Perceptions of emergency medicine residents on the quality of residency training in the United States and Saudi Arabia

doi:10.5847/wjem.j.1920-8642.2018.01.001

Abstract

Abstract:

BACKGROUND: We compare educational environments (i.e. physical, emotional and intellectual experiences) of emergency medicine (EM) residents training in the United States of America (USA) and Saudi Arabia (SA).
METHODS: A cross-sectional survey study was conducted using an adapted version of the validated Postgraduate Hospital Educational Environment Measure (PHEEM) survey instrument from April 2015 through June 2016 to compare educational environments in all emergency medicine residency programs in SA and three selected programs in the USA with a history of training Saudi physicians. Overall scores were compared across programs, and for subscales (autonomy, teaching, and social Support), using chi-squared, t-tests, and analysis of variance.
RESULTS: A total of 219 surveys were returned for 260 residents across six programs (3 SA, 3 USA), with a response rate of 84%. Program-specific response rates varied from 79%-100%. All six residencies were qualitatively rated as “more positive than negative but room for improvement”. Quantitative PHEEM scores for the USA programs were significantly higher: 118.7 compared to 109.9 for SA, P=0.001. In subscales, perceptions of social support were not different between the two countries (P=0.243); however, role autonomy (P<0.001) and teaching (P=0.005) were better in USA programs. There were no significant differences by post-graduate training year.
CONCLUSION: EM residents in all three emergency medicine residency programs in SA and the three USA programs studied perceive their training as high quality in general, but with room for improvements. USA residency programs scored higher in overall quality. This was driven by more favorable perceptions of role autonomy and teaching. Understanding how residents perceive their programs may help drive targeted quality improvement efforts.

Key words: Emergency medicine residents, Residency training, United States of America, Saudi Arabia

Ahmad Aalam, Mark Zocchi, Khalid Alyami, Abdullah Shalabi, Abdullah Bakhsh, Asaad Alsufyani, Abdulrahman Sabbagh, Mohammed Alshahrani, Jesse M. Pines. Perceptions of emergency medicine residents on the quality of residency training in the United States and Saudi Arabia[J]. World Journal of Emergency Medicine, 2018, 9(1): 5-13.

Figures/Tables 3

Table 1

Figure 1.

Table 2

References 20

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Subscale	Score: PHEEM Interpretation	Saudi Arabia (n=109)	United States of America (n=108)	P
I. Perceptions of role autonomy	0-14: very poor	0	0
	15-28: a negative view of one’s role	5	2
	29-42: a more positive perception of one’s job	83	59	<0.001*
	43-56 excellent perception of one’s job	21	47
II. Perceptions of teaching	0-15: very poor quality	1	0
	16-30: in need of some retraining	4	3	0.005*
	31-45: moving in the right direction	70	46
	46-60: model teachers	34	59
III. Perceptions of social support	0-11: non-existent	1	0	0.243
	12-22: not a pleasant place	9	6
	23-33: more pros than cons	82	75
	34-44: a good supportive environment	17	27
Total score	0-40: very poor	0	0	0.001*
	41-80: plenty of problems	5	1
	81-120: more positive than negative but room for improvement	80	58
	121-160: excellent	24	49

Parameters		Subscales		Total (max=160)
Parameters	Autonomy (max=56)	Teaching (max=60)	Social support (max=44)	Total (max=160)
Program
US site #1	40.9	44.9	30.6	116.4
US site #2	42.9	49.0	30.6	122.6
US site #3	40.5	43.5	30.0	114.0
SA site #1	38.3	43.6	29.0	110.9
SA site #2	35.9	39.7	27.4	103.0
SA site #3	39.6	44.5	28.2	112.2
P value (ANOVA)	<0.001*	<0.001*	0.114	<0.001*
Country
Saudi Arabia	38.1	43.1	28.6	109.8
United States	41.8	46.5	30.5	118.7
P value (t-test)	<0.001*	0.001*	0.007*	<0.001*
Post-graduate years
1	39.4	45.0	29.6	114.0
2	40.0	43.9	29.2	113.2
3	40.8	45.9	29.7	116.3
4^＃	40.2	44.8	30.0	115.0
P value (ANOVA)	0.662	0.579	0.935	0.779