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Original Research

Formal assessment of the educational environment experienced by interns placed in rural hospitals in Western Australia

Submitted: 21 February 2013
Revised: 27 June 2013
Accepted: 30 July 2013
Published: 20 October 2013

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Author(s) : Auret KA, Skinner L, Sinclair C, Evans SF.

Citation: Auret KA, Skinner L, Sinclair C, Evans SF.  Formal assessment of the educational environment experienced by interns placed in rural hospitals in Western Australia. Rural and Remote Health (Internet) 2013; 13: 2549. Available: (Accessed 21 October 2017)


Introduction:  Increased numbers of rural hospital rotations for interns (first postgraduate year) are being created in Western Australia (WA). This study utilised the Postgraduate Hospital Educational Environment Measure (PHEEM), an internationally validated multidimensional questionnaire, to assess and compare the educational environment of five new or established rural sites and an urban teaching hospital.
Methods:  The PHEEM was modified slightly: to make language appropriate for the WA context and to collect information about intern location. It was administered at the completion of each 10-week term over the first postgraduate year in 2009.
Results:  A total of 147 completed PHEEM questionnaires were returned from 74 interns, evaluating a maximum of 210 individual 10-week terms (105 each from urban and combined rural). Average completion time was 6.4 minutes. The median score for teaching was 45.0 (interquartile range 39.0, 50.0) in rural locations and 43.0 (37.5, 46.0) in urban locations (p=0.046). The median scores for autonomy were 39.0 (35.0, 45.0) and 39.0 (36.0, 41.5) (p=0.672) and for support median scores 33.0 (28.0, 35.0) and 31.0 (28.0, 33.0) (p=0.019) in rural and urban locations respectively.
Conclusion:  This study has utilised an Australian-appropriate version of the PHEEM and has provided the first confirmation that, in terms of educational environment, rural intern rotations compare favourably with those in urban settings in WA.

Key words: rural hospitals, educational environment, graduate medical education, internship and residency.

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