><span lang=\"EN-ID\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"433\" valign=\"top\" style=\"width: 280.115%; text-align: left;\">\r\n<p><span lang=\"EN-US\">&#8220;What is lacking is the supervisor&#8217;s time to provide mentoring; there are still several clinical teachers who lack time to provide discussion, and there are even some who directly accept the scientific task without going through discussion.&#8221; &#8211; P3-FGD2<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"216\" valign=\"top\" style=\"width: 43.6964%; text-align: left;\">\r\n<p><span lang=\"EN-ID\">5. <\/span><span lang=\"EN-US\">Lack of teaching hospitals\/clinics<\/span><span lang=\"EN-ID\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"433\" valign=\"top\" style=\"width: 280.115%; text-align: left;\">\r\n<p><span lang=\"EN\">&#8220;Maybe there can be an additional teaching hospital or clinic in Makassar.&#8221; &#8211; P10-FGD2<\/span><span lang=\"EN-ID\"><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n<p align=\"center\"><span lang=\"EN-ID\">Table 4. Supporting statements of themes<\/span><\/p>\r\n<\/div>\r\n<p><i><span lang=\"EN-ID\">C. Quantitative and Qualitative Data Integration<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">The integration of quantitative and qualitative data can be shown in Figure 1 and Supplement Table 2. Overall, the mean total PHEEM scores (123.40<\/span><span lang=\"EN\">\u00b1<\/span><span lang=\"EN-ID\">12.35), which indicated an excellent LE environment, were confirmed by more positive perception themes compared with negative perception found in qualitative data analyses (Figure 1). Besides, we could also see that in each subscale, the composition of the themes connecting to each subscale could confirm the results of the quantitative data, whether the trend of the graphs is primarily high, average, or low. For example, in the perception of teaching, we could see mostly positive perception themes were connected to the subscale rather than negative perception; from this, we could say that the quantitative data of the perception of teaching in which mostly classified as model&#8217;s teacher was confirmed by its connection towards the final themes.<\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2024\/03\/OA3074-Figure-1.1-1-300x92.png\" alt=\"\" class=\"alignnone  wp-image-72430 aligncenter\" width=\"584\" height=\"179\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2024\/03\/OA3074-Figure-1.1-1-300x92.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2024\/03\/OA3074-Figure-1.1-1-768x235.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2024\/03\/OA3074-Figure-1.1-1.png 833w\" sizes=\"auto, (max-width: 584px) 100vw, 584px\" \/><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2024\/03\/OA3074-Figure-1.2-300x248.png\" alt=\"\" class=\" wp-image-72429 aligncenter\" width=\"601\" height=\"497\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2024\/03\/OA3074-Figure-1.2-300x248.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2024\/03\/OA3074-Figure-1.2-768x636.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2024\/03\/OA3074-Figure-1.2.png 940w\" sizes=\"auto, (max-width: 601px) 100vw, 601px\" \/><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">Figure 1.<\/span><span lang=\"EN-US\"> Integration of overall quantitative data classification with qualitative data<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Quantitative data represent by graph and qualitative data (positive and negative perceptions) represent by box. Perceptions in the circle area means that it was connected to the area. Overlapping box in the circle means that perception was connected to more than one area.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-ID\">In each subscale, the high and low items&#8217; scores were confirmed with the final themes, both for positive and negative perception (Supplement Table 2). All positive perceptions confirmed quantitative results by related with a minimum of one item from 3 subscales with mostly high mean scores (&gt;3). Only three negative perceptions related to a minimum of one item from 3 subscales with low scores (&lt;3) confirm these themes&#8217; relation to quantitative results. One negative perception (Inadequate learning opportunities among residents\/discrimination issue) is connected to an item with high scores, showing that this theme did not confirm the quantitative finding. Two themes appear contradictory in positive and negative perceptions (well-established facilities and suboptimum facilities). Both themes were related to the same item in which the scores were not high or low, which could confirm the possibility from both perspectives. <\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">IV. DISCUSSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Our finding shows an excellent perception of LE of ophthalmology residents. Based on previously published articles, this study has the highest score for overall scores and for each subscale among peer-reviewed publications of PHEEM studies worldwide. The highest score from a previous peer-reviewed publication was a study by Ong et al. (2020), which reported a more positive than negative internal medicine residents&#8217; perceptions of their LE in Singapore. On the contrary, Fisseha et al. (2021) and Liaqat et al. (2019) reported a plenty of problems LE from the perception of internal medicine residents in Ethiopia and pediatric surgery residents&#8217; perception in Iran, respectively. Many factors, such as differences in discipline and sites of training, could cause the differences. There is no previous study yet about ophthalmic residents&#8217; perception of LE using PHEEM. However, it is previously proved that some studies evaluated several different training programs reported that there is a difference in overall and subscale PHEEM scores among various training programs <\/span><span lang=\"EN-US\">(Chan et al., 2016)<\/span><span lang=\"EN-US\">. In line with discipline, studies that evaluated different sites of training mainly reported that there is a different score between sites of training (Chan et al., 2016). Another reason for the difference could be a result of the differences in curriculum and teaching methods. Some studies reported increasing perception of LE after implementing modern curriculum and student-centred learning <\/span><span lang=\"EN-US\">(Brown et al., 2011; Shankar et al., 2014)<\/span><span lang=\"EN-US\">. The themes found from our qualitative study also supported this excellent perception of residents toward their LE. Most of our themes were positive and related to all aspects of the PHEEM questionnaire. Gruppen et al. (2019) reported a conceptual framework of LE in which all components of the framework, i.e., personal, social, physical, and organisational, supported and covered by our positive perception themes finding, confirming the excellent perception of LE from the residents.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">We did not find any different perceptions of LE between gender and year of study. Our findings were similar to some studies that reported no gender differences <\/span><span lang=\"EN-US\">(Al-Shiekh et al., 2014; Ong et al., 2020; Sandhu et al., 2018)<\/span><span lang=\"EN-US\">. Other studies have different results; some studies reported that males have a better perception than females <\/span><span lang=\"EN-US\">(Fisseha et al., 2021; Gough et al., 2010)<\/span><span lang=\"EN-US\">; on the contrary, Liaqat et al. (2019) reported a better perception of females than males. Similar to Risberg et al. (2003) that reported, gender issues were more significant and essential during clinical consultation than tutoring. Our qualitative data did not confirm our quantitative results. There is one negative perception theme in which some of our students feel that there is a discrimination issue related to learning opportunities; one of them is gender discrimination. Although our quantitative data show no differences between gender, the negative perception theme regarding discrimination issues must be taken into account by the stakeholder.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Concerning the year of training, we also found no significant difference in perception. The finding regarding different perceptions for different years of training was varied. Our result was the same with some studies (Ong et al., 2019; Sandhu et al., 2018), but other studies also reported higher PHEEM scores for senior to junior (Gough et al., 2010; Khoja, 2015; Liaqat et al., 2019; Pinnock et al., 2009), and some studies also reported that junior has better score than senior (Fisseha et al., 2021; Mahendran et al., 2013). The differences in perception of junior and senior residents could be explained by some reason, such as available access to educational opportunities (Mahendran et al., 2013), greater responsibility with increased seniority (Pinnock et al., 2009), and different training locations for trainees of different seniority (Khoja, 2015).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">All subscales show promising results; residents&#8217; perception of teaching was the highest among other subscales. Our qualitative data also support this finding; most of our positive theme was related to the perception of teaching, one of them being a good clinical teacher. <\/span><span lang=\"EN-US\">Despite good perceptions on teaching, residents also experienced less mentoring time with clinical teachers. Fisseha et al. (2021) also reported the same issue. Inadequate supervision was proved to be a barrier in post-graduate medical education, as reported by Talib et al. (2019). Ong et al. (2019) also reported that focus group data suggested that inadequate supervisor contact and feedback resulted in negative perceptions of the LE. <\/span><span lang=\"EN-US\">This finding informs us that residents need appropriate supervision, and clinical teachers should be understanding and prepared for their roles in residency training programs (Ramani &amp; Leinster, 2008). Increasing learning time without any addition to supervisor-resident contact time still results in a low perception of LE (Silkens et al., 2018), proving the importance of the supervisor-resident relationship. Besides, <\/span><span lang=\"EN-US\">good supervisory strategies proved to be contributed to a good LE (Boor, 2009). <\/span><span lang=\"EN-US\">A good teaching environment influences the standard of the learning process (Al-Shiekh et al., 2014; Bari et al., 2018), satisfaction with education, and determines the outcome of the curriculum (Bari et al., 2018; Binsaleh et al., 2015). Faculty should focus on developing adequate supervision and teaching skills programs for clinical teachers.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Perception of social support has the lowest score among other; it is affirmed by our qualitative finding in which three negative perception was connected to this subscale. Similar results were also reported from studies in intensive care and pediatric training program (<\/span><span lang=\"EN-US\">Al-Shiekh et al., 2014; Clapham et al., 2007). Related to social support, catering facilities is problem area of this study, other studies also identified this issue as a problem (Al-Shiekh et al., 2014; Binsaleh et al., 2015; Fisseha et al., 2021; Ong et al., 2020). This finding was not specifically appeared on FGD, but the strategy to solve the problem should be considered. Another interesting result related to social support is about facilities. The topic has both perspectives, positive and negative. Quantitative item related to this finding was not had very high or very low scores, supporting that some facilities were good, but there is still area for improvement, especially for diagnostic tools and surgical training facilities, as stated in FGD. Other studies also reported that suboptimal facilities related to hospital diagnostic tools were also a barrier to achieving good LE (Fisseha et al., 2021; Talib et al., 2019). Sch\u00f6nrock-Adema et al. (2012) have highlighted that interaction and collaboration with others were significant in determining the LE. Faculty should pay attention to social support as it has a vital role in a residency program, as it could alleviate the effects of stress, depression, and burnout (Vieira, 2008). Strategy to escalate this area should be considered, especially in providing good facilities for the learning process.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Residents&#8217; perception of the role of autonomy is also satisfying, most of the positive themes confirmed this subscale. Good autonomy can improve decision-making skills, self-confidence, and responsibility, which further influence the readiness of residents to be independent (Allen et al., 2019). It also improves work satisfaction and can reduce burnout (Allen et al., 2019). Although overall autonomy perception was good, there are some areas for improvement. <\/span><span lang=\"EN-US\">Our finding shows that residents were imposed with inappropriate tasks, such as administrative tasks. Some activities not related to education are also obligated to the residents at a certain level of training. This condition could lead to an excessive, inappropriate workload and interfere with protected educational time. Therefore, the faculty should set precise regulations regarding job descriptions and accountability.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Our study was done in the main teaching hospital which was part of a university-based study program, the results could be benefit for other hospital with same basis. It shows that university-based program has a good teaching area especially for the curriculum and teaching resources including human resources and facilities. University-based teaching hospital could enhance their program by maximising their teaching area also paying attention to some factors that could be a barrier in university-based program such as learning opportunity and inappropriate task.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">A mixed method with explanatory sequential design is fundamental in our study as it provides a comprehensive perception of residents. Qualitative data make our finding more solid, show us some weaknesses, and emphasise our areas for improvement which are not easily identified from quantitative analyses. This is also a pioneer study for ophthalmology residents&#8217; perception of LE, making our finding also crucial in adding insight to understanding residency LE from multiple perspectives. On the other hand, several limitations were also identified. First, our study was only done in one centre and discipline, which may limit data generalisability. Second, the study time constraint was cross-sectional, so the causative relation between factors could not be established. Third, differences perceptions in each different training year cannot be ascertained because there can be information bias related to the perceptions of second-year students and so on towards their experiences in previous years. Fourth, the researcher is a clinical lecturer from the program who conducted the study, which could be the subject of bias. However, a single trained data collector was used to collect open-ended questions data and facilitate FGD to reduce the possible bias effect.<\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">V. CONCLUSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">In conclusion, our finding shows that our resident has an excellent perception of their ophthalmology residency training. The program has strong areas such as a good clinical teacher, a well-organised learning system, and a good social environment. Several areas should pay attention to, especially equal learning opportunities, mentoring time, and facilities. Faculty should organise strategies for preserving current LE and to further improve the LE along with monitoring and evaluation. <\/span><span lang=\"EN-US\">Our finding could be benefit for other university-based teaching hospital especially in Asia regions to enhance their program. <\/span><span lang=\"EN-US\">Further study involving multiple centres and disciplines should be done to give a more general perspective of LE in residency training.<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Notes on Contributors<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Muhammad Irfan Kamaruddin involved in conception or design of the work, data collection, data analysis and interpretation, drafting the article, critical revision of the article, and final approval of the version to be published.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Andi Alfian Zainuddin involved in conception or design of the work, data analysis and interpretation, critical revision of the article, and final approval of the version to be published.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Berti Julian Nelwan involved in conception or design of the work, critical revision of the article, and final approval of the version to be published.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Sri Asriyani involved in conception or design of the work, critical revision of the article, and final approval of the version to be published.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Firdaus Hamid involved in conception or design of the work, critical revision of the article, and final approval of the version to be published.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Tenri Esa involved in conception or design of the work, critical revision of the article, and final approval of the version to be published.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Irawan Yusuf involved in conception or design of the work, critical revision of the article, and final approval of the version to be published.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Ethical Approval<\/span><\/strong><\/p>\r\n<p><span lang=\"EN-GB\">Before conducting the research, permission was obtained from Faculty of Medicine, Hasanuddin University Institutional Review Board \u00a0(Reference number 36\/UN4.6.4.5.31\/PP36\/2023). Participants were informed of the objectives and purpose of the study. They were invited to sign an informed consent if they agreed to be part of the study. Every participant was given a chance to deliberate on their rights to participate, refuse, or withdraw at any time they wished to do so.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Data Availability<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The authors confirm that the data supporting the findings of this study are available within the article and its quantitative data along with supplemental tables are openly available in Figshare repository <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.6084\/m9.figshare.23606157\"><span lang=\"EN-GB\">https:\/\/doi.org\/10.6084\/m9.figshare.23606157<\/span><\/a><\/span><span lang=\"EN-GB\">. Representative qualitative data translated into English are shown in the Result section (Kamaruddin et al., 2023). All qualitative data, open questions, and the FGD protocol which all written in Bahasa, are available from the corresponding author on reasonable request.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Acknowledgement<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">The authors would like to express our sincere gratitude to Ichlas Nanang Affandi from the Psychology study program, Faculty of Medicine, Hasanuddin University, for his valuable support throughout the research process. His expertise in qualitative study helps us to overcome challenges. In particular, we would like to thank Natalia Widiasih Raharjanti, MD, from the Department of Psychiatry, Faculty of Medicine University of Indonesia, and Assistant Professor Henok Fisseha, MD, from the Department of Internal Medicine, St. Paul&#8217;s Hospital Millennium Medical College, Addis Ababa, Ethiopia for their support in allowing us to use their research instrument and study protocol as one of our references in our research. Thank you also to Rusdina Bte Ladju, MD, Ph.D., for her valuable input to our manuscript. We are also grateful to the Department of Medical Education, Faculty of Medicine, Hasanuddin University, and Department of Ophthalmology, Faculty of Medicine, Hasanuddin University, for providing us with the resources and support needed to complete this study.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Funding<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">None of the authors receive any financial support for this study.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Declaration of Interest<\/span><\/strong><\/p>\r\n<p><span lang=\"EN-GB\">The authors did not have a conflict of interest to be declared in this study.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">References<\/span><\/strong><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Allen, M., Gawad, N., Park, L., &amp; Ra\u00eeche, I. (2019). 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(2019). <\/span><span lang=\"EN-US\">Assessment of environment of pediatric surgery residents of Pakistan using PHEEM.\u00a0<i>Iranian Journal of Pediatric Surgery<\/i>,\u00a0<i>5<\/i>(1), 11\u201320. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.22037\/irjps.v5i1.22773\">https:\/\/doi.org\/10.22037\/irjps.v5i1.22773<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Mahendran, R., Broekman, B., Wong, J. C. M., Lai, Y. M., &amp; Kua, E. H. (2013). 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Using the postgraduate hospital educational environment measure to identify areas for improvement in a Singaporean residency program. <i>Journal of Graduate Medical Education<\/i>, <i>11<\/i>(4s), 73\u201378. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.4300\/JGME-D-19-00234\">https:\/\/doi.org\/10.4300\/JGME-D-19-00234<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Pinnock, R., Reed, P., &amp; Wright, M. (2009). The learning environment of paediatric trainees in New Zealand. <i>Journal of Paediatrics and Child Health<\/i>, <i>45<\/i>(9), 529\u2013534. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1111\/j.1440-1754.2009.01553.x\">https:\/\/doi.org\/10.1111\/j.1440-1754.2009.01553.x<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Prins, J. T., Hoekstra-Weebers, J. E. H. M., Gazendam-Donofrio, S. M., Dillingh, G. S., Bakker, A. 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Validity and reliability od postgraduate hospital educational environment measure &#8211; bahasa indonesia version. <i>Jurnal Pendidikan Kedokte- ran Indonesia: The Indonesian Journal of Medical Educa- tion<\/i>, <i>5<\/i>(3), 157. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.22146\/jpki.25375\">https:\/\/doi.org\/10.22146\/jpki.25375<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Ramani, S., &amp; Leinster, S. (2008). AMEE Guide no. 34: Teaching in the clinical environment. <i>Medical Teacher<\/i>, <i>30<\/i>(4), 347\u2013364. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1080\/01421590802061613\">https:\/\/doi.org\/10.1080\/01421590802061613<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Ripp, J. A., Privitera, M. R., West, C. P., Leiter, R., Logio, L., Shapiro, J., &amp; Bazari, H. (2017). Well-being in graduate medical education: A call for action. <i>Academic Medicine<\/i>, <i>92<\/i>(7), 914\u2013917. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1097\/ACM.0000000000001735\">https:\/\/doi.org\/10.1097\/ACM.0000000000001735<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Risberg, G., Johansson, E. E., Westman, G., &amp; Hamberg, K. (2003). Gender in medicine \u2013 An issue for women only? A survey of physician teachers\u2019 gender attitudes. <i>International Journal for Equity in Health<\/i>, <i>2<\/i>(1), Article 10. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1186\/1475-9276-2-10\">https:\/\/doi.org\/10.1186\/1475-9276-2-10<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Roff, S., McAleer, S., &amp; Skinner, A. (2005). Development and validation of an instrument to measure the postgraduate clinical learning and teaching educational environment for hospital-based junior doctors in the UK. <i>Medical Teacher<\/i>, <i>27<\/i>(4), 326\u2013331. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1080\/01421590500150874\">https:\/\/doi.org\/10.1080\/01421590500150874<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Sandhu, A., Liaqat, N., Waheed, K., Ejaz, S., Khanum, A., Butt, A., Randhawa, F. A., &amp; Dar, S. H. (2018). Evaluation of educational environment for postgraduate residents using Post Graduate Hospital Educational Environment Measure. <i>The Journal of the Pakistan Medical Association<\/i>, <i>68<\/i>(5), 790\u2013792.<\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Sch\u00f6nrock-Adema, J., Bouwkamp-Timmer, T., van Hell, E. A., &amp; Cohen-Schotanus, J. (2012). Key elements in assessing the educational environment: Where is the theory? <i>Advances in Health Sciences Education<\/i>, <i>17<\/i>(5), 727\u2013742. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1007\/s10459-011-9346-8\">https:\/\/doi.org\/10.1007\/s10459-011-9346-8<\/a><\/span><span lang=\"EN-US\"> \u00a0<\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Shankar, P. R., Balasubramanium, R., Dwivedi, N. R., &amp; Nuguri, V. (2014). Student feedback about the integrated curriculum in a Caribbean medical school. <i>Journal of Educational Evaluation for Health Professions<\/i>, <i>11<\/i>, 23. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.3352\/jeehp.2014.11.23\">https:\/\/doi.org\/10.3352\/jeehp.2014.11.23<\/a><\/span><span lang=\"EN-US\"> \u00a0<\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Silkens, M. E. W. M., Chahine, S., Lombarts, K. M. J. M. H., &amp; Arah, O. A. (2018). From good to excellent: Improving clinical departments\u2019 learning climate in residency training. <i>Medical Teacher<\/i>, <i>40<\/i>(3), 237\u2013243. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1080\/0142159X.2017.1398821\">https:\/\/doi.org\/10.1080\/0142159X.2017.1398821<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Talib, Z., Narayan, L., &amp; Harrod, T. (2019). Postgraduate medical education in Sub-saharan Africa: A scoping review spanning 26 years and lessons learned. <i>Journal of Graduate Medical Education<\/i>, <i>11<\/i>(4s), 34\u201346. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.4300\/JGME-D-19-00170\">https:\/\/doi.org\/10.4300\/JGME-D-19-00170<\/a><\/span><span lang=\"EN-US\"> <\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Vieira, J. E. (2008). The postgraduate hospital educational environment measure (PHEEM) questionnaire identifies quality of instruction as a key factor predicting academic achievement. <i>Clinics<\/i>, <i>63<\/i>(6), 741\u2013746. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1590\/S1807-59322008000600006\">https:\/\/doi.org\/10.1590\/S1807-59322008000600006<\/a> <\/span><\/p>\r\n<p style=\"text-align: left;\">*<span lang=\"EN-GB\">Muhammad Irfan Kamaruddin<\/span><br \/>\r\n<span lang=\"EN-GB\">Department of Medical Education<\/span>, <br \/>\r\n<span lang=\"EN-GB\">Faculty of Medicine, Hasanuddin University,<\/span><br \/>\r\n<span lang=\"EN-GB\">Jalan Perintis Kemerdekaan KM 10<\/span><br \/>\r\n<span lang=\"EN-GB\">Makassar 90245<\/span><br \/>\r\n<span lang=\"EN-GB\">Email: iphenk_tampo@yahoo.com<\/span><\/p>","protected":false},"featured_media":0,"parent":0,"menu_order":5,"template":"","issues_category":[12],"archive_category":[],"issue_type":[25],"volume_category":[61882],"class_list":["post-72424","issues","type-issues","status-publish","hentry","issues_category-original-articles","issue_type-past-issue","volume_category-volume-9-number-2-april-2024"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - 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