Evaluating the hospital learning environment for medical interns in Uganda: a cross-sectional study at three national referral hospitals

Medical internship is a crucial phase of medical training, where theoretical knowledge is translated into practical skills through supervised patient care. Globally, this training is grounded in work-based learning principle, but balancing educational objectives with service delivery often creates challenges. In developed settings, learning environments are integral to accreditation standards, while in Uganda, issues such as poor supervision, inadequate resources, and dissatisfaction among interns remain prevalent. Structural changes to internship rotations and frequent strikes further highlight the need for systematic evaluation. Despite these challenges, no formal feedback mechanisms exist to capture intern doctors’ perspectives on their clinical learning environments. We sought to evaluate intern doctors’ perceptions of their hospital learning environment and compare these perceptions across clinical departments in three National Referral Hospitals. We conducted a cross-sectional study at Mulago, Kawempe, and Kiruddu National Referral Hospitals among medical interns in August 2021. Medical interns who had completed at least one month in their current rotation were consecutively enrolled and completed a self-administered Postgraduate Hospital Education Environment Measure (PHEEM) questionnaire adapted to the local context. The tool assessed perceptions of the learning environment across three subscales: autonomy, teaching, and social support, with negatively worded items reversed. Data were analyzed using SPSS 17.0, with mean, total and subscale scores compared across clinical disciplines using independent t-test, ANOVA and Bonferroni-adjusted post-hoc tests, and statistical significance set at p ≤ 0.05. A total of 200 medical interns participated in our study. The mean learning environment score for the three hospitals was 93.27 (maximum 160), with subscale scores of 31.35 (maximum 56) for autonomy, 37.37 (maximum 60) for teaching, and 23.65 (maximum 44) for social support. Overall perception scores varied across clinical rotations, with internal medicine scoring highest (98 ± 24.5) and surgery the lowest (84 ± 16.7). Surgery scored significantly lower than internal medicine (mean difference = 13.9, CI: (1.77–26.2), ( p = 0.016)). Among the three subscales, medical rotations were scored higher in perception of role autonomy and social support than the surgical rotations with significant mean differences (Internal medicine 4.16 (95% CI: 0.04–8.29) and pediatrics 3.92 (95% CI: 0.15–7.96)). Overall perception scores were higher in male interns (93.9) than females (88.48), but this difference was not statistically significant. The hospital learning environment in the three hospitals assessed was more positive than negative, with room for improvement. Medical interns’ perceptions of the learning environment varied across clinical rotations, with medical clinical rotations scoring higher in the overall and subscale comparisons than the surgical clinical rotation. Targeted interventions in surgical rotations to enhance the educational environment are key. Policymakers and hospital administrators could prioritize improving mentorship and social support structures across rotations to optimize interns’ learning outcomes.