Evaluation of the Postgraduate Learning Environment in Tunisian University Hospitals Using an Adapted French Version of the PHEEM Questionnaire

Abstract Background The clinical learning environment plays a fundamental role in the professional development and well-being of medical residents. In Tunisia, there has been a lack of validated tools to assess this environment in a structured and consistent manner. This study aims to evaluate the perceptions of residents regarding their training environment using an adapted French version of the Postgraduate Hospital Educational Environment Measure (PHEEM). Methods A descriptive cross-sectional study was carried out between June and December 2024 in the faculty of medicine of Tunis and multiple Tunisian teaching hospitals. Residents from various specialties and all postgraduate years were invited to complete the PHEEM questionnaire, culturally adapted by modifying two items. Internal consistency was assessed using Cronbach’s alpha, and principal component analysis (PCA) was used to explore the factorial structure. Results A total of 400 residents participated in the study, of whom 372 completed the full questionnaire and were included in the final analysis. The overall Cronbach’s alpha was 0.922, indicating excellent internal consistency. PCA identified nine components with eigenvalues > 1, explaining 63.4% of total variance. The first three components aligned with the original domains (role autonomy, teaching, and social support). The mean overall PHEEM score was 127/200, interpreted as “more positive than negative”. Surgical residents reported significantly lower scores than those in medical and intensive care specialties (p < 0.001). Conclusions This study supports the construct validity and internal consistency of an adapted French version of the PHEEM questionnaire for use in Tunisia. It also provides the first national insight into residents’ perceptions of their learning environment, highlighting specific areas for improvement; particularly in surgical specialties. These findings offer a valuable baseline for future reforms in postgraduate medical education in resource-limited settings.