Abstract:
Background: An effective tool in analysing the learning environment, customised to the Sri
Lankan setting, is vital for the assessment and delivery of quality healthcare training of preregistration
house officers. Such a tool should be reliable and valid. We assessed psychometric
properties such as internal reliability and construct validity of a modified version of the
Postgraduate Hospital Educational Environment Measure (PHEEM). Materials and Methods:
A modified PHEEM questionnaire customised to the Sri Lankan context was developed in
accordance to the Sri Lanka Medical Council guidelines. The questionnaire was distributed to
all interns at the National Hospital of Sri Lanka, Colombo North Teaching Hospital and
Wathupitiwala Base Hospital during a calendar year (n = 100, response rate = 86%). Internal
reliability and construct validity of the inventory were assessed by using Cronbach’s alpha and
exploratory factor analysis respectively as statistical methods. Results: PHEEM consists of 3
subscales: perceptions of autonomy, social support and teaching, which are factors perceived to
be influencing the educational environment. This administration demonstrated high internal
reliability as reflected by a Cronbach’s alpha value of 0.84. Exploratory factor analysis identified
12 factors with eigenvalue >1. However, the first factor had an eigenvalue of 6.7 (accounting for
19.7% of variance), while the rest had eigenvalues < 2.5. These results suggest a single predictive
factor and thus a one-dimensional scale as opposed to the three-dimensional scale which is used
in the current questionnaire. Conclusions: The psychometric properties of this tool reflect a high
degree of internal reliability in assessing the educational environment of intern doctors in Sri
Lanka. It is possible that the clinical educational environment is collectively represented as a
single dimension. This may be due to the complex interplay between individual items in the
questionnaire. Therefore the psychometric properties do not justify the interpretation of the
educational environment through specified subscales.