Perceptions of Healthcare Students about Operation Theatre as Clinical Learning Environment and Related Factors Affecting Learning Outcomes: A Cross-sectional Study among Health Care Students in Saudi Arabia

Perceptions of Healthcare Students about Operation Theatre as Clinical Learning Environment and Related Factors Affecting Learning Outcomes: A Cross-sectional Study among Health Care Students in Saudi Arabia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Perceptions of Healthcare Students about Operation Theatre as Clinical Learning Environment and Related Factors Affecting Learning Outcomes: A Cross-sectional Study among Health Care Students in Saudi Arabia Hassan Shaaib, Nada Almalki, Asya Aldossari, Salem Alyatimi, Ahmed Alqahtani, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7375873/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The operating theatre is a complex educational environment for healthcare students. It can significantly influence the clinical competencies and educational outcomes of the learners. Understanding student perceptions of this environment is crucial for enhancing learning strategies. Objective: This study examines healthcare students' perceptions of the operating theatre as a clinical learning environment and identifies factors that affect their learning outcomes in Saudi Arabia. Methods The study employed a descriptive, cross-sectional method and conducted data collection from April to May 2025. By utilizing a questionnaire administered to 250 healthcare students from various disciplines, including anesthesia technology, nursing, and others. Data were analyzed using SPSS version 28, employing descriptive statistics and chi-square tests. Results The sample consisted of 250 participants, predominantly male (78.8%), with 68% in their fourth year of study. A remarkable 99.2% of students reported that instructors were enthusiastic, but only 36.4% received constructive feedback. While 50% agreed that there were sufficient theatre sessions for experience, only 34.8% felt they were integrated into the team. In addition, 38.8% felt they received adequate supervision, while 44.8% expressed concern about being too busy with other tasks. Significant correlations were identified for educational opportunities, ambiance, and oversight based on specialty. Conclusion: The study's findings indicate a generally positive perception of the operating theatre as a learning environment, but also highlight the need for improvements in feedback mechanisms and team integration. Enhancing this educational atmosphere is essential for fostering student engagement and improving clinical competencies. Further research is needed to address these gaps. Operating Theatre Healthcare Students Clinical Learning Environment Educational Outcomes Figures Figure 1 Figure 2 Figure 3 Introduction The operating theatre (OT), often referred to as the operating room (OR), serves as a complex and dynamic educational environment where healthcare students, including those studying anesthesia technology, nursing, and paramedic studies, develop essential clinical competencies. (Davies, 2020) The educational atmosphere, essential for effective learning in clinical environments, encompasses both the physical and psychological environments that influence how learners interpret instructional and academic contexts. This positive atmosphere has a positive impact on educational outcomes and enduring excellence in practice. Due to its complex nature, which fluctuates across diverse settings, assessment and enhancing the academic atmosphere necessitate valid and dependable instruments (Al-Daken et al. , 2024) (Raksamani and Stalmeijer, 2019) The shift from theoretical comprehension to practical application constitutes a vital facet of healthcare training, affirming that learners gain the necessary skills and competencies to deliver optimal patient care. This procedure synthesizes teaching approaches, skill development, and evaluative methods that connect the divide between educational learning and real-world clinical experience. (Romancenco et al. , 2024) The effectiveness of care provided by healthcare practitioners is significantly influenced by their experiences within the operating theatre (OT) environment. A supportive learning atmosphere not only enhances clinical skills but also leads to improved patient outcomes. Many studies agree upon the importance of collaborative and experiential learning in clinical settings. (Houchens, Harrod, and Saint, 2023) Several vital components underscore the importance of the OT as a learning environment. Primarily, the surgical theatre (ST) represents a crucial pedagogical environment characterized by heightened stakes, wherein errors may profoundly affect patient welfare. Therefore, cultivating a positive learning experience in this context is vital for improving patient safety (Houchens, Harrod, and Saint, 2023) The field of clinical practice relies on fieldwork for the development of students' skills. The increasing number of students, the lack of qualified educators, and competition for placements underscore the necessity for clinical experiences in an academic setting. Experiential learning, which promotes student engagement and innovation, is acknowledged across diverse educational fields. (Erickson, 2018) Factors such as inadequate resources, the intricacy of clinical scenarios, and the level of esteem granted by supervisors significantly influence the educational outcomes of healthcare students in the operating theatre. (Ebrahim et al. , 2024) Optimizing the learning environment in the operating theatre in Saudi Arabia is imperative for fostering student engagement, motivation, and confidence. However, existing literature indicates a deficiency in addressing this context, underscoring the necessity for further investigation into healthcare students' perspectives to enhance educational strategies. (Alsolami, 2024) The investigation into the educational environment of the operating theatre for healthcare students in Saudi Arabia reveals critical insights into their experiences and perceptions, as emerging research increasingly shifts its focus from medical professionals and residents to the challenges and opportunities faced by undergraduate students. (Almansour et al. , 2024) This study aims to examine healthcare students' perceptions of the operating theatre as a clinical learning environment and identify factors that affect their learning outcomes in Saudi Arabia Methodology Study Design In this study, a non-interventional, descriptive, cross-sectional methodology was used, focusing on a questionnaire to investigate healthcare students' perceptions of the operating theatre (OT) as a key clinical educational environment. The research aimed to examine healthcare students' perceptions of the operating theatre as a clinical learning environment and identify various factors influencing their learning outcomes. The study was conducted in Saudi Arabia from April to May 2025 Study Population The study population consisted of healthcare students from diverse disciplines, including anesthesia technology, nursing, sterilization technology, respiratory therapy, and paramedicine, all of whom were selected from clinical settings where exposure to operating theatres was essential to their education. Sample Size To determine the appropriate sample size for this study, a conventional statistical formula specifically tailored for estimating proportions within descriptive research frameworks was used. This formula resulted in a calculated minimum requirement of approximately 158 participants to ensure the robustness and validity of the findings obtained through this research. Where: n: Sample size z: -score corresponding to the desired confidence level p^: Estimated proportion of the population ϵ\ Margin of error The study collected a maximum required sample size of approximately 250. This larger sample size improves the reliability of statistical analysis, enhances subgroup comparisons, and increases the generalizability of the findings, aligning with best practices for ensuring statistical power in cross-sectional survey designs. Selection Criteria Inclusion Criteria and Exclusion Criteria The parameters determined for excluding participants were explicitly outlined to include students outside of healthcare, individuals who lack adequate clinical exposure, anyone below the age of 18, and participants who could not meet the requirements set by the survey employed in this analysis. Variables The dependent variables identified for analysis in this research included assessing the quality of the clinical educational environment and the corresponding student learning outcomes. In contrast, the independent variables were systematically categorized to include age, gender, academic discipline, level of study, prior clinical exposure, supervisors' perceived behavior, distractions within the educational setting, and the availability of essential resources necessary for effective learning. Data Collection Tools: The research used the Surgical Theatre Educational Environment Measure (STEEM) questionnaire as a validated tool for assessing students' perceptions of the operating theatre as a clinical learning context. This questionnaire, authorized by Sarfraz et al. (2024), includes demographic data and STEEM items that span four domains: instruction and training, learning opportunities, environment, and supervision. The study used a questionnaire containing STEEM items and evaluated the variables on a 5-point Likert scale. Data Collection Procedure and Ethical Considerations Ethical approval was granted by the Institutional Review Board at Prince Sultan Military College of Health Sciences (Ref. IRB-2025-AT-045). Participant recruitment was conducted through formal channels, with data collection occurring from April to May 2025. Informed consent was obtained from all participants, ensuring confidentiality and voluntary participation. Clinical trial number: not applicable.’ Statistical Analysis Data analysis was conducted using SPSS version 28, with descriptive statistics and chi-square tests employed to investigate the associations between variables. The significance benchmark is locked in at p ≤ 0.05. Results 1. Demographic Data The study involved 250 participants, predominantly male, with 197 males (78.8%) compared to 53 females (21.2%), as shown in Fig. 1 . In terms of academic year, 170 respondents (68%) were in their fourth year, 22 (8.8%) were in their third year, 30 (12%) were in on-the-job training, and 28 (11.2%) were in internships, as reflected in Fig. 2 . Regarding specialties, 8 participants (3.2%) were in Respiratory Therapy, 39 (15.6%) in Paramedical, 129 (51.6%) in Anesthesia Technology, 28 (11.2%) in other specialties, and 46 (18.4%) in Nursing, as detailed in Fig. 3 . 2. Perceptions of Healthcare Students about the Operating Theatre as a Clinical Learning Environment Among the 250 participants, the study revealed that 99.2% felt instructors showed enthusiasm for teaching. Additionally, 42.0% agreed that instructors discussed surgical methodologies, while 41.6% found the operative list educational. However, only 36.4% felt they received constructive feedback, and 44.0% believed instructors were patient and encouraged questions, indicating a need for improved communication and feedback (see Table 1 ). Table 1 Perceptions of Healthcare Students about the Operating Theatre as a Clinical Learning Environment statement Strongly Disagree Disagree Neutral Agree Strongly Agree 1. My trainer is enthusiastic about teaching. 0 (0.0%) 2 (0.8%) 0 (0.0%) 248 (99.2%) 0 (0.0%) 2. Before the operation, my trainer discusses the surgical technique planned. 9 (3.6%) 13 (5.2%) 38 (15.2%) 85 (34.0%) 105 (42.0%) 3. My trainer uses the operating list as a learning opportunity. 9 (3.6%) 26 (10.4%) 32 (12.8%) 79 (31.6%) 104 (41.6%) 4. I receive constructive feedback on my performance. 5 (2.0%) 24 (9.6%) 41 (16.4%) 89 (35.6%) 91 (36.4%) 5. My trainer is patient when teaching. 7 (2.8%) 14 (5.6%) 39 (15.6%) 80 (32.0%) 110 (44.0%) 3. Perceptions of Healthcare Students about Educational Opportunities Half of the participants (50.0%) strongly concurred that there are ample theatre sessions each week to gain appropriate experience. Furthermore, 52.8% felt they had sufficient opportunities to assist in procedures, and 56.8% agreed that they could execute procedures under supervision. A majority, 53.6%, affirmed that the elective operative list encompassed the appropriate case mix. In comparison, 57.2% strongly agreed that the variety of emergency cases provides adequate exposure, underscoring a generally positive perception of experiential learning (see Table 2 ). Table 2 Perceptions of Healthcare Students about Educational Opportunities Statement Strongly Disagree Disagree Neutral Agree Strongly Agree 1. There are enough theatre sessions per week for me to gain the appropriate experience. 11 (4.4%) 13 (5.2%) 26 (10.4%) 75 (30.0%) 125 (50.0%) 2. I get enough opportunity to assist. 10 (4.0%) 14 (5.6%) 33 (13.2%) 61 (24.4%) 132 (52.8%) 3. I get enough opportunity to perform procedures under supervision. 7 (2.8%) 9 (3.6%) 36 (14.4%) 56 (22.4%) 142 (56.8%) 4. The elective operating list has the proper case mix to suit my training. 7 (2.8%) 10 (4.0%) 29 (11.6%) 70 (28.0%) 134 (53.6%) 5. The variety of emergency cases gives me appropriate exposure. 8 (3.2%) 10 (4.0%) 32 (12.8%) 57 (22.8%) 143 (57.2%) 6. The timing of lists allows enough time for teaching. 10 (4.0%) 16 (6.4%) 48 (19.2%) 74 (29.6%) 102 (40.8%) 4. Perceptions of Healthcare Students about Ambiance in the Operating Theatre In terms of ambiance, 49.6% of trainees strongly concurred that the theatre environment is agreeable. However, only 34.8% felt integrated as part of the team, and 35.6% agreed that theatre personnel were amicable. Additionally, 36.8% perceived communication among team members as satisfactory, and 37.6% felt esteemed by the staff. These results suggest a need to cultivate a more inclusive and supportive environment (see Table 3 ). Table 3 Perceptions of Healthcare Students about Ambiance in the Operating Theatre Statement Strongly Disagree Disagree Neutral Agree Strongly Agree 1. The atmosphere in the theatre is pleasant. 6 (2.4%) 14 (5.6%) 38 (15.2%) 68 (27.2%) 124 (49.6%) 2. I feel like a part of the team in the theatre. 15 (6.0%) 20 (8.0%) 59 (23.6%) 87 (34.8%) 69 (27.6%) 3. The theatre staff are friendly. 9 (3.6%) 13 (5.2%) 51 (20.4%) 89 (35.6%) 88 (35.2%) 4. Communication among team members is good. 5 (2.0%) 13 (5.2%) 57 (22.8%) 92 (36.8%) 83 (33.2%) 5. I am treated with respect by the staff. 7 (2.8%) 13 (5.2%) 50 (20.0%) 86 (34.4%) 94 (37.6%) 6. Theatre sessions are well organized. 3 (1.2%) 10 (4.0%) 44 (17.6%) 85 (34.0%) 108 (43.2%) 7. I feel confident asking questions in the theatre. 14 (5.6%) 20 (8.0%) 41 (16.4%) 85 (34.0%) 90 (36.0%) 8. I feel safe expressing uncertainty or concerns. 6 (2.4%) 15 (6.0%) 43 (17.2%) 82 (32.8%) 104 (41.6%) 5. Perceptions of Healthcare Students about Oversight, Workload, and Assistance Regarding oversight and workload, 38.8% strongly concurred that they receive adequate supervision during procedures. While 40.8% noted that guidance is accessible when required, 44.8% expressed concerns about being excessively occupied with other tasks to attend the theatre. Moreover, 40.8% felt the workload allowed time for teaching, and 32.0% agreed that they do not encounter discrimination based on gender or ethnicity. The results indicate a need for enhanced supervisory and support systems (see Table 4 ). Table 4 Perceptions of Healthcare Students about Oversight, Workload, and Assistance Statement Strongly Disagree Disagree Neutral Agree Strongly Agree 1. I receive adequate supervision during procedures. 7 (2.8%) 23 (9.2%) 44 (17.6%) 79 (31.6%) 97 (38.8%) 2. There is always someone available to guide me if needed. 4 (1.6%) 15 (6.0%) 42 (16.8%) 87 (34.8%) 102 (40.8%) 3. I am not too busy with other tasks to attend the theatre. 5 (2.0%) 15 (6.0%) 37 (14.8%) 81 (32.4%) 112 (44.8%) 4. The workload allows time for teaching. 6 (2.4%) 16 (6.4%) 39 (15.6%) 87 (34.8%) 102 (40.8%) 5. I do not feel discriminated against because of my sex or race. 12 (4.8%) 24 (9.6%) 55 (22.0%) 79 (31.6%) 80 (32.0%) 6. Specialty-Based Insights The analysis revealed no statistically significant correlation between specialty and perceptions of teaching and training (p-value: 0.3047). However, significant correlations were identified for educational opportunities (p-value: 0.0101), ambiance (p-value: 0.0132), and oversight/workload/assistance (p-value: 0.0177), indicating that perceptions vary significantly across different specialties. Discussion The surgical theatre constitutes a distinctive and dynamic educational environment that accommodates a diverse array of learning modalities, including spatial, auditory, verbal, kinaesthetic, logical, and intrapersonal dimensions. (Almansour et al. , 2024). Research indicates perceptual differences in student preferences. Generally, preferred atmospheres yield better results than tangible environments, except in instances where student collaboration is involved. Notably, innovation and individualism demonstrated significant yet minor effects.(Wubshet et al. , 2024). The investigation conducted by Wubshet et al. (2024) determined that whereas 141 out of 313 undergraduate anesthesia scholars evaluated the surgical theatre educational milieu as commendable, elements such as scarcity of resources, absence of instructors, auditory disturbances, and oversight complications underscored the necessity for enhancements in pedagogical methodologies within Ethiopian medical facilities.(Wubshet et al. , 2024).The investigation by Rupani et al. (2022) analyzed the merits and drawbacks of the operating room educational environment among 54 surgical trainees in a specific region of England. Trainees highlighted the need for enhanced educational opportunities and instruction surrounding the pre- and postoperative phases while reporting satisfaction with supervision and workload. Constraints included regional limitations and the influence of COVID-19, which diminished educational prospects. (Rupani, Evans and Iqbal, 2022). The research by Sarfaz et al. (2024) at Liaquat College involved 88 final-year medical students who evaluated their surgical rotation through a questionnaire. The findings revealed a high level of student satisfaction with the educational environment of the surgical theatre and the perceived quality of training(Access, 2024) In terms of Teaching and Training, an impressive 99.2% of respondents concurred that their instructors exhibit enthusiasm for teaching. Instructor enthusiasm is positively associated with increased academic self-efficacy, intrinsic motivation, and engagement with training materials. This fact is substantiated by research demonstrating that passionate educators can significantly enhance students' behavioral, cognitive, and emotional engagement. (Orosz et al. , 2015)(Zhang, 2014) This was also discovered in virtual environments, vocal fervor from educators has been demonstrated to enhance pupil involvement and drive to persist in their studies. However, it may not directly influence assessment performance. (Marty-Dugas et al. , 2024). The emotional contagion hypothesis posits that educator fervor can be conveyed to learners, consequently augmenting their motivation, focus, and involvement. This phenomenon has been documented across diverse educational environments, indicating that enthusiasm can serve as a powerful tool for enhancing student experiences. (Palmer, 2020) (Marty-Dugas et al. , 2024). Enthusiastic teaching is associated with better learning outcomes, including improved recall scores and increased emotional engagement with the subject. It also plays a role in reducing academic cheating by fostering intrinsic motivation and reducing amotivation among students (Orosz et al., 2015) In surgical training, enthusiasm is identified as a key attribute of successful trainers, alongside approachability and supportiveness. This enthusiasm fosters a lively and interactive learning environment, promoting active participation from trainees. While instructor enthusiasm is generally seen as beneficial, it is important to consider that not all students may respond equally to enthusiastic teaching. Other factors, such as teaching methods or personal interest in the subject, may have a greater influence on some students. Additionally, while enthusiasm can enhance engagement and motivation, it may not always translate into improved academic performance, as seen in some online learning contexts (Marty-Dugas et al., 2024) Effective communication and feedback mechanisms are crucial in surgical education, as they significantly impact the development and performance of trainees. The current state of feedback in surgical training reveals a need for improvement, as evidenced by the mixed perceptions of trainees regarding the feedback they receive. While some trainees appreciate the educational opportunities provided by operative lists, others feel that constructive criticism and patient, inquiry-fostering environments are lacking. This result underscores the need for improved feedback strategies and communication standards in surgical education. Feedback is a critical tool for learning and performance improvement in surgical education, with various methods evolving to enhance its application (El Boghdady and Alijani, 2017). Effective feedback can positively influence trainee attitudes, skill acquisition, and competence, ultimately impacting patient outcomes (Bello et al. , 2016). The high-intensity environment of surgical operations often complicates the delivery of effective feedback, as traditional methods may not translate well into practice (Wallach et al. , 2019) (Wallach et al., 2019). Barriers such as reduced trainee duty hours and increased patient demands further challenge the provision of timely and effective feedback (Bello et al. , 2016)(Bello et al., 2016). Implementing structured feedback models, such as the Briefing, Intraoperative Teaching, Debriefing (BID) model, can help integrate feedback into live operations, although practical implementation remains challenging (Wallach et al. , 2019). Emphasizing quality over quantity in teaching moments, with a focus on preparation, effective communication, and postoperative feedback, can enhance the educational experience (Champagne, 2013). Utilizing validated objective assessment tools for post-procedure Evaluation can improve feedback quality, though these tools are currently underutilized (Champagne, 2013). While the need for improved feedback mechanisms is evident, it is essential to recognize the complexities involved in implementing these changes. The dynamic nature of surgical environments and the diverse needs of trainees necessitate a tailored approach to feedback, striking a balance between theoretical insights and practical application. Further research and innovation in feedback strategies are necessary to optimize surgical education and trainee development. The operating theatre is perceived as a positive educational environment, with high scores in teaching and training, learning opportunities, and supervision (Knfe et al. , 2024) (Amir et al. , 2023). A study at St. Paul's Hospital reported a mean score of 69% for the overall educational environment, with teaching and training receiving the highest subscale score (Knfe et al. , 2024) Neurosurgical residents also reported positive perceptions of their learning environment, with favorable responses from residents in their first and fifth years of residency (Amir et al. , 2023) A majority of participants agree that the elective operative list provides an appropriate case mix, and the variety of emergency cases offers adequate exposure (Knfe et al. , 2024). The diversity of cases is crucial for experiential learning, as it allows residents to encounter a wide range of surgical scenarios(Knfe et al. , 2024) (Goh et al. , 2020). Supervision and support are critical components of the educational environment, with studies indicating that residents feel they can perform procedures under supervision (Knfe et al. , 2024)(Amir et al. , 2023). The presence of consultants and the opportunity for one-on-one teaching significantly enhance the educational value of the operating theatre (Goh et al. , 2020). Some studies noted differences in perceptions based on gender and experience level, with male residents often perceiving the environment more positively than female residents (Amir et al. , 2023). Junior and senior residents may have differing views on learning opportunities and the atmosphere, highlighting the need for tailored educational strategies (Knfe et al. , 2024)(Syed et al. , 2025). Despite the generally positive perception, there is room for improvement in areas such as workload management and the provision of feedback (Khan et al. , 2021) (Syed et al. , 2025). Regular assessments of the educational environment can help identify areas needing enhancement and ensure continuous improvement (Khan et al. , 2021). While the perception of the educational environment in operating theatres is mainly positive, it is important to consider the potential for biases and disparities in experiences among different groups of residents. Gender differences and variations in perceptions based on experience level suggest that more personalized approaches to training may be beneficial. Additionally, while the current environment is supportive, ongoing evaluations and adjustments are necessary to maintain and improve the quality of surgical education. The perception of the theatre atmosphere is crucial for trainee satisfaction and professional development. The study at the University of the Witwatersrand highlights that while the overall environment is perceived positively, there is room for improvement in the perception of atmosphere and team integration (Khan et al. , 2021). The ATEEM tool, developed to assess the educational environment, identifies problem areas such as team dynamics and communication, which are critical for fostering a supportive learning environment (Holt and Roff, 2004). Effective communication among team members is essential for a cohesive working environment. The Australasian study found that trainees' satisfaction was closely linked to their relationship with supervisors and the clarity of their roles within the team (Mahoney, Crowe and Harris, 2010). The social environment in theatres, as observed by Tanner and Timmons, can be complex, with backstage dynamics influencing team interactions. Addressing these dynamics can improve communication and integration (Tanner and Timmons, 2000). Creating an inclusive environment involves addressing both physical and social aspects of the environment. The study on relaxed performances in Canada highlights the importance of adapting environments to meet diverse needs, a principle that can be applied to theatre settings to enhance inclusivity (Hammouni et al. , 2021). The use of creative interventions, such as verbatim theatre, has been shown to raise awareness and motivate behavior change regarding workplace culture, suggesting a potential strategy for improving inclusivity and support in theatre environments (Hooker et al. , 2024). Regular assessments using validated tools, such as ATEEM, can help identify areas needing improvement and track progress over time (Khan et al. , 2021). (Holt and Roff, 2004). Engaging in participatory approaches to redesign the theatre environment, as seen in the Canadian study, can ensure that changes meet the needs of all stakeholders (Hammouni et al. , 2021). Implementing creative interventions to address workplace culture and communication issues can foster a more supportive and inclusive environment (Hooker et al. , 2024). While the current theatre environment is perceived as agreeable by many, the need for improved team integration, communication, and inclusivity is evident. Addressing these areas through regular assessments, participatory redesign, and creative interventions can enhance the overall educational and professional experience for trainees. This approach not only benefits trainees but also contributes to a more effective and harmonious working environment for all theatre personnel. Adequate supervision is essential for delivering accurate and high-quality healthcare. A study found that good supervision significantly improves the accuracy of administering infusion fluids, while excessive workload can detract from this accuracy (Ardiyanti and Anisah, 2023). In mental health disciplines, supervision is integral to training, with familiar elements like fostering collaborative relationships and encouraging self-evaluation being linked to positive outcomes (Almansour et al. , 2024) (Yoo, 2023). In general practice, supervision involves establishing a culture of help-seeking and balancing entrustment among supervisors, trainees, and patients, which is vital for patient safety and trainee learning (Sturman, Parker, and Jorm, 2021). Work overload is a barrier to compliance with hygiene procedures, indicating that reducing workload and improving work organization can enhance adherence to protocols (Oryginalna et al., 2011). Regular, structured supervision meetings can improve the efficiency and effectiveness of supervision, ensuring consistent feedback and active participation from supervisees (Coutts & Marshall, 2019)(Coutts & Marshall, 2019). While the need for enhanced supervision and workload management is evident, it is also crucial to consider the limitations and challenges associated with implementing these improvements. For instance, despite the identification of common supervision elements, their direct impact on outcomes can vary, suggesting that a one-size-fits-all approach may not be practical (Almansour et al. , 2024). Additionally, the interplay of various factors, such as cultural and organizational dynamics, can influence the effectiveness of supervision and workload management strategies. The perception of educational opportunities varies significantly across specialties, as indicated by the p-value of 0.0101. This result suggests that different specialties offer varying levels of educational opportunities, which can impact the learning experience. In the context of oncology, for example, students report less exposure to radiation oncology compared to medical oncology, which affects their perception of educational opportunities in these fields (Hoover, Cho and Reddy, 2023) (Hoover et al., 2023). Similarly, in surgical specialties, there is alignment in perceptions of program strengths and opportunities for improvement, indicating that educational opportunities are perceived differently across specialties (Caniano et al. , 2016). The ambiance of the educational environment also shows significant variation across specialties, with a p-value of 0.0132. The result highlights the variation in the atmosphere and environment in which training occurs across different specialties. A study on the educational environment in health programs highlights the importance of a favorable environment in enhancing the learning experience, which can vary significantly between specialties (Córdova-León and FernándezHuerta, 2019) (Córdova-León & Fernández-Huerta, 2019). The National Defense University of Malaysia study also emphasizes the role of ambiance in shaping students' perceptions of their educational environment, which can differ based on the unique combination of medical and military training (Jaffar et al. , 2019) (Jaffar et al., 2019). Oversight, workload, and assistance are other areas where perceptions differ significantly across specialties, as indicated by a p-value of 0.0177. The fact suggests that the level of support and workload management varies between specialties. In the context of clinical training, students' perceptions of oversight and workload can significantly impact their training experience, as seen in the study of clinical training experiences in professional psychology (Rodriguez-Menendez et al. , 2017) (Rodriguez-Menendez et al., 2017). The study on interprofessional education also highlights the importance of teamwork and assistance in shaping perceptions, which can vary across different health professions (Reddington, Egli and Schmuck, 2018)(Reddington et al., 2018). While the core perceptions of pedagogy and training do not differ significantly across specialties, variations in educational opportunities, ambiance, oversight/workload, and assistance/assistance highlight the importance of these factors in shaping the overall educational experience. These differences can influence students' perceptions and their career choices within the medical field. Understanding these variations can help tailor educational programs more effectively to meet the needs of students across different specialties. Conclusion This research provides valuable insights into healthcare students' perceptions of the operating theatre as a clinical learning environment in Saudi Arabia. The study emphasizes the importance of a nurturing educational environment, adequate supervision, and constructive feedback, all of which are essential for enhancing student engagement and learning outcomes. The need for improvement in communication and inclusivity within the operating theatre is apparent, as these elements significantly impact the overall educational experience. By addressing these aspects, healthcare education programs can more effectively equip students for their future responsibilities in patient care. Abbreviations AFHSR - Armed Forces Hospitals, Southern Region ATEEM - Anesthetic Theatre Educational Environment Measure IRB - Institutional Review Board KFMMC - King Fahd Military Medical Complex NGHA - National Guard Hospital Affairs OT - Operating Theatre OR - Operating Room PSMCHS - Prince Sultan Military College of Health Sciences SPSS - Statistical Package for the Social Sciences STEEM - Surgical Theatre Educational Environment Measure BID - Briefing, Intraoperative Teaching, Debriefing Declarations Ethical approval Approval for ethical considerations was granted by the Institutional Review Board at Prince Sultan Military College of Health Sciences (Ref. IRB-2025-AT-045), and prior to the study, informed consent was diligently obtained from all participants, in alignment with the updated principles of the Declaration of Helsinki. Consent for publication All the authors have reviewed and granted their approval for the final manuscript to be made public Data Availability and Materials The data that support the findings and analysis in this study are available from the corresponding author upon reasonable request. Conflict of interest The author has disclosed no conflicts of interest. Funding Not applicable Authors contribution H.S. and N.A. wrote the main manuscript text. A.A. and S.A. conducted the data analysis and prepared figures 1-3. M.A. contributed to the literature review and supported the methodology section. All authors reviewed and approved the final manuscript. Acknowledgments The researchers would like to express their gratitude to all the healthcare students who participated in this study, as well as the faculty and staff at the participating institutions for their support. 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(2024) ‘Perception of the operation theatre learning environment and related factors among anesthesia students in Ethiopian higher education teaching hospitals: a multicenter cross-sectional study’, BMC Medical Education , 24(303), pp. 1–14. Available at: https://doi.org/10.1186/S12909-024-05320-6 . Zhang Q. (2014) ‘Assessing the Effects of Instructor Enthusiasm on Classroom Engagement, Learning Goal Orientation, and Academic Self-Efficacy’, Communication Teacher , 28(1), pp. 44–56. Available at: https://doi.org/10.1080/17404622.2013.839047 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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2","display":"","copyAsset":false,"role":"figure","size":31401,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of Healthcare Students by academic years\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7375873/v1/298a5f1c50d7f606e6ac5712.png"},{"id":93018598,"identity":"d5d66357-0c7b-4693-9611-a4b69d997232","added_by":"auto","created_at":"2025-10-08 08:23:59","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":38167,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of Healthcare Students by Specialty\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7375873/v1/5d084c2093b4a7fdcfa18d43.png"},{"id":109217176,"identity":"a0223bdc-342d-4d51-a961-9e9319d86259","added_by":"auto","created_at":"2026-05-13 18:09:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":383772,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7375873/v1/7bbdcca7-7725-462e-a57d-1cd095a5eeb6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perceptions of Healthcare Students about Operation Theatre as Clinical Learning Environment and Related Factors Affecting Learning Outcomes: A Cross-sectional Study among Health Care Students in Saudi Arabia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe operating theatre (OT), often referred to as the operating room (OR), serves as a complex and dynamic educational environment where healthcare students, including those studying anesthesia technology, nursing, and paramedic studies, develop essential clinical competencies. (Davies, 2020)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe educational atmosphere, essential for effective learning in clinical environments, encompasses both the physical and psychological environments that influence how learners interpret instructional and academic contexts. This positive atmosphere has a positive impact on educational outcomes and enduring excellence in practice. Due to its complex nature, which fluctuates across diverse settings, assessment and enhancing the academic atmosphere necessitate valid and dependable instruments (Al-Daken \u003cem\u003eet al.\u003c/em\u003e, 2024) (Raksamani and Stalmeijer, 2019) The shift from theoretical comprehension to practical application constitutes a vital facet of healthcare training, affirming that learners gain the necessary skills and competencies to deliver optimal patient care. This procedure synthesizes teaching approaches, skill development, and evaluative methods that connect the divide between educational learning and real-world clinical experience. (Romancenco \u003cem\u003eet al.\u003c/em\u003e, 2024)\u003c/p\u003e\n\u003cp\u003eThe effectiveness of care provided by healthcare practitioners is significantly influenced by their experiences within the operating theatre (OT) environment. A supportive learning atmosphere not only enhances clinical skills but also leads to improved patient outcomes. Many studies agree upon the importance of collaborative and experiential learning in clinical settings. (Houchens, Harrod, and Saint, 2023)\u003c/p\u003e\n\u003cp\u003eSeveral vital components underscore the importance of the OT as a learning environment. Primarily, the surgical theatre (ST) represents a crucial pedagogical environment characterized by heightened stakes, wherein errors may profoundly affect patient welfare. Therefore, cultivating a positive learning experience in this context is vital for improving patient safety (Houchens, Harrod, and Saint, 2023)\u003c/p\u003e\n\u003cp\u003eThe field of clinical practice relies on fieldwork for the development of students\u0026apos; skills. The increasing number of students, the lack of qualified educators, and competition for placements underscore the necessity for clinical experiences in an academic setting. Experiential learning, which promotes student engagement and innovation, is acknowledged across diverse educational fields. (Erickson, 2018)\u003c/p\u003e\n\u003cp\u003eFactors such as inadequate resources, the intricacy of clinical scenarios, and the level of esteem granted by supervisors significantly influence the educational outcomes of healthcare students in the operating theatre. (Ebrahim \u003cem\u003eet al.\u003c/em\u003e, 2024) Optimizing the learning environment in the operating theatre in Saudi Arabia is imperative for fostering student engagement, motivation, and confidence. However, existing literature indicates a deficiency in addressing this context, underscoring the necessity for further investigation into healthcare students\u0026apos; perspectives to enhance educational strategies. (Alsolami, 2024)\u003c/p\u003e\n\u003cp\u003eThe investigation into the educational environment of the operating theatre for healthcare students in Saudi Arabia reveals critical insights into their experiences and perceptions, as emerging research increasingly shifts its focus from medical professionals and residents to the challenges and opportunities faced by undergraduate students. (Almansour \u003cem\u003eet al.\u003c/em\u003e, 2024) This study aims to examine healthcare students\u0026apos; perceptions of the operating theatre as a clinical learning environment and identify factors that affect their learning outcomes in Saudi Arabia\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, a non-interventional, descriptive, cross-sectional methodology was used, focusing on a questionnaire to investigate healthcare students\u0026apos; perceptions of the operating theatre (OT) as a key clinical educational environment. The research aimed to examine healthcare students\u0026apos; perceptions of the operating theatre as a clinical learning environment and identify various factors influencing their learning outcomes. The study was conducted in Saudi Arabia from April to May 2025\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population consisted of healthcare students from diverse disciplines, including anesthesia technology, nursing, sterilization technology, respiratory therapy, and paramedicine, all of whom were selected from clinical settings where exposure to operating theatres was essential to their education.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo determine the appropriate sample size for this study, a conventional statistical formula specifically tailored for estimating proportions within descriptive research frameworks was used. This formula resulted in a calculated minimum requirement of approximately 158 participants to ensure the robustness and validity of the findings obtained through this research.\u003c/p\u003e\n\u003cp\u003e\u003cimg width=\"154\" height=\"60\" src=\"data:image/jpeg;base64,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\" alt=\"image\"\u003e\u003c/p\u003e\n\u003cp\u003eWhere:\u003c/p\u003e\n\u003cp\u003en: Sample size\u003c/p\u003e\n\u003cp\u003ez: -score corresponding to the desired confidence level\u003c/p\u003e\n\u003cp\u003ep^:\u0026nbsp;Estimated proportion of the population\u003c/p\u003e\n\u003cp\u003eϵ\\ Margin of error\u003c/p\u003e\n\u003cp\u003eThe study collected a maximum required sample size of approximately 250. This larger sample size improves the reliability of statistical analysis, enhances subgroup comparisons, and increases the generalizability of the findings, aligning with best practices for ensuring statistical power in cross-sectional survey designs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSelection Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInclusion Criteria and Exclusion Criteria\u003c/p\u003e\n\u003cp\u003eThe parameters determined for excluding participants were explicitly outlined to include students outside of healthcare, individuals who lack adequate clinical exposure, anyone below the age of 18, and participants who could not meet the requirements set by the survey employed in this analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dependent variables identified for analysis in this research included assessing the quality of the clinical educational environment and the corresponding student learning outcomes. In contrast, the independent variables were systematically categorized to include age, gender, academic discipline, level of study, prior clinical exposure, supervisors\u0026apos; perceived behavior, distractions within the educational setting, and the availability of essential resources necessary for effective learning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Tools:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research used the Surgical Theatre Educational Environment Measure (STEEM) questionnaire as a validated tool for assessing students\u0026apos; perceptions of the operating theatre as a clinical learning context.\u0026nbsp;This questionnaire, authorized by Sarfraz et al. (2024), includes demographic data and STEEM items that span four domains: instruction and training, learning opportunities, environment, and supervision. The study used a questionnaire containing STEEM items and evaluated the variables on a 5-point Likert scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Procedure and Ethical Considerations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was granted by the Institutional Review Board at Prince Sultan Military College of Health Sciences (Ref. IRB-2025-AT-045). Participant recruitment was conducted through formal channels, with data collection occurring from April to May 2025. Informed consent was obtained from all participants, ensuring confidentiality and voluntary participation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable.\u0026rsquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analysis was conducted using SPSS version 28, with descriptive statistics and chi-square tests employed to investigate the associations between variables. The significance benchmark is locked in at p \u0026le; 0.05.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\n\u003ch3\u003e1. Demographic Data\u003c/h3\u003e\n\u003cp\u003eThe study involved 250 participants, predominantly male, with 197 males (78.8%) compared to 53 females (21.2%), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. In terms of academic year, 170 respondents (68%) were in their fourth year, 22 (8.8%) were in their third year, 30 (12%) were in on-the-job training, and 28 (11.2%) were in internships, as reflected in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Regarding specialties, 8 participants (3.2%) were in Respiratory Therapy, 39 (15.6%) in Paramedical, 129 (51.6%) in Anesthesia Technology, 28 (11.2%) in other specialties, and 46 (18.4%) in Nursing, as detailed in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\n\u003ch3\u003e2. Perceptions of Healthcare Students about the Operating Theatre as a Clinical Learning Environment\u003c/h3\u003e\n\u003cp\u003eAmong the 250 participants, the study revealed that 99.2% felt instructors showed enthusiasm for teaching. Additionally, 42.0% agreed that instructors discussed surgical methodologies, while 41.6% found the operative list educational. However, only 36.4% felt they received constructive feedback, and 44.0% believed instructors were patient and encouraged questions, indicating a need for improved communication and feedback (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003ePerceptions of Healthcare Students about the Operating Theatre as a Clinical Learning\u003c/b\u003e Environment\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003estatement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrongly Disagree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDisagree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAgree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStrongly Agree\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. My trainer is enthusiastic about teaching.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (0.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e248 (99.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0 (0.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Before the operation, my trainer discusses the surgical technique planned.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (3.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (5.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38 (15.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e85 (34.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e105 (42.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. My trainer uses the operating list as a learning opportunity.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (3.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26 (10.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e32 (12.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e79 (31.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e104 (41.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. I receive constructive feedback on my performance.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (2.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24 (9.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41 (16.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e89 (35.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e91 (36.4%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. My trainer is patient when teaching.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (2.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14 (5.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39 (15.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e80 (32.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e110 (44.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003e3. Perceptions of Healthcare Students about Educational Opportunities\u003c/h3\u003e\n\u003cp\u003e Half of the participants (50.0%) strongly concurred that there are ample theatre sessions each week to gain appropriate experience. Furthermore, 52.8% felt they had sufficient opportunities to assist in procedures, and 56.8% agreed that they could execute procedures under supervision. A majority, 53.6%, affirmed that the elective operative list encompassed the appropriate case mix. In comparison, 57.2% strongly agreed that the variety of emergency cases provides adequate exposure, underscoring a generally positive perception of experiential learning (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePerceptions of Healthcare Students about Educational Opportunities\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStatement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrongly Disagree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDisagree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAgree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStrongly Agree\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. There are enough theatre sessions per week for me to gain the appropriate experience.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11 (4.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (5.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26 (10.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e75 (30.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e125 (50.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. I get enough opportunity to assist.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (4.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14 (5.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e33 (13.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e61 (24.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e132 (52.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. I get enough opportunity to perform procedures under supervision.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (2.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9 (3.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e36 (14.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e56 (22.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e142 (56.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. The elective operating list has the proper case mix to suit my training.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (2.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (4.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29 (11.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e70 (28.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e134 (53.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. The variety of emergency cases gives me appropriate exposure.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8 (3.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (4.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e32 (12.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e57 (22.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e143 (57.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. The timing of lists allows enough time for teaching.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e10 (4.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16 (6.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48 (19.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e74 (29.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e102 (40.8%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003e4. Perceptions of Healthcare Students about Ambiance in the Operating Theatre\u003c/h3\u003e\n\u003cp\u003eIn terms of ambiance, 49.6% of trainees strongly concurred that the theatre environment is agreeable. However, only 34.8% felt integrated as part of the team, and 35.6% agreed that theatre personnel were amicable. Additionally, 36.8% perceived communication among team members as satisfactory, and 37.6% felt esteemed by the staff. These results suggest a need to cultivate a more inclusive and supportive environment (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003ePerceptions of Healthcare Students about Ambiance in the Operating Theatre\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStatement\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrongly Disagree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDisagree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAgree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStrongly Agree\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. The atmosphere in the theatre is pleasant.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (2.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14 (5.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e38 (15.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e68 (27.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e124 (49.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. I feel like a part of the team in the theatre.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15 (6.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20 (8.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e59 (23.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e87 (34.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e69 (27.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. The theatre staff are friendly.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9 (3.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (5.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e51 (20.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e89 (35.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e88 (35.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Communication among team members is good.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (2.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (5.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e57 (22.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e92 (36.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e83 (33.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. I am treated with respect by the staff.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (2.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (5.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e50 (20.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e86 (34.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e94 (37.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. Theatre sessions are well organized.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3 (1.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10 (4.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44 (17.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e85 (34.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e108 (43.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. I feel confident asking questions in the theatre.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14 (5.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20 (8.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41 (16.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e85 (34.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e90 (36.0%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8. I feel safe expressing uncertainty or concerns.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6 (2.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15 (6.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43 (17.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e82 (32.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e104 (41.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003e5. Perceptions of Healthcare Students about Oversight, Workload, and Assistance\u003c/h3\u003e\n\u003cp\u003eRegarding oversight and workload, 38.8% strongly concurred that they receive adequate supervision during procedures. While 40.8% noted that guidance is accessible when required, 44.8% expressed concerns about being excessively occupied with other tasks to attend the theatre. Moreover, 40.8% felt the workload allowed time for teaching, and 32.0% agreed that they do not encounter discrimination based on gender or ethnicity. The results indicate a need for enhanced supervisory and support systems (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab4\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePerceptions of Healthcare Students about Oversight, Workload, and Assistance\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStatement\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStrongly Disagree\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStrongly Agree\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. I receive adequate supervision during procedures.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7 (2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44 (17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e79 (31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97 (38.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2. There is always someone available to guide me if needed.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15 (6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42 (16.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102 (40.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3. I am not too busy with other tasks to attend the theatre.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5 (2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15 (6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37 (14.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e81 (32.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e112 (44.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4. The workload allows time for teaching.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16 (6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e39 (15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87 (34.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e102 (40.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5. I do not feel discriminated against because of my sex or race.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24 (9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55 (22.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e79 (31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80 (32.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ch3\u003e6. Specialty-Based Insights\u003c/h3\u003e\n\u003cp\u003eThe analysis revealed no statistically significant correlation between specialty and perceptions of teaching and training (p-value: 0.3047). However, significant correlations were identified for educational opportunities (p-value: 0.0101), ambiance (p-value: 0.0132), and oversight/workload/assistance (p-value: 0.0177), indicating that perceptions vary significantly across different specialties.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe surgical theatre constitutes a distinctive and dynamic educational environment that accommodates a diverse array of learning modalities, including spatial, auditory, verbal, kinaesthetic, logical, and intrapersonal dimensions. (Almansour \u003cem\u003eet al.\u003c/em\u003e, 2024). Research indicates perceptual differences in student preferences. Generally, preferred atmospheres yield better results than tangible environments, except in instances where student collaboration is involved. Notably, innovation and individualism demonstrated significant yet minor effects.(Wubshet \u003cem\u003eet al.\u003c/em\u003e, 2024). The investigation conducted by Wubshet et al. (2024) determined that whereas 141 out of 313 undergraduate anesthesia scholars evaluated the surgical theatre educational milieu as commendable, elements such as scarcity of resources, absence of instructors, auditory disturbances, and oversight complications underscored the necessity for enhancements in pedagogical methodologies within Ethiopian medical facilities.(Wubshet \u003cem\u003eet al.\u003c/em\u003e, 2024).The investigation by Rupani et al. (2022) analyzed the merits and drawbacks of the operating room educational environment among 54 surgical trainees in a specific region of England. Trainees highlighted the need for enhanced educational opportunities and instruction surrounding the pre- and postoperative phases while reporting satisfaction with supervision and workload. Constraints included regional limitations and the influence of COVID-19, which diminished educational prospects. (Rupani, Evans and Iqbal, 2022). The research by Sarfaz et al. (2024) at Liaquat College involved 88 final-year medical students who evaluated their surgical rotation through a questionnaire. The findings revealed a high level of student satisfaction with the educational environment of the surgical theatre and the perceived quality of training(Access, 2024) In terms of Teaching and Training, an impressive 99.2% of respondents concurred that their instructors exhibit enthusiasm for teaching. Instructor enthusiasm is positively associated with increased academic self-efficacy, intrinsic motivation, and engagement with training materials. This fact is substantiated by research demonstrating that passionate educators can significantly enhance students\u0026apos; behavioral, cognitive, and emotional engagement. (Orosz \u003cem\u003eet al.\u003c/em\u003e, 2015)(Zhang, 2014) This was also discovered in virtual environments, vocal fervor from educators has been demonstrated to enhance pupil involvement and drive to persist in their studies. However, it may not directly influence assessment performance. (Marty-Dugas \u003cem\u003eet al.\u003c/em\u003e, 2024). The emotional contagion hypothesis posits that educator fervor can be conveyed to learners, consequently augmenting their motivation, focus, and involvement. This phenomenon has been documented across diverse educational environments, indicating that enthusiasm can serve as a powerful tool for enhancing student experiences. (Palmer, 2020) (Marty-Dugas \u003cem\u003eet al.\u003c/em\u003e, 2024). Enthusiastic teaching is associated with better learning outcomes, including improved recall scores and increased emotional engagement with the subject. It also plays a role in reducing academic cheating by fostering intrinsic motivation and reducing amotivation among students (Orosz et al., 2015) In surgical training, enthusiasm is identified as a key attribute of successful trainers, alongside approachability and supportiveness. This enthusiasm fosters a lively and interactive learning environment, promoting active participation from trainees. While instructor enthusiasm is generally seen as beneficial, it is important to consider that not all students may respond equally to enthusiastic teaching. Other factors, such as teaching methods or personal interest in the subject, may have a greater influence on some students. Additionally, while enthusiasm can enhance engagement and motivation, it may not always translate into improved academic performance, as seen in some online learning contexts (Marty-Dugas et al., 2024) Effective communication and feedback mechanisms are crucial in surgical education, as they significantly impact the development and performance of trainees. The current state of feedback in surgical training reveals a need for improvement, as evidenced by the mixed perceptions of trainees regarding the feedback they receive. While some trainees appreciate the educational opportunities provided by operative lists, others feel that constructive criticism and patient, inquiry-fostering environments are lacking. This result underscores the need for improved feedback strategies and communication standards in surgical education. Feedback is a critical tool for learning and performance improvement in surgical education, with various methods evolving to enhance its application (El Boghdady and Alijani, 2017). Effective feedback can positively influence trainee attitudes, skill acquisition, and competence, ultimately impacting patient outcomes (Bello \u003cem\u003eet al.\u003c/em\u003e, 2016). The high-intensity environment of surgical operations often complicates the delivery of effective feedback, as traditional methods may not translate well into practice (Wallach \u003cem\u003eet al.\u003c/em\u003e, 2019) (Wallach et al., 2019). Barriers such as reduced trainee duty hours and increased patient demands further challenge the provision of timely and effective feedback (Bello \u003cem\u003eet al.\u003c/em\u003e, 2016)(Bello et al., 2016). Implementing structured feedback models, such as the Briefing, Intraoperative Teaching, Debriefing (BID) model, can help integrate feedback into live operations, although practical implementation remains challenging (Wallach \u003cem\u003eet al.\u003c/em\u003e, 2019). Emphasizing quality over quantity in teaching moments, with a focus on preparation, effective communication, and postoperative feedback, can enhance the educational experience (Champagne, 2013). Utilizing validated objective assessment tools for post-procedure Evaluation can improve feedback quality, though these tools are currently underutilized \u0026nbsp;(Champagne, 2013). While the need for improved feedback mechanisms is evident, it is essential to recognize the complexities involved in implementing these changes. The dynamic nature of surgical environments and the diverse needs of trainees necessitate a tailored approach to feedback, striking a balance between theoretical insights and practical application. Further research and innovation in feedback strategies are necessary to optimize surgical education and trainee development. The operating theatre is perceived as a positive educational environment, with high scores in teaching and training, learning opportunities, and supervision (Knfe \u003cem\u003eet al.\u003c/em\u003e, 2024) (Amir \u003cem\u003eet al.\u003c/em\u003e, 2023). A study at St. Paul\u0026apos;s Hospital reported a mean score of 69% for the overall educational environment, with teaching and training receiving the highest subscale score (Knfe \u003cem\u003eet al.\u003c/em\u003e, 2024) Neurosurgical residents also reported positive perceptions of their learning environment, with favorable responses from residents in their first and fifth years of residency (Amir \u003cem\u003eet al.\u003c/em\u003e, 2023) \u0026nbsp;A majority of participants agree that the elective operative list provides an appropriate case mix, and the variety of emergency cases offers adequate exposure (Knfe \u003cem\u003eet al.\u003c/em\u003e, 2024). The diversity of cases is crucial for experiential learning, as it allows residents to encounter a wide range of surgical scenarios(Knfe \u003cem\u003eet al.\u003c/em\u003e, 2024) (Goh \u003cem\u003eet al.\u003c/em\u003e, 2020). Supervision and support are critical components of the educational environment, with studies indicating that residents feel they can perform procedures under supervision (Knfe \u003cem\u003eet al.\u003c/em\u003e, 2024)(Amir \u003cem\u003eet al.\u003c/em\u003e, 2023). The presence of consultants and the opportunity for one-on-one teaching significantly enhance the educational value of the operating theatre (Goh \u003cem\u003eet al.\u003c/em\u003e, 2020). Some studies noted differences in perceptions based on gender and experience level, with male residents often perceiving the environment more positively than female residents (Amir \u003cem\u003eet al.\u003c/em\u003e, 2023). Junior and senior residents may have differing views on learning opportunities and the atmosphere, highlighting the need for tailored educational strategies (Knfe \u003cem\u003eet al.\u003c/em\u003e, 2024)(Syed \u003cem\u003eet al.\u003c/em\u003e, 2025). Despite the generally positive perception, there is room for improvement in areas such as workload management and the provision of feedback (Khan \u003cem\u003eet al.\u003c/em\u003e, 2021) (Syed \u003cem\u003eet al.\u003c/em\u003e, 2025). Regular assessments of the educational environment can help identify areas needing enhancement and ensure continuous improvement (Khan \u003cem\u003eet al.\u003c/em\u003e, 2021). While the perception of the educational environment in operating theatres is mainly positive, it is important to consider the potential for biases and disparities in experiences among different groups of residents. Gender differences and variations in perceptions based on experience level suggest that more personalized approaches to training may be beneficial. Additionally, while the current environment is supportive, ongoing evaluations and adjustments are necessary to maintain and improve the quality of surgical education. The perception of the theatre atmosphere is crucial for trainee satisfaction and professional development. The study at the University of the Witwatersrand highlights that while the overall environment is perceived positively, there is room for improvement in the perception of atmosphere and team integration (Khan \u003cem\u003eet al.\u003c/em\u003e, 2021). The ATEEM tool, developed to assess the educational environment, identifies problem areas such as team dynamics and communication, which are critical for fostering a supportive learning environment (Holt and Roff, 2004). Effective communication among team members is essential for a cohesive working environment. The Australasian study found that trainees\u0026apos; satisfaction was closely linked to their relationship with supervisors and the clarity of their roles within the team (Mahoney, Crowe and Harris, 2010). The social environment in theatres, as observed by Tanner and Timmons, can be complex, with backstage dynamics influencing team interactions. Addressing these dynamics can improve communication and integration (Tanner and Timmons, 2000). Creating an inclusive environment involves addressing both physical and social aspects of the environment. The study on relaxed performances in Canada highlights the importance of adapting environments to meet diverse needs, a principle that can be applied to theatre settings to enhance inclusivity (Hammouni \u003cem\u003eet al.\u003c/em\u003e, 2021). The use of creative interventions, such as verbatim theatre, has been shown to raise awareness and motivate behavior change regarding workplace culture, suggesting a potential strategy for improving inclusivity and support in theatre environments (Hooker \u003cem\u003eet al.\u003c/em\u003e, 2024). Regular assessments using validated tools, such as ATEEM, can help identify areas needing improvement and track progress over time (Khan \u003cem\u003eet al.\u003c/em\u003e, 2021). (Holt and Roff, 2004). Engaging in participatory approaches to redesign the theatre environment, as seen in the Canadian study, can ensure that changes meet the needs of all stakeholders (Hammouni \u003cem\u003eet al.\u003c/em\u003e, 2021). Implementing creative interventions to address workplace culture and communication issues can foster a more supportive and inclusive environment (Hooker \u003cem\u003eet al.\u003c/em\u003e, 2024). While the current theatre environment is perceived as agreeable by many, the need for improved team integration, communication, and inclusivity is evident. Addressing these areas through regular assessments, participatory redesign, and creative interventions can enhance the overall educational and professional experience for trainees. This approach not only benefits trainees but also contributes to a more effective and harmonious working environment for all theatre personnel. Adequate supervision is essential for delivering accurate and high-quality healthcare. A study found that good supervision significantly improves the accuracy of administering infusion fluids, while excessive workload can detract from this accuracy (Ardiyanti and Anisah, 2023). In mental health disciplines, supervision is integral to training, with familiar elements like fostering collaborative relationships and encouraging self-evaluation being linked to positive outcomes (Almansour \u003cem\u003eet al.\u003c/em\u003e, 2024) (Yoo, 2023). In general practice, supervision involves establishing a culture of help-seeking and balancing entrustment among supervisors, trainees, and patients, which is vital for patient safety and trainee learning (Sturman, Parker, and Jorm, 2021). Work overload is a barrier to compliance with hygiene procedures, indicating that reducing workload and improving work organization can enhance adherence to protocols (Oryginalna et al., 2011). Regular, structured supervision meetings can improve the efficiency and effectiveness of supervision, ensuring consistent feedback and active participation from supervisees (Coutts \u0026amp; Marshall, 2019)(Coutts \u0026amp; Marshall, 2019). While the need for enhanced supervision and workload management is evident, it is also crucial to consider the limitations and challenges associated with implementing these improvements. For instance, despite the identification of common supervision elements, their direct impact on outcomes can vary, suggesting that a one-size-fits-all approach may not be practical (Almansour \u003cem\u003eet al.\u003c/em\u003e, 2024). Additionally, the interplay of various factors, such as cultural and organizational dynamics, can influence the effectiveness of supervision and workload management strategies. The perception of educational opportunities varies significantly across specialties, as indicated by the p-value of 0.0101. This result suggests that different specialties offer varying levels of educational opportunities, which can impact the learning experience. In the context of oncology, for example, students report less exposure to radiation oncology compared to medical oncology, which affects their perception of educational opportunities in these fields (Hoover, Cho and Reddy, 2023) (Hoover et al., 2023). Similarly, in surgical specialties, there is alignment in perceptions of program strengths and opportunities for improvement, indicating that educational opportunities are perceived differently across specialties (Caniano \u003cem\u003eet al.\u003c/em\u003e, 2016). The ambiance of the educational environment also shows significant variation across specialties, with a p-value of 0.0132. The result highlights the variation in the atmosphere and environment in which training occurs across different specialties. A study on the educational environment in health programs highlights the importance of a favorable environment in enhancing the learning experience, which can vary significantly between specialties (C\u0026oacute;rdova-Le\u0026oacute;n and Fern\u0026aacute;ndezHuerta, 2019) (C\u0026oacute;rdova-Le\u0026oacute;n \u0026amp; Fern\u0026aacute;ndez-Huerta, 2019). The National Defense University of Malaysia study also emphasizes the role of ambiance in shaping students\u0026apos; perceptions of their educational environment, which can differ based on the unique combination of medical and military training (Jaffar \u003cem\u003eet al.\u003c/em\u003e, 2019) (Jaffar et al., 2019). Oversight, workload, and assistance are other areas where perceptions differ significantly across specialties, as indicated by a p-value of 0.0177. The fact suggests that the level of support and workload management varies between specialties. In the context of clinical training, students\u0026apos; perceptions of oversight and workload can significantly impact their training experience, as seen in the study of clinical training experiences in professional psychology (Rodriguez-Menendez \u003cem\u003eet al.\u003c/em\u003e, 2017) (Rodriguez-Menendez et al., 2017). The study on interprofessional education also highlights the importance of teamwork and assistance in shaping perceptions, which can vary across different health professions (Reddington, Egli and Schmuck, 2018)(Reddington et al., 2018). While the core perceptions of pedagogy and training do not differ significantly across specialties, variations in educational opportunities, ambiance, oversight/workload, and assistance/assistance highlight the importance of these factors in shaping the overall educational experience. These differences can influence students\u0026apos; perceptions and their career choices within the medical field. Understanding these variations can help tailor educational programs more effectively to meet the needs of students across different specialties.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis research provides valuable insights into healthcare students\u0026apos; perceptions of the operating theatre as a clinical learning environment in Saudi Arabia. The study emphasizes the importance of a nurturing educational environment, adequate supervision, and constructive feedback, all of which are essential for enhancing student engagement and learning outcomes. The need for improvement in communication and inclusivity within the operating theatre is apparent, as these elements significantly impact the overall educational experience. By addressing these aspects, healthcare education programs can more effectively equip students for their future responsibilities in patient care.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eAFHSR\u003c/strong\u003e - Armed Forces Hospitals, Southern Region\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eATEEM\u003c/strong\u003e - Anesthetic Theatre Educational Environment Measure\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIRB\u003c/strong\u003e - Institutional Review Board\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKFMMC\u003c/strong\u003e - King Fahd Military Medical Complex\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNGHA\u003c/strong\u003e - National Guard Hospital Affairs\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOT\u003c/strong\u003e - Operating Theatre\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e - Operating Room\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePSMCHS\u003c/strong\u003e - Prince Sultan Military College of Health Sciences\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSPSS\u003c/strong\u003e - Statistical Package for the Social Sciences\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSTEEM\u003c/strong\u003e - Surgical Theatre Educational Environment Measure\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBID\u003c/strong\u003e - Briefing, Intraoperative Teaching, Debriefing\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproval for ethical considerations was granted by the Institutional Review Board at Prince Sultan Military College of Health Sciences (Ref. IRB-2025-AT-045), and prior to the study, informed consent was diligently obtained from all participants, in alignment with the updated principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors have reviewed and granted their approval for the final manuscript to be made public\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAvailability and Materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings and analysis in this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author has disclosed no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eH.S. and N.A. wrote the main manuscript text. A.A. and S.A. conducted the data analysis and prepared figures 1-3. M.A. contributed to the literature review and supported the methodology section. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe researchers would like to express their gratitude to all the healthcare students who participated in this study, as well as the faculty and staff at the participating institutions for their support. Special thanks to the Institutional Review Board at Prince Sultan Military College of Health Sciences for granting ethical approval and guidance throughout the research process\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAccess O. Assessing students\u0026rsquo; perception of the surgical theatre educational environment of a private medical college in Pakistan. 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(2014) \u0026lsquo;Assessing the Effects of Instructor Enthusiasm on Classroom Engagement, Learning Goal Orientation, and Academic Self-Efficacy\u0026rsquo;, \u003cem\u003eCommunication Teacher\u003c/em\u003e, 28(1), pp. 44\u0026ndash;56. Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/17404622.2013.839047\u003c/span\u003e\u003cspan address=\"10.1080/17404622.2013.839047\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Operating Theatre, Healthcare Students, Clinical Learning Environment, Educational Outcomes","lastPublishedDoi":"10.21203/rs.3.rs-7375873/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7375873/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe operating theatre is a complex educational environment for healthcare students. It can significantly influence the clinical competencies and educational outcomes of the learners. Understanding student perceptions of this environment is crucial for enhancing learning strategies.\u003c/p\u003e\u003cp\u003e\u003cb\u003eObjective:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study examines healthcare students' perceptions of the operating theatre as a clinical learning environment and identifies factors that affect their learning outcomes in Saudi Arabia.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study employed a descriptive, cross-sectional method and conducted data collection from April to May 2025. By utilizing a questionnaire administered to 250 healthcare students from various disciplines, including anesthesia technology, nursing, and others. Data were analyzed using SPSS version 28, employing descriptive statistics and chi-square tests.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe sample consisted of 250 participants, predominantly male (78.8%), with 68% in their fourth year of study. A remarkable 99.2% of students reported that instructors were enthusiastic, but only 36.4% received constructive feedback. While 50% agreed that there were sufficient theatre sessions for experience, only 34.8% felt they were integrated into the team. In addition, 38.8% felt they received adequate supervision, while 44.8% expressed concern about being too busy with other tasks. Significant correlations were identified for educational opportunities, ambiance, and oversight based on specialty.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study's findings indicate a generally positive perception of the operating theatre as a learning environment, but also highlight the need for improvements in feedback mechanisms and team integration. Enhancing this educational atmosphere is essential for fostering student engagement and improving clinical competencies. Further research is needed to address these gaps.\u003c/p\u003e","manuscriptTitle":"Perceptions of Healthcare Students about Operation Theatre as Clinical Learning Environment and Related Factors Affecting Learning Outcomes: A Cross-sectional Study among Health Care Students in Saudi Arabia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 08:23:20","doi":"10.21203/rs.3.rs-7375873/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"876c15b3-8edc-4bfe-977e-f1aeca252b91","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-05-13T18:06:17+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-13T18:09:25+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 08:23:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7375873","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7375873","identity":"rs-7375873","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}