title: Validation of the Postgraduate Hospital Educational Environment Measure (PHEEM) in a sample of 731 Greek residents.
abstract: BACKGROUND
  The Greek version of the Postgraduate Hospital Educational Environment Measure (PHEEM) was evaluated to determine its psychometric properties, i.e., validity, internal consistency, sensitivity and responsiveness to be used for measuring the learning environment in Greek hospitals.
  
  
  METHODS
  The PHEEM was administered to Greek hospital residents. Internal consistency was measured using Cronbach's alpha. Root Mean Square Error of Approximation (RMSEA) was used to evaluate the fit of Structural Equation Models. Content validity was addressed by the original study. Construct validity was tested using confirmatory (to test the set of underlying dimensions suggested by the original study) and exploratory (to explore the dimensions needed to explain the variability of the given answers) factor analysis using Varimax rotation. Convergent validity was calculated by Pearson's correlation coefficient regarding the participant's PHEEM score and participant's overall satisfaction score of the added item "Overall, I am very satisfied with my specialization in this post". Sensitivity was checked by comparing good versus poor aspects of the educational environment and by satisfied versus unsatisfied participants.
  
  
  RESULTS
  A total of 731 residents from 83 hospitals and 41 prefectures responded to the PHEEM. The original three-factor model didn't fit better compared to one factor model that is accounting for 32% of the variance. Cronbach's α was 0.933 when assuming one-factor model. Using a three-factor model (autonomy, teaching, social support), Cronbach's α were 0.815 (expected 0.830), 0.908 (0.839), 0.734 (0.793), respectively. The three-factor model gave an RMSEA value of 0.074 (90% confidence interval 0.071, 0.076), suggesting a fair fit. Pearson's correlation coefficient between total PHEEM and global satisfaction was 0.765. Mean question scores ranged from 19.0 (very poor) to 73.7 (very good), and mean participant scores from 5.5 (very unsatisfied) to 96.5 (very satisfied).
  
  
  CONCLUSIONS
  The Greek version of PHEEM is a valid, reliable, and sensitive instrument measuring the educational environment among junior doctors in Greek hospitals and it can be used for evidence-based SWOT analysis and policy.
authors.affiliation: Department of Public Health, School of Medicine, University of Patras, Patras, Greece. persakoutsogiann@gmail.com.
authors.forename: Persa
authors.initials: P
authors.lastname: Koutsogiannou
authors.affiliation: Medical Education Unit, Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece. idimolia@uoi.gr.
authors.forename: Ioannis D K
authors.initials: ID
authors.lastname: Dimoliatis
authors.affiliation: Medical Education Unit, Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece. dmavridi@cc.uoi.gr.|Department of Primary Education, University of Ioannina, Ioannina, Greece. dmavridi@cc.uoi.gr.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Mavridis
authors.affiliation: Medical Education Unit, Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece. bellos.stefanos@gmail.com.
authors.forename: Stefanos
authors.initials: S
authors.lastname: Bellos
authors.affiliation: Medical Education Unit, Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece. vasiliskarathanos@hotmail.com.
authors.forename: Vassilis
authors.initials: V
authors.lastname: Karathanos
authors.affiliation: Department of Public Health, School of Medicine, University of Patras, Patras, Greece. jelasto@upatras.gr.
authors.forename: Eleni
authors.initials: E
authors.lastname: Jelastopulu
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate / Q000592:standards*; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006115:Greece; D006761:Hospitals; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D055815:Young Adult