恢复叙利亚后阿萨德时代教学医院的临床学习环境：PHEEM分析与建议
Restoring the Clinical Learning Environment at Teaching Hospitals in Post-Assad Syria: A PHEEM Analysis and Recommendations.
作者信息
Alfakhry Ghaith, Kodmani Rama, Ghandour Munir, Al Munajjed Amer, Khwanda Rawan
机构信息
Education Quality and Scientific Research Office, Al-Sham Private University, Damascus, Damascus Governorate, NA, Syria.
University Hospital of Dermatology and Venereology, Damascus University, Damascus, Damascus Governorate, NA, Syria.
出版信息
MedEdPublish (2016). 2025 Apr 14;15:15. doi: 10.12688/mep.20955.1. eCollection 2025.
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.
引言
在阿萨德家族长达54年的独裁统治之后，叙利亚终于获得自由，但却满目疮痍。卫生专业教育培训体系也不例外，文献中有许多相关指标，但均未采用经过验证的方法对临床学习环境（CLE）进行系统评估。因此，本研究旨在评估叙利亚大马士革教学医院的临床学习环境。
方法
这项横断面研究于2023年年中在叙利亚大马士革进行，当时阿萨德政权尚未垮台。研究对象包括在大马士革任何一家教学医院工作和培训的所有住院医生。我们使用最近经过验证的36项PHEEM量表作为数据收集工具，并添加了10项与叙利亚具体情况相关的额外项目。还有一个开放式问题。我们采用非概率抽样技术从14家不同的教学医院招募参与者。
结果
共有来自31个医学专业的1490名住院医生参与了研究，约占当时总人口的37%。女性参与者占总样本的50.7%（n = 754）。克朗巴哈系数为0.925。PHEEM量表的总平均分为72.4±21.4（满分144）。除学习者参与度和社会参与度外，PHEEM量表的所有领域均存在明显不足。得分最低的领域是外部监管、工作文化和生活条件，得分分别为48.5%、40.8%和31.2%。另外10项与战争相关项目的结果很重要。其中一项显示，只有14%的受访者没有移民计划。书面评论在更多背景下再次印证了PHEEM量表的一些结果。
讨论
本研究为临床教育工作者、立法者和新领导人制定了路线图，以便他们进行有针对性的改革和投资，以恢复临床学习环境。存在一些重大问题，这些问题不仅使住院医生培训效果不佳，还危及住院医生和患者的安全。
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