Perception of the clinical learning environment among cardiology residents: A PHEEM-based cross-sectional study in a Moroccan university hospital

Abstract

Background: The hospital learning environment quality is a key determinant of postgraduate medical training outcomes. The PHEEM is a validated 40-item instrument widely used to evaluate residents' perceptions of their clinical training environment. No study has previously assessed the learning environment among cardiology residents in Morocco. Methods: A cross-sectional survey was conducted in February 2026 at Ibn Sina University Hospital, Rabat, Morocco. All cardiology residents were invited to participate, yielding a response rate of 86.1% (130/151). The French-language validated PHEEM was distributed electronically. Global and subscale scores were computed for perception of role autonomy, teaching, and social support. Internal consistency was assessed using Cronbach's alpha and group comparisons by one-way ANOVA. Results: The mean global PHEEM score was 82.43 ± 19.42 out of 160, placing the learning environment in the "more positive than negative" category. Subscale scores were 30.20 ± 8.18 out of 56 for autonomy, 32.15 ± 8.09 out of 60 for teaching, and 20.08 ± 5.24 out of 44 for social support. Internal consistency was excellent (Cronbach's α = 0.928). No significant differences were found by year of residency (F = 0.650, p = 0.584) or subspecialty interest (F = 1.500, p = 0.195). However, role autonomy differed significantly across subspecialty groups (F = 2.730, p = 0.022), with heart failure residents scoring highest and cardiac imaging residents lowest. Conclusion: Cardiology residents perceived their learning environment positively overall, though social support was the most deficient domain. Subspecialty-specific disparities in autonomy warrant targeted interventions within imaging-oriented training tracks.