Quality Gaps in Clinical Medical Education in Yemen: A Comparative Study of Student Satisfaction in Public and Private Universities

Hisham S Ibrahim Al-shaikhli; Redhwan Ahmed  Al-Naggar; Julie  Trafford; Mahmood  Al-Khateeb; Bahaa  Saleh

doi:10.48161/qaj.v6n2a2117

Authors

Hisham Al-Shaikhli Department of Pre-Clinical Affairs, College of Nursing, QU-Health Sector, Qatar University, Doha, P.O. Box 2713, Zone 68, Qatar; https://orcid.org/0000-0001-8413-7060
Redhwan Ahmed Al-Naggar Department of Family Medicine, Faculty of Medicine, Aljeel Aljadeed University, Sana'a 15000, Yemen; https://orcid.org/0000-0002-6448-6930
Julie Trafford Department of Environmental Science, School of Public Health & Interdisciplinary Studies, Auckland University of Technology, Auckland, 1010, New Zealand; https://orcid.org/0000-0002-7162-1053
Mahmood Al-Khateeb Department of Pre-Clinical Affairs, College of Nursing, QU-Health Sector, Qatar University, Doha, P.O. Box 2713, Zone 68, Qatar; https://orcid.org/0000-0003-2447-7666
Bahaa Saleh Department of Sciences, Selwyn College, University of Auckland, Auckland 1071, New Zealand. https://orcid.org/0000-0002-5256-230X

DOI:

https://doi.org/10.48161/qaj.v6n2a2117

Keywords:

Clinical medical education, Student satisfaction analysis, Public vs private universities, Healthcare education quality gaps, Educational equity in Yemen

Abstract

The quality of clinical training is a decisive component of medical education, yet empirical evidence from conflict-affected settings such as Yemen remains scarce. This study investigates undergraduate medical students’ satisfaction with clinical education quality across public and private universities, with a focus on identifying structural and demographic determinants of variation. A cross-sectional survey was conducted among 670 clinical-phase medical students in two major Yemeni cities using an Arabic-adapted version of the National Student Survey (NSS), covering eight domains of educational quality. Data were analyzed using non-parametric statistical techniques at a significance level of α = 0.05. The findings reveal consistently higher levels of satisfaction among students enrolled in private universities, particularly in teaching quality, assessment and feedback, learning opportunities, and academic support. In contrast, public university students reported lower satisfaction across most domains, suggesting systemic constraints in resource availability and instructional delivery. Demographic factors also influenced perceptions, with male, married, and older students (24–26 years) reporting significantly higher satisfaction in selected areas. Importantly, institutional characteristics emerged as stronger predictors of satisfaction than individual-level factors. This study provides robust evidence of inequities in clinical education quality within Yemen’s higher education system. It contributes to the limited regional literature by offering a comparative and data-driven assessment of student experience in a fragile context. The findings underscore the need for targeted policy interventions, resource optimization, and pedagogical reforms to enhance the effectiveness, equity, and responsiveness of clinical medical education in Yemen.

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References

Bracken, K., et al. (2021). Spiralling pre-clerkship concepts into the clinical phase: Augmenting knowledge transfer using innovative technology-enhanced curriculum activities. Medical Science Educator, 31(5), 1607–1620.

Suikkala, A., et al. (2021). Healthcare student–patient relationship and the quality of the clinical learning environment: A cross-sectional study. BMC Medical Education, 21, 1–11.

Shaban, A. A., & Ali, R. I. (2026). Toward Human-Centered Artificial Intelligence in Education: Adaptive Learning Models for Personalized and Equitable Academic Outcomes. Qubahan Techno Journal, 5(1), 1-16.

Gonullu, I., Bayazit, A., & Erden, S. (2024). Exploring medical students’ perceptions of individual and group-based clinical reasoning with virtual patients: A qualitative study. BMC Medical Education, 24(1), 189.

Bansal, A., et al. (2020). Developing medical students’ broad clinical diagnostic reasoning through GP-facilitated teaching in hospital placements. Advances in Medical Education and Practice, 379–388.

Agha, S., Alhamrani, A. Y., & Khan, M. A. (2015). Satisfaction of medical students with simulation-based learning. Saudi Medical Journal, 36(6), 731.

Nejad, F. M., et al. (2019). Investigation of nursing student satisfaction with the first clinical education experience in universities of medical sciences in Iran. Journal of Medicine and Life, 12(1), 75.

Vahdat, S., et al. (2022). Investigating the barriers to clinical education among medical students in Iran: A narrative review study. Journal of Family Medicine and Primary Care, 11(12), 7537–7542.

Ingale, M. H., Tayade, M. C., & Bhamare, S. (2023). Early clinical exposure: Dynamics, opportunities, and challenges in modern medical education. Journal of Education and Health Promotion, 12(1), 295.

Ellis, M. V., et al. (2014). Inadequate and harmful clinical supervision: Testing a revised framework and assessing occurrence. The Counseling Psychologist, 42(4), 434–472.

Günay, U., & Kılınç, G. (2018). The transfer of theoretical knowledge to clinical practice by nursing students and the difficulties they experience: A qualitative study. Nurse Education Today, 65, 81–86.

Hashemiparast, M., Negarandeh, R., & Theofanidis, D. (2019). Exploring the barriers of utilizing theoretical knowledge in clinical settings: A qualitative study. International Journal of Nursing Sciences, 6(4), 399–405.

Guzman, S. T. (2025). Designing Trustworthy Educational Artificial Intelligence: A Systemic Framework for Explainability, Adaptivity, and Ethical Learning Analytics. Qubahan Techno Journal, 4(3), 41-50.

Zhao, W., et al. (2020). The effectiveness of the combined problem-based learning (PBL) and case-based learning (CBL) teaching method in clinical practical teaching of thyroid disease. BMC Medical Education, 20, 1–10.

Al-Wardy, N. M. (2010). Assessment methods in undergraduate medical education. Sultan Qaboos University Medical Journal, 10(2), 203.

Wong, B. M., & Headrick, L. A. (2021). Application of continuous quality improvement to medical education. Medical Education, 55(1), 72–81.

Tibeihaho, H., et al. (2021). Continuous quality improvement as a tool to implement evidence-informed problem solving: Experiences from district and health facility levels in Uganda. BMC Health Services Research, 21, 1–11.

Stalmeijer, R. E., et al. (2023). Continuous enhancement of educational quality: Fostering a quality culture (AMEE Guide No. 147). Medical Teacher, 45(1), 6–16.

Dureab, F., et al. (2021). Forms of health system fragmentation during conflict: The case of Yemen. Frontiers in Public Health, 9, 659980.

Ewnte, B., & Yigzaw, T. (2023). Early clinical exposure in medical education: The experience from Debre Tabor University. BMC Medical Education, 23(1), 252.

Patel, M. S., Lypson, M. L., & Davis, M. M. (2009). Medical student perceptions of education in health care systems. Academic Medicine, 84(9), 1301–1306.

Xia, J., et al. (2023). The impact of student engagement on satisfaction with medical education in China: A supplementary perspective. Advances in Health Sciences Education, 28(4), 1265–1288.

Keshavarzi, M. H., et al. (2022). Exploring the role of a clinical supervisor to improve professional skills of medical students: A content analysis study. BMC Medical Education, 22(1), 399.

Blouin, D., & Tekian, A. (2018). Accreditation of medical education programs: Moving from student outcomes to continuous quality improvement measures. Academic Medicine, 93(3), 377–383.

Arja, S. B., et al. (2024). The impact of accreditation on continuous quality improvement in undergraduate medical education programs: A scoping review. MedEdPublish, 14, 13.

Pollet, T. V., & Shepherd, L. (2022). Subscales in the National Student Survey (NSS): Considerations on their structure. Journal of Further and Higher Education, 46(9), 1195–1211.

Brislin, R. W. (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1(3), 185–216.

Al Ansari, A., et al. (2017). Analysis of psychometric properties of the modified SETQ tool in undergraduate medical education. BMC Medical Education, 17, 1–9.

Kruja, D., Ha, H., & Tabaku, E. (2021). Students’ perception and satisfaction of services in public and private higher education institutions: A case study in Albania. International Journal of Quality and Service Sciences, 13(3), 359–380.

Kruk, M. E., et al. (2018). High-quality health systems in the Sustainable Development Goals era: Time for a revolution. The Lancet Global Health, 6(11), e1196–e1252.

Petrescu, G.-D., et al. (2025). Evaluating medical students’ satisfaction with e-learning platforms during the COVID-19 pandemic: A structural equation modeling analysis within a multimodal educational framework. Social Sciences, 14(3), 160.

Kamel, S. (2014). Education in the Middle East: Challenges and opportunities. In Business and education in the Middle East (pp. 99–130).

Azad, R., Shakour, M., & Moharami, N. (2024). Designing an evaluation tool for evaluating training programs of medical students in clinical skill training center from consumers’ perspective. BMC Medical Education, 24(1), 502.

Tabish, S. A. (2008). Assessment methods in medical education. International Journal of Health Sciences, 2(2).

Devi, S. (2021). Yemen's health system has “collapsed”, warns UN. The Lancet, 397(10289), 2036.

Bdaiwi, Y., et al. (2023). Medical education system (re)building in a fragile setting: Northwest Syria as a case study. PLOS Global Public Health, 3(4), e0001340.

Burgess, A., & Mellis, C. (2015). Feedback and assessment for clinical placements: Achieving the right balance. Advances in Medical Education and Practice, 373–381.

Zimmerman, B. J. (2002). Becoming a self-regulated learner: An overview. Theory Into Practice, 41(2), 64–70.

Huggett, K. N., & Jeffries, W. B. (2014). An introduction to medical teaching (Vol. 271). Springer.

Hattie, J., & Timperley, H. (2007). The power of feedback. Review of Educational Research, 77(1), 81–112.

Shute, V. J. (2008). Focus on formative feedback. Review of Educational Research, 78(1), 153–189.

Topping, K. (1998). Peer assessment between students in colleges and universities. Review of Educational Research, 68(3), 249–276.

Black, P., & Wiliam, D. (2010). Inside the black box: Raising standards through classroom assessment. Phi Delta Kappan, 92(1), 81–90.

Bazán-Perkins, B., & Santibañez-Salgado, J. A. (2025). Relationship between learning gains and learning style preferences among students from the school of medicine and health sciences. BMC Medical Education, 25(1), 1–6.

Asrifan, A., et al. (2025). Traditional learners vs. non-traditional learners: Bridging the educational divide. In Mitigating learner disadvantages in teaching and learning (pp. 59–90). IGI Global Scientific Publishing.

Aguillon, S. M., et al. (2020). Gender differences in student participation in an active-learning classroom. CBE—Life Sciences Education, 19(2), ar12.

Bassi, M., et al. (2018). Failing to notice? Uneven teachers’ attention to boys and girls in the classroom. IZA Journal of Labor Economics, 7(1), 1–22.

Robins, L. S., et al. (1997). A predictive model of student satisfaction with the medical school learning environment. Academic Medicine, 72(2), 134–139.

Cujec, B., et al. (2000). Career and parenting satisfaction among medical students, residents and physician teachers at a Canadian medical school. CMAJ, 162(5), 637–640.

Papastavrou, E., et al. (2016). Nursing students’ satisfaction with the clinical learning environment: A research study. BMC Nursing, 15, 1–10.

Lempp, H., & Seale, C. (2006). Medical students' perceptions in relation to ethnicity and gender: A qualitative study. BMC Medical Education, 6(1), 17.

Atwa, H., Alkhadragy, R., & Abdelaziz, A. (2020). Medical students' perception of the educational environment in a gender-segregated undergraduate program. Journal of Medical Education, 19(3), e104934.

Ercan, N. B., & Karaoğlu, N. (2025). Gender perception of physician candidates: A cross-sectional study from Turkey. Korean Journal of Medical Education, 37(3), 269.

Pope, R. L., & LePeau, L. A. (2023). The influence of institutional context and culture. In Why Aren’t We There Yet? (pp. 103–130). Routledge.

Benti Terefe, A., & Gemeda Gudeta, T. (2022). Factors associated with nursing student satisfaction with their clinical learning environment. Nursing Research and Practice, 2022, 3465651.

Lee, C. Y., White, B., & Hong, Y. M. (2009). Comparison of clinical practice satisfaction of nursing students in Korea and the USA. Nursing & Health Sciences, 11(1), 10–16.

Denson, N., & Szelényi, K. (2022). Faculty perceptions of work-life balance: The role of marital/relationship and family status. Higher Education, 83(2), 261–278.

Wu, A. Y., Moore, Q., & Wood, R. G. (2021). Healthy marriage and relationship education with integrated economic stability services. Mathematica Policy Research.

Camarao, M. K. G. (2024). Traditional and nontraditional family structures: Influence on students’ academic ability, achievement, and readiness. Journal of Health Research and Society, 3(1), 16–25.

Ng, M., & Newpher, T. M. (2021). Class size and student performance in a team-based learning course. Journal of Undergraduate Neuroscience Education, 20(1), A49.

Baert, S., et al. (2021). Student internships and employment opportunities after graduation: A field experiment. Economics of Education Review, 83, 102141.

Garwe, E. C. (2014). Quality assurance challenges and opportunities faced by private universities in Zimbabwe. Journal of Case Studies in Education, 5.

Ochwa-Echel, J. (2016). Private universities in Uganda: Issues and challenges. International Journal of Education and Social Science, 3(3), 7–18.

Suleiman, Y., Hanafi, Z. B., & Taslikhan, M. (2017). Private universities and development of higher education in Nigeria: A mixed methods approach. The Qualitative Report, 22(7).

Ayedh, A. M. M., & Omar, O. H. M. (2019). Impact of strategic flexibility on the performance of Yemeni universities. Journal of Social Studies, 25(2), 111–136.

Al-haimi, B., Hamid, A., & Hujainah, F. (2018). Factors affecting Yemen higher education institutions performance: Challenges & obstacles. International Journal of Engineering & Technology, 7(3.21), 256–260.

Denis, L. G., Odeyemi, C. I., & Mistura, O. A. (2024). Educational organizations and academic institutions: An appraisal of public and private institutions in Africa. International Journal of Social Science Archives, 7(4).

Megahed, N., & Otaiba, A. (2013). Comparative education at universities in Egypt. In At Universities Worldwide (p. 293).

Yassin, A. (2024). Integration of simulation-based medical education: Student satisfaction and self-confidence. Saudi Journal for Health Sciences, 13(3), 249–257.

Abu-Rumman, A., & Qawasmeh, R. (2022). Assessing international students' satisfaction using the service quality model. Journal of Applied Research in Higher Education, 14(4), 1742–1760.

Ali, H. T., et al. (2025). Exploring quality of life of university students in Egypt using WHOQOL-BREF. American Journal of Health Promotion, 39(2), 263–273.

Joshanloo, M., & Jovanović, V. (2020). The relationship between gender and life satisfaction across demographic groups and global regions. Archives of Women’s Mental Health, 23(3), 331–338.