Cross-sectional survey finds lower learning-environment scores among Ugandan medical interns in surgery

Medical interns at three national referral hospitals in Uganda rated their hospital learning environments more positively than negatively overall, but perceptions varied by clinical rotation, with surgery receiving the lowest scores. The study abstract reports a mean total score of 93.27 out of a possible 160 across Mulago, Kawempe and Kiruddu National Referral Hospitals. Internal medicine received the highest rotation-specific mean score at 98 ± 24.5, while surgery scored 84 ± 16.7.

The cross-sectional study enrolled 200 medical interns in August 2021. Interns who had completed at least one month in their current rotation were consecutively enrolled and asked to complete a self-administered Postgraduate Hospital Education Environment Measure adapted to the local context. The questionnaire assessed three subscales: autonomy, teaching and social support, with negatively worded items reversed. Mean, total and subscale scores were compared across clinical disciplines using independent t-tests, analysis of variance and Bonferroni-adjusted post-hoc tests. Data were analyzed with SPSS 17.0, and statistical significance was set at p ≤ 0.05.

Across the three hospitals, interns’ mean subscale scores were 31.35 out of 56 for autonomy, 37.37 out of 60 for teaching and 23.65 out of 44 for social support. Surgery’s overall score was significantly lower than internal medicine’s, with a reported mean difference of 13.9 and confidence interval of 1.77–26.2 (p = 0.016). In the subscale comparisons, internal medicine had a mean difference of 4.16 relative to surgery for role autonomy, with a confidence interval of 0.04–8.29, while pediatrics had a mean difference of 3.92 for social support, with a confidence interval of 0.15–7.96. Male interns recorded an overall perception score of 93.9, compared with 88.48 among female interns, but this difference was not statistically significant.

The findings concern interns’ reported perceptions at one point in time rather than measured learning outcomes or changes in clinical competence. Because the study was cross-sectional and relied on self-administered questionnaires, it cannot establish that rotation type caused the observed differences or determine whether perceptions of the learning environment affected subsequent training outcomes. Its reported scope was also limited to 200 interns at three national referral hospitals during a single month in August 2021.

The authors characterized the learning environment at the hospitals assessed as generally positive but still in need of improvement. They concluded that surgical rotations warranted particular attention and stated that policymakers and hospital administrators could prioritize improvements to mentorship and social-support structures across rotations. These conclusions apply to the interns and hospitals included in the survey and should not be interpreted as evidence of causal effects on clinical performance or learning outcomes.

Subject of Research: Medical interns’ perceptions of hospital learning environments across clinical rotations in three Ugandan national referral hospitals

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

Article References: Musa, K., Mubuuke, A. G., Mutesi, C., Paul, M., Munabi, I. G., & Sarah, K. (2026). Evaluating the hospital learning environment for medical interns in Uganda: a cross-sectional study at three national referral hospitals. BMC Medical Education. https://doi.org/10.1186/s12909-026-10468-4

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10468-4

Keywords: medical education, clinical learning environment, medical interns, Uganda, cross-sectional study, surgical rotation, clinical rotations, autonomy, teaching, social support, Evaluating, hospital