Assessment of Training Environment of Plastic, Reconstructive, and Hand Surgery in Ethiopia

Abstract

Background: A supportive clinical learning environment is critical for effective surgical training, promoting professional growth and problem-solving skills. Despite global use of tools like the Postgraduate Hospital Educational Environment Measure (PHEEM), Ethiopia lacks data on the training environment for plastic and reconstructive surgery, limiting efforts toward educational quality improvement.This study aims to explore and assess the perceptions and experiences of trainees and educators in Ethiopia's plastic, reconstructive, and hand surgery programs regarding the training environment. Methods: A mixed-methods design was used at Addis Ababa University and St. Paul's Hospital Millennium Medical College. Quantitative data were collected using the validated PHEEM questionnaire, whereas qualitative data were gathered through in-depth interviews and focus group discussions. Purposeful sampling was used, and data collection continued until thematic saturation. Thematic analysis was conducted using NVivo software. Results: Forty-eight residents participated (56.3% male), with a mean age of 28. The average PHEEM score was 85 of 160 (53% satisfaction). Subscale scores indicated moderate satisfaction across domains: autonomy (51.9%), teaching (55.3%), and social support (51.8%). Teaching received the highest score, whereas social support was the lowest. Qualitative analysis identified 4 key themes: poor training environment, the importance of collaboration and networking, the role of resilience, and the need to move from general to specialized plastic surgery practice. Conclusions: Although residents appreciated aspects of teaching, there is a clear need to strengthen social support and overall training quality. Findings highlight opportunities for targeted improvements in Ethiopia's surgical education system.