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PHEEM is the Postgraduate Hospital Educational Environment Measure, a scored forty item questionnaire that was developed by Roff et al. to evaluate various aspects of the clinical learning environment for junior doctors. PHEEM scores three domains of the clinical learning environment: perceptions of autonomy; perceptions of teaching; and perceptions of social support. Psychometric testing of the PHEEM instrument in 2007 by Boor et al. concluded that it is one-dimensional and does not measure three domains; however, further psychometric testing in 2009 by Riquelme et al. suggests the PHEEM instrument is multi-dimensional. PHEEM has been used successfully in several countries.
The Victorian PHEEM project is an ongoing initiative facilitated by the Postgraduate Medical Council of Victoria and jointly conducted by Medical Education Officers (MEOs) at participating hospitals. The PHEEM instrument used in Victoria is identical to the original UK version except for minor amendments to language, which make it congruent with Australian terminology. The demographics section of the Victorian PHEEM instrument was expanded.
Conducting the PHEEM
MEOs at participating hospitals administer the PHEEM at the end of each term rotation to junior doctors in their first, second and third postgraduate years (PGY 1, 2, 3). Completed questionnaires are collected and PMCV coordinates the processing and statistical analysis of the information, which is then reported back to the participating hospitals. Each hospital is responsible for disseminating their data as necessary to address their needs.
Hospitals have varying needs and purposes in relation to their involvement in the PHEEM project including the capacity to benchmark; and to find out what hospitals individually and collectively do well and where improvement is needed.
Statistical analysis of the PHEEM data includes the production of mean results for an overall score ( /160) and for all 40 items (rated 0-4). An overall PHEEM score of more than 81/160 indicates a positive response, while results lower than this indicate that plenty of problems exist in the educational environment. A mean score of 3 or 4 for an item reflects positively for that aspect of the educational environment; conversely, a score of less than 2 reflects negatively.
Rollout of the PHEEM project in Victoria
The project commenced in 2006 with six hospitals involved; the Royal Children’s Hospital; Bendigo Hospital; Latrobe Regional Health; Peter MacCallum Cancer Centre; Western Hospital; and Hamilton Base Hospital.
Other hospitals that have joined the PHEEM project include: Albury Wodonga Health; Ballarat Health Services; Northern Health; Southwest Health Care; Western Health; Echuca Health; Bendigo Health; Melbourne Health and St Vincent's Health.
A Feedback Toolkit for Supervisors has been developed and is available on the PMCV website. The Toolkit has been developed in response to information from supervisors that highlighted their perceived lack of preparedness to provide feedback, especially negative feedback to address performance concerns.