The learning environment of surgical training in Kenya: results from a multi-institutional survey of trainees within two educational paradigms

Purposes Surgical trainees are immersed in a learning environment that can either foster or inhibit their growth into compassionate and competent surgeons. This study sought to identify organizational and institutional cultures that influence the learning environment and trainees' professional development. Methods The Postgraduate Hospital Educational Environment Measure (PHEEM) was electronically distributed to all surgical trainees in Kenya in March 2020 by the Surgical Society of Kenya. The PHEEM instrument consists of 40 questions, grouped into three subscales for perceptions of role autonomy, teaching, and social support. Additional data included type of training, availability of faculty, and trainee gender. Data were analyzed for frequency, and comparisons examined the impact of trainee gender and type of training institution. Results The survey had a 16% response rate (n = 75). 54 men (74%) and 19 women (26%) participated and represented 19 different training sites. The mean PHEEM overall score was 95.8 (SD 31.5), with scores of 37.9 (12.9) on teaching, 32.4 (11.2) on autonomy, and 25.5 (8.6) on social support. There were significant differences in overall scores between training paradigms (COSECSA 107.2 versus MMed 79.6; p < 0.001) and trainee gender (men 101.2 versus women 82.8; p = 0.03). Availability of faculty and training at mission hospitals was strongly predictive of higher PHEEM scores. Conclusions This baseline assessment of surgical training in Kenya reveals strengths and weaknesses to inform future quality improvement initiatives. The findings demonstrate that trainees' perceptions of their learning environments are impacted by their institution and faculty supervisors.