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

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Ahmad Aalam1,2, Mark Zocchi3, Khalid Alyami4, Abdullah Shalabi5, Abdullah Bakhsh1, Asaad Alsufyani6, Abdulrahman Sabbaghr7, Mohammed Alshahrani4, Jesse M. Pines2,3


1 Department of Emergency Medicine, King Abdulaziz University, Jeddah, Saudi Arabia


Department of Emergency Medicine, The George Washington University, Washington, DC, USA


3 Center for Healthcare Innovation and Policy Research, The George Washington University, Washington, DC, USA


4 Department of Pediatrics, University of Dammam, Dammam, Saudi Arabia


5 Department of Emergency Medicine, King Abdulaziz Medical City, National Guard Hospital, Jeddah, Saudi Arabia


6 Department of Emergency Medicine, University of Toledo, Toledo, Ohio, USA


7 Department of Emergency Medicine, King Fahad Medical City, Riyadh, Saudi Arabia


Corresponding Author: Muhammad Akhter Hamid, Email: mahamid@rougevalley.ca


© 2017 World Journal of Emergency Medicine


DOI: 10.5847/wjem.j.1920–8642.2018.01.001


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-specifi c 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 signifi cant 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.

(World J Emerg Med 2018;9(1):5–12)


KEY WORDS: Emergency medicine residents; Residency training; United States of America; Saudi Arabia



A central question for applicants to emergency medicine residency training programs is the quality of their educational experience and environment. Emergency medicine residency programs differ by educational quality, patient care experiences, faculty, ancillary support (e.g. nursing staff, etc.), workplace environment, how evaluations are conducted, and personal support.[1] Educational environment includes physical environment (comforts, food, accommodations), emotional environment (constructive feedback, security, supports, and having a bullying-free environment) and intellectual environment (learning through patient care, evidence-based teaching, motivation, active participation by learners, and planned education).[2]

Many physicians who are citizens of Saudi Arabia (SA) have the option to be supported by the King Abdullah scholarship program which funds United States (USA) and Canadian universities and hospitals programs to train SA physicians. As of 2016, USA emergency medicine residencies have 1,896 training slots in 174 programs compared with 133 training slots in 3 programs in SA.[3,4] Many physicians around the world and in SA seek training in the USA for its well-developed EM residency programs. In 2014 the Saudi Arabian Cultural Mission (SACM) matched 88 Saudi physicians in USA residency programs, wi th 11 physicians entering emergency medicine.[5] Therefore, comparing the quality of EM training in USA and SA residency training programs is important to help physicians who are choosing whether to train in the USA or SA. It is also helpful in identifying differences in educational environments to allow emergency physician educators to identity targeted areas for improvement in both countries. To our knowledge, no studies have directly compared the quality of the educational environment of emergency medicine training programs in the USA and SA.

In this study, we compare educational environments in emergency medicine training programs between a select group of residency programs in the USA that have a history of training Saudi Arabian physicians and all three emergency medicine residency programs in SA using a modified version of a validated instrument, the Postgraduate Hospital Educational Environment Measure (PHEEM) survey. In the paper, we fi rst compare differences in the overall PHEEM score across the two countries, then directly compare subscales and discuss the implications of the fi ndings.



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