Educational environment in intensive care medicine—use of Postgraduate Hospital Educational Environment Measure (PHEEM)

Figures & data

Table

Practice points
•The educational climate or environment is an important educational measure in the quality of the doctors’ postgraduate training.
•PHEEM is simple to use.
•PHEEM is a reliable and useful tool with which to measure educational climate.
•Intensive care medicine might be perceived by some as a stressful, intensive and threatening environment within which junior doctors work.
•The educational climate in intensive care medicine is in fact good, is supportive to junior doctors and there is no racism or sexism experienced within these posts.

Table 1.  Summary results of PHEEM questionnaire (## – questions with reverse scoring)

	Mean	Median	Std. deviation
q1 – I have a contract of employment that provides information about hours of work	2.26	3	1.24
q2 – My clinical teachers set clear expectations	2.26	3	1.05
q3 – I have protected educational time in this post	2.34	3	1.25
q4 – I had an informative induction programme	2.24	3	1.25
q5 – I have the appropriate level of responsibility in this post	3.09	3	0.79
q6 – I have good clinical supervision at all time	3.20	3	0.88
q7 – There is racism in this post ##	3.19	3	0.98
q8 – I have to perform inappropriate tasks ##	2.62	3	1.12
q9 – There is an informative Junior Doctors handbook	1.84	2	1.01
q10 – My clinical teachers have good communication skills	2.96	3	0.93
q11 – I am bleeped inappropriately ##	2.55	3	1.01
q12 – I am able to participate actively in educational events	2.68	3	0.88
q13 – There is sexism in this post ##	3.15	3	0.94
q14 – There are clear clinical protocols in this post	2.47	3	0.94
q15 – My clinical teachers are enthusiastic	2.91	3	0.93
q16 – I have good collaboration with other doctors in my grade	3.18	3	0.67
q17 – My hours conform to the new deal	2.62	3	1.02
q18 – I have the opportunity to provide continuity of care	2.49	3	0.87
q19 – I have suitable access to careers advice	2.40	3	0.91
q20–This hospital has good quality accommodation for junior doctors, especially when on call	1.74	1.5	1.15
q21 – There is access to an educational programme relevant to my needs	2.39	3	1.05
q22 – I get regular feedback from seniors	2.10	2	1.11
q23 – My clinical teachers are well organized	2.34	3	1.04
q24 – I feel physically safe within the hospital environment	2.99	3	0.78
q25 – There is a no-blame culture in this post	2.64	3	1.04
q26 – There adequate catering facilities when I am on call	1.69	1	1.29
q27 – I have enough clinical learning opportunities for my needs	2.66	3	0.93
q28 – My clinical teachers have good teaching skills	2.83	3	0.95
q29 – I feel part of a team working here	3.01	3	0.83
q30 – I have opportunities to acquire the appropriate practical procedures for my grade	2.99	3	0.84
q31 – My clinical teachers are accessible	3.01	3	0.78
q32 – My workload in this job is fine	2.90	3	0.64
q33 – Senior staff utilize learning opportunities effectively	2.35	2	0.87
q34 – The training in this post makes me feel ready to be a SpR/Consultant	2.52	3	0.88
q35 – My clinical teachers have good mentoring skills	2.51	3	0.81
q36 – I get a lot of enjoyment out of my present job	2.93	3	0.76
q37 – My clinical teachers encourage me to be an independent learner	2.68	3	0.79
q38 – There are good counselling opportunities for junior doctors who fail to complete their training satisfactorily	1.98	2	0.67
q39 – The clinical teachers provide me with good feedback on my strengths and weaknesses	2.13	2	1.03
q40 – My clinical teachers promote an atmosphere of mutual respect	2.75	3	1.05

Table 2.  Questions with mean scores high (more than 3) or low (less than 2) [## reverse scores high = little racism or sexism]

High mean > 3	Low mean < 2
q6 – I have good clinical supervision at all time	q38 – There are good counselling opportunities for junior doctors who fail to complete their training satisfactorily
q7 – There is (no) racism in this post ##	q26 – There adequate catering facilities when I am on call
q16 – I have good collaboration with other doctors in my grade	q20 -This hospital has good quality accommodation for junior doctors, especially when on call
q13 – There is (no) sexism in this post ##	q9 – There is an informative Junior Doctors handbook
q5 – I have an appropriate level of responsibility
q29 – I feel part of a team working here
q31 – My clinical teachers are accessible

Table 3.  Summary of aggregate scores from PHEEM questionnaire

	Mean	Median	Std. deviation
Global overview (all questions) (out of 160)	103.5	105	19.10
Perceptions of teaching (2, 3, 6, 10, 12, 15, 21, 22, 23, 27, 28, 31, 33, 37, 39) (out of 60)	38.8	40.5	9.46
Perceptions of role autonomy (1, 4, 5, 8, 9, 11, 14, 17, 18, 29, 30, 32, 34, 40) (out of 56)	35.7	35.5	7.03
Perceptions of social support (7, 13, 16, 19, 20, 24, 25, 26, 35, 36, 38) (out of 44)	28.43	29	5.20

Table 4.  Numbers of trainees in PHEEM categories

Overall scores	<40 very poor	1
	41–80 plenty problems	8
	81–120 more + than–	110
	>120 excellent	15
Perceptions of teaching	0–15 poor	2
	16–30 need retraining	25
	31–45 moving right direction	75
	46–60 model teachers	32
Perceptions of autonomy	0–14 poor	0
	15–28 negative view of ones role	19
	29–42 more positive perception	98
	43–56 excellent	17
Perceptions social support	0–11 non-existent	1
	12–22 not pleasant	14
	23–33 more pros than cons	102
	34–44 good support	17

Table 5.  Factors shown in PHEEM data

The Teacher
q33 – Senior staff utilise learning opportunities effectively
q23 – My clinical teachers are well organised
q14 – There are clear clinical protocols in this post
q35 – My clinical teachers have good mentoring skills
q39 – The clinical teachers provide me with good feedback on my strengths and weaknesses
q15 – My clinical teachers are enthusiastic
q22 – I get regular feedback from seniors
q2 – My clinical teachers set clear expectations
Learning doctoring skills in a safe environment
q30 – I have opportunities to acquire the appropriate practical procedures for my grade
q28 – My clinical teachers have good teaching skills
q31 – My clinical teachers are accessible
q18 – I have the opportunity to provide continuity of care
q40 – My clinical teachers promote an atmosphere of mutual respect
Happiness
q25 – There is a no-blame culture in this post
q24 – I feel physically safe within the hospital environment
q17 – My hours conform to the new deal
q36 – I get a lot of enjoyment out of my present job

Table

		Strongly Agree	Agree	Uncertain	Disagree	Strongly Disagree
1	I have a contract of employment that provides information about hours of work	□	□	□	□	□
2	My clinical teachers set clear expectations	□	□	□	□	□
3	I have protected educational time in this post	□	□	□	□	□
4	I had an informative induction programme	□	□	□	□	□
5	I have the appropriate level of responsibility in this post	□	□	□	□	□
6	I have good clinical supervision at all time	□	□	□	□	□
7	There is racism in this post	□	□	□	□	□
8	I have to perform inappropriate tasks	□	□	□	□	□
9	There is an informative Junior Doctors handbook	□	□	□	□	□
10	My clinical teachers have good communication skills	□	□	□	□	□
11	I am bleeped inappropriately	□	□	□	□	□
12	I am able to participate actively in educational events	□	□	□	□	□
13	There is sex discrimination in this post	□	□	□	□	□
14	There are clear clinical protocols in this post	□	□	□	□	□
15	My clinical teachers are enthusiastic	□	□	□	□	□
16	I have good collaboration with other doctors in my Grade	□	□	□	□	□
17	My hours conform to the new deal	□	□	□	□	□
18	I have the opportunity to provide continuity of care	□	□	□	□	□
19	I have suitable access to careers advice	□	□	□	□	□
20	This hospital has good quality accommodation for junior doctors, especially when on call	□	□	□	□	□
21	There is access to an educational programme relevant to my needs	□	□	□	□	□
22	I get regularly feedback from seniors	□	□	□	□	□
23	My clinical teachers are well organised	□	□	□	□	□
24	I feel physically safe within the hospital environment	□	□	□	□	□
25	There is a no-blame culture in this post	□	□	□	□	□
26	There adequate catering facilities when I am on call	□	□	□	□	□
27	I have enough clinical learning opportunities for my needs	□	□	□	□	□
28	My clinical teachers have good teaching skills	□	□	□	□	□
29	I feel part of a team working here	□	□	□	□	□
30	I have opportunities to acquire the appropriate practical procedures for my grade	□	□	□	□	□
31	My clinical teachers are accessible	□	□	□	□	□
32	My workload in this job is fine	□	□	□	□	□
33	Senior staff utilise learning opportunities effectively	□	□	□	□	□
34	The training in this post makes me feel ready to be a SpR/Consultant	□	□	□	□	□
35	My clinical teachers have good mentoring skills	□	□	□	□	□
36	I get a lot of enjoyment out of my present job	□	□	□	□	□
37	My clinical teachers encourage me to be an independent learner	□	□	□	□	□
38	There are good counselling opportunities for junior doctors who fail to complete their training satisfactorily	□	□	□	□	□
39	The clinical teachers provide me with good feedback on my strengthens and weaknesses	□	□	□	□	□
40	My clinical teachers promote an atmosphere of mutual respect	□	□	□	□	□