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Article . 2025 . Peer-reviewed
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Restoring the Clinical Learning Environment at Teaching Hospitals in Post-Assad Syria: A PHEEM Analysis and Recommendations [version 1; peer review: 2 approved]

Authors: Amer Al Munajjed; Rama Kodmani; Ghaith Alfakhry; Rawan Khwanda; Munir Ghandour;

Restoring the Clinical Learning Environment at Teaching Hospitals in Post-Assad Syria: A PHEEM Analysis and Recommendations [version 1; peer review: 2 approved]

Abstract

Introduction After 54 years of Assad’s family dictatorship, Syria was finally free but, nonetheless, was in ruins. The health profession education training system is no exception, and there have been many indicators of this in the literature, but none of them have provided a systematic evaluation of the clinical learning environment (CLE) using validated approaches. Therefore, this study aimed to evaluate CLE at teaching hospitals in Damascus, Syria. Methods This cross-sectional study was conducted in Damascus, Syria, during mid-2023, before Assad’s regime collapsed. The study population included all resident doctors working and training at any teaching hospital in Damascus. We used the recently validated 36-item PHEEM inventory as a data collection tool and added 10 extra items related to Syria’s specific context. There was also one open-ended question. We recruited participants from 14 different teaching hospitals using nonprobability sampling techniques. Results A total of 1490 residents from 31 medical specialties participated in the study, which was approximately 37% of the total population at that time. The female participants comprised 50.7% (n=754) of the total sample. The Cronbach’s alpha was 0.925. The total PHEEM mean score was 72.4±21.4 (Max. 144). All the PHEEM domains showed significant shortcomings, except for learner engagement and social participation. The worst-scoring domains were external regulation, work culture, and living conditions, with scores of 48.5%, 40.8%, and 31.2%, respectively. The results of the additional 10 war-related items were important. One item showed that only 14% of respondents did not have plans to migrate. The written comments re-echo some of the PHEEM findings in more context. Discussion This study draws a roadmap for clinical educators, lawmakers, and new leaders to make targeted reforms and investments to restore the clinical learning environment. There are major issues that not only render training residents suboptimal but also compromise residents' and patients’ safety.

Keywords

eng, post-Assad Syria., LC8-6691, Postgraduate Hospital Education Environment Measure, R, Medicine, Arabic PHEEM, PHEEM, Special aspects of education, Clinical Learning Environment

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
Average
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