Exploring Challenges and Enablers of Pediatric Residency Training in a Resource-Limited Teaching Hospital in Northern Ethiopia

Abstract

Background

Pediatric residency training is essential for developing a skilled pediatric workforce, particularly in low- and middle-income countries such as Ethiopia. Newly established programs in resource-limited, post-conflict settings face multiple challenges that may compromise training quality. Understanding both barriers and facilitators from residents’ perspectives is critical to identifying priority areas for program improvement. Despite the rapid expansion of pediatric residency programs in Ethiopia, empirical evidence on implementation challenges remains limited. Therefore, this study aimed to explore the barriers and facilitators affecting pediatric residency training at Aksum University College of Health Sciences and identify actionable priorities for program improvement using the Consolidated Framework for Implementation Research (CFIR).

Methods

A descriptive qualitative study was conducted in May 2025 among all first- and second-year pediatric residents at the Aksum University Comprehensive Specialized Hospital (n = 10). Semi-structured in-depth interviews were conducted, audio-recorded, transcribed verbatim, and analyzed using deductive thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR) constructs. Barriers and facilitators were mapped to the CFIR constructs, and a prioritization matrix was used to guide actionable recommendations.

Results

Participants identified barriers and facilitators across four CFIR domains: Inner Setting, Intervention Characteristics, Characteristics of individuals and teams, and process factors. High-priority barriers included the absence of a Pediatric Intensive Care Unit (PICU) and limited diagnostic services, which constrained clinical exposure and evidence-based decision-making. Moderate barriers included inadequate teaching infrastructure, subspecialty shortages, residents’ welfare concerns (housing and workload), and administrative limitations. Facilitators included functional Neonatal Intensive Care unit (NICU) and emergency wards, peer and senior support, structured morning sessions, proactive learning, and the harmonized curriculum, which collectively mitigated some systemic constraints. Participants highlighted the value of collaborative peer learning and senior supervision in sustaining the quality of training.

Conclusion

Pediatric residency training in this resource-limited, post-conflict setting faces interconnected structural, resource, and administrative challenges. Existing facilitators help offset some constraints, but targeted interventions to strengthen critical care and diagnostic capacity, expand subspecialty training, enhance educational infrastructure, and address residents’ welfare could improve training effectiveness. These findings provide actionable, context-specific evidence to guide program improvements in Ethiopia and similar low-resource settings.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-026-09689-4.

Background

Globally, children constitute a substantial portion of the population requires specialized healthcare services. Approximately 1.9 billion children under the age of 15 account for nearly 26% of the world’s population, and in many low and middle-income countries (LMICs), children represent more than 40% of the total population [1, 2]. Therefore, ensuring access to high-quality pediatric care is a critical component of strengthening health systems and improving child survival outcomes.

Despite progress in reducing child mortality, many LMICs, including Ethiopia, continue to face severe shortages of trained pediatric specialists. Ethiopia has one of the lowest healthcare workforce densities in Africa [3], prompting expansion of medical education and postgraduate training programs to strengthen service delivery [3, 4]. Pediatric residency programs are central to this effort, as they prepare physicians to manage complex childhood illnesses while contributing to health system development.

Medical residency is a highly demanding phase of a physician’s career, often characterized by heavy workloads, extended shifts, limited resources, and evolving levels of clinical autonomy [5, 6]. Furthermore, compared with senior physicians, residents spend more time at the bedside performing routine but essential patient care tasks, including admission assessments, medication reconciliation, and daily progress documentation. They interact with patients across multiple care settings, such as inpatient wards, outpatient clinics, and subspecialty services and often observe the challenges faced by families navigating the healthcare system [7, 8].These conditions influence both training quality and resident well-being. Therefore, understanding the barriers and enabling factors in residency programs is crucial for optimizing training environments and ensuring that graduates acquire the competencies necessary for effective pediatric care [9, 10].

Pediatric residency training in Ethiopia began at Addis Ababa University in 1979 to address the high burden of childhood diseases and produce specialists capable of supporting national health priorities [3, 11]. Since then, the programs have expanded across multiple universities. However, rapid expansion has not always been accompanied by proportional growth in infrastructure, faculty capacity, and diagnostic resources [11]. Consequently, newly established residency programs may face implementation challenges, particularly in resource-limited and post-conflict settings, which can affect the quality of training.

Aksum University College of Health Sciences launched its pediatric residency program in 2024, as part of the national residency expansion strategy. The program includes pediatric inpatient care, neonatal intensive care, outpatient clinics, and emergency and critical care services for children. Considering the recent establishment of the program and the post-conflict context, exploring residents’ experiences provides valuable insights into barriers, facilitators, and areas for targeted improvement.

Implementation science frameworks provide a structured approach to understanding complex interventions, such as residency training programs. The Consolidated Framework for Implementation Research (CFIR) enables a systematic examination of organizational context, intervention characteristics, individual factors, and implementation processes. Applying the CFIR at the construct level facilitates the identification of actionable barriers and facilitators and guides the prioritization of strategies for program improvement.

Despite the expansion of pediatric residency programs in Ethiopia, empirical evidence on trainees’ experiences in newly established programs remains limited. Understanding the challenges from the trainees’ perspective in this context is essential to identifying programmatic gaps and improving the quality of training delivery. Therefore, this study explored barriers and enabling factors affecting pediatric residency training at Aksum University College of Health Sciences using the CFIR and identified priority areas to strengthen training in resource-limited teaching hospitals.

Operational definition

Residency program

A supervised clinical training period involving intensive, full-time professional engagement, typically requiring 60–80 working hours per week. The program provides physicians (residents or trainees) with hands-on clinical experience and progressively increasing autonomy in patient care under the supervision of experienced attending staff physicians.

Methods

Study area

The study was conducted at the College of Health Sciences, Aksum University, Department of Pediatrics and Child Health. Aksum University Comprehensive Specialized Hospital (AKU-CSH) is a referral and teaching hospital located in Aksum City, Tigray Region in northern Ethiopia. It is the second-largest public medical teaching hospital in the region, after Ayder Comprehensive Specialized Hospital. The hospital was established in 2015 as a referral and medical center serving an estimated population of 3.5 million within its catchment area. It provides a wide range of inpatient and outpatient medical services and offers training for students in various disciplines, including medicine, nursing, midwifery, public health, pharmacy, anesthesia, and medical laboratory sciences, at both undergraduate and postgraduate levels. The hospital employs more than 50 medical specialists and a large number of other health professionals.

Due to the recent conflict between the Tigray Region and the Federal Democratic Republic of Ethiopia, which broke out in November 2020 and ended with the Pretoria Peace Agreement in November 2022. The hospital has since been serving an even larger population including displaced individuals from western Tigray [12–14]. College and hospital infrastructure was significantly damaged during the conflict but is now undergoing rehabilitation and recovery efforts.

The college launched its residency programs in 2024, in alignment with the national residency expansion plan, and participated in the country-wide residency matching program for the first time. According to the national harmonized curriculum, pediatric residency training in Ethiopia spans three years. The Department of Pediatrics and Child Health is one of the major departments, staffed by ten pediatric specialists. It includes pediatric inpatient care including a malnutrition unit, Neonatal Intensive Care Unit (NICU), outpatient clinics, and an emergency and critical care units. The pediatric residency program, one of four major residency programs (along with general surgery, internal medicine, and obstetrics and gynecology), currently trains ten residents (first- and second-year). Before the residency program was established, patient care was provided by pediatricians, general practitioners, and nurses.

Study design

We conducted a descriptive qualitative study to explore the challenges and enabling factors experienced by pediatric residents at AKU-CSH. This approach allowed an in-depth understanding of residents’ perceptions regarding barriers, including infrastructure gaps and limited diagnostic capacity, and facilitators including supportive senior staff and structured curriculum, influencing program implementation.

Participants and sampling

The study population included all first- and second-year pediatric residents enrolled in the postgraduate program between May 1–31, 2025. A total population purposive sampling strategy was used to include all residents with relevant experiences, yielding a sample of 10 participants.

Data collection

Data were collected through in-depth interviews until thematic saturation. A semi-structured, piloted interview guide covering socio-demographics, learning environment, administrative issues, supervision, curriculum implementation, and social–personal factors (Supplementary 1) was used. Interviews were conducted by a public health specialist experienced in qualitative research who had no prior trainer-trainee relationship with the participants, ensuring confidentiality and minimizing social desirability bias. All interviews were audio-recorded, transcribed verbatim, and anonymized for analysis.

Data analysis

Deductive thematic analysis was guided by the Consolidated Framework for Implementation Research (CFIR). Initial codes were mapped to CFIR constructs to identify barriers including absence of a dedicated PICU, limited diagnostic tools, and inadequate teaching infrastructure and facilitators involving structured curriculum, supportive supervision, and peer interactions. Related codes were grouped into themes corresponding to CFIR domains including inner setting, intervention characteristics, characteristics of individuals and teams, and process and contextual factors. Themes were iteratively reviewed by the research team to ensure accurate representation of participants’ perspectives and synthesized into a narrative highlighting the interplay of barriers and facilitators in residency training.

Results

Ten pediatric residents (five first-year and five second-year) participated in in-depth interviews. Three participants were female, and the mean age was 30 years. While most responses were similar between first- and second-year residents, some differences emerged in terms of subspecialty exposure and workload. Using the Consolidated Framework for Implementation Research (CFIR) as an analytic lens, the findings were analyzed at the construct level, identifying key barriers to effective training and facilitators that mitigated these challenges.

Residents described substantial limitations in their learning environment and administrative structures. The absence of a dedicated Pediatric Intensive Care Unit (PICU) was highlighted as a major barrier, restricting exposure to critical cases and limiting the development of competencies in emergency and intensive care medicine. Clinical areas, including the emergency ward, NICU, and kangaroo mother care rooms were reported overcrowded, poorly organized, and affected by unreliable power supply. Morning session rooms were reported small, poorly furnished, and lacking basic audiovisual tools such as television screens. Additional barriers included the absence of separate duty rooms for male and female residents, lack of a postgraduate library, and poor broadband internet connectivity. Facilitators included the functional NICU, Emergency unit, and KMC unit; structured morning sessions with senior staff; and strong peer collaboration, which helped residents navigate these limitations.

Participant 9: “We have a central ICU with few beds admitting patients from all over the hospital. We do not have a separate PICU, which detaches us from critical care cases. I think it is time to establish a separate PICU.”

Participant 5: “Our neonatal ICU and KMC rooms have inadequate power supply, which makes it difficult to perform multiple tasks at a time.”

Participants reported organizational barriers related to working conditions and welfare, including limited night duty exposure, low salaries, and lack of housing and benefit packages. Challenges in meeting national residency training standards were perceived to affect morale and hinder the full implementation of the harmonized curriculum. The, facilitators included structured rotation schedules and supportive senior staff, which helped residents manage workload and maintain continuity in clinical learning despite administrative constraints.

Barriers related to intervention characteristics were predominantly attributed to the inadequate availability of essential medical equipment and diagnostic resources. Residents highlighted shortages of mechanical ventilators, phototherapy equipment, Continuous Positive Airway Pressure (CPAP) equipment (often requiring the use of manual alternatives), as well as deficiencies in resuscitation equipment and life-saving medications. Diagnostic limitations included the unavailability of cerebrospinal fluid analysis, electrolyte and organ function testing, culture services, and advanced imaging such as Magnetic Resonance Imaging (MRI). Residents actively adapt to hese limitations, optimizing available resources to enhance clinical learning.

Participant 7: “Our NICU lacks vital equipment such as mechanical ventilators and CPAP machines for neonates. We are currently using manual CPAP, which is not ideal.”

Participant 8: “Important investigation modalities such as culture services and MRI are unavailable. We also need portable ultrasound and X-ray machines in the NICU.”

Manpower and supervision were also key determinants of training quality. Participants reported insufficient staffing relative to workload, which contributed to fatigue and limited study time. The absence of subspecialists in areas such as cardiology and neurology was a concern, particularly for advanced stages of residency. Motivated residents, structured morning seminars, and guidance from senior pediatricians were identified as key facilitators. Peer collaboration further helped the residents navigate gaps in subspecialty teaching.

Participant 3: “For now, the available seniors are adequate for our level as first-year residents, but as we advance to second and third year, we’ll need subspecialists.”

Participant 6: “We need subspecialty lectures such as cardiology. So far, only nephrology lectures have been given.”

Most participants (eight out of ten) reported adequate case volume and diversity, particularly in the NICU. Variability in patient flow was noted, and residents suggested that stronger referral linkages with primary and general hospitals could enhance learning opportunities. Access to functional diagnostic tools was recognized as a facilitator for maximizing the educational value of clinical exposure.

Participant 1: “Although the case flow varies, we are getting adequate cases and variety, particularly in the NICU.”

Curriculum implementation and social-personal factors also influenced the training experience. Although the national harmonized pediatric residency curriculum was adopted, infrastructure limitations, diagnostic constraints, and the lack of a PICU restricted its full implementation. Residents suggested that structured rotations in better-equipped institutions and increased subspecialist supervision would strengthen the execution, although these would require additional resources. Social and personal challenges including shared dormitory accommodation, restrictions on cooking, financial strain, and language barriers indirectly affected the quality of training however, peer support and teamwork mitigated these challenges and maintained focus on learning and patient care.

Participant 2: “Despite the curriculum being comprehensive and well structured, its implementation in practice could be strengthened.”

Participant 3: “I sometimes have difficulty communicating in the local language, Tigrinya, with patients and attendants. My colleagues help me translate, and I am working on learning the language to overcome this challenge.”

To facilitate the prioritization of these findings for programmatic action, barriers and facilitators were mapped to CFIR constructs and assessed according to the severity of impact and feasibility of intervention (Table 1). This pragmatic matrix provides a framework for targeting the most critical barriers first while leveraging facilitators that are already present.

Table 1.

Prioritization of key barriers and facilitators in pediatric residency training (CFIR-based)

CFIR Domain / Construct	Key Barrier	Facilitator	Severity / Impact	Feasibility / Effort	Priority
Inner Setting: Available Resources	Absence of PICU; overcrowded clinical areas; unreliable power	Functional NICU, Emergency and, KMC units	High	High	1
Inner Setting: Structural Characteristics	No separate duty rooms, no library, poor internet access	Peer support, structured morning sessions	Medium	Medium	3
Intervention Characteristics: Tools & Technology	Limited mechanical ventilators, CPAP, diagnostic tests	Resident adaptation and proactive engagement	High	Medium	2
Characteristics of Individuals	Limited subspecialist supervision, heavy workload	Motivated residents, senior guidance, peer collaboration	High	Medium	2
Process: Curriculum Implementation	Limited implementation due to infrastructure and staffing	Harmonized curriculum framework, self-directed learning	Medium	Medium	3
Process: Social-Personal Factors	Shared dormitories, financial strain, language barriers	Peer support and teamwork	Medium	High	3

Discussion

Medical education is inherently resource-intensive and requires sustained institutional commitment, particularly in resource-limited settings. This study explored the experiences of pediatric residents in a newly established residency program at Aksum University College of Health Sciences and identified a range of barriers and facilitators that shape the implementation of training within this context. The findings illustrate that residency training is influenced by the interaction of structural limitations, institutional factors, and individual-level experiences, a pattern that has been described in several residency training programs in low and middle-income countries (LMICs) [1, 5, 11].

To better understand the factors influencing pediatric residency training in this setting, the findings were synthesized into a barrier–facilitator matrix (Table 2) based on the Consolidated Framework for Implementation Research (CFIR). The matrix summarizes the key structural, institutional, and contextual barriers alongside enabling factors identified by residents within the training environment.

Table 2.

Barrier–facilitator matrix for pediatric residency training at aksum university college of medicine and health science, 2025

Barrier	CFIR Domain / Construct	Impact on Training	Facilitator	Evidence / Quote
Absence of Pediatric Intensive Care Unit (PICU)	Inner Setting, Available Resources	High	Functional NICU, Emergency Ward, and KMC units provide alternative clinical exposure	“Although the case flow varies, we are getting adequate cases and variety, particularly in the NICU.”
Limited diagnostic services (MRI, culture, advanced labs)	Intervention, Characteristics – Complexity	High	Residents maximize use of available diagnostics and clinical reasoning	“Important investigation modalities such as Culture services and MRI are unavailable.”
Inadequate teaching infrastructure (small teaching rooms, limited audiovisual tools)	Inner Setting, Structural Characteristics	Moderate	Structured morning sessions and seminars with senior staff	“Morning sessions are conducted in small and poorly furnished rooms.”
Subspecialty shortages	Characteristics of Individuals – Knowledge & Beliefs	High	Resident motivation, peer learning, and senior pediatric supervision	“We need subspecialty lectures like cardiology.”
Resident welfare issues (housing, salary, living conditions)	Process / Context, Individual Needs	Moderate	Peer support networks and teamwork	Residents assist each other with translation and daily logistics
High workload and limited staff	Process, Execution	High	Structured rotations and supportive supervision	Morning seminars and planned rotations guide clinical responsibilities
Curriculum implementation constraints	Process, Planning & Execution	Moderate	Harmonized national curriculum provides structured training framework	“The curriculum is good but difficult to implement fully.”

One of the most prominent barriers identified by residents was the absence of a dedicated Pediatric Intensive Care Unit (PICU). The lack of a PICU limits exposure to critically ill pediatric patients and may restrict opportunities for residents to develop competencies in pediatric critical care and advanced clinical decision making. Similar infrastructural limitations have been reported in many LMICs, where shortages of specialized units constrain both clinical service delivery and postgraduate training opportunities [1, 11, 15]. Despite this limitation, the residents highlighted several facilitators within the existing clinical environment. In particular, the presence of a functional Neonatal Intensive Care Unit (NICU), pediatric emergency services, and Kangaroo Mother Care units provided opportunities for exposure to a wide range of pediatric conditions. As one participant noted, “Although the case flow varies, we are getting adequate cases and variety, particularly in the NICU.” These services appear to partially compensate for the absence of a PICU and support ongoing clinical learning.

Limited diagnostic services were also identified as a major barriers to clinical training. Participants reported the absence of important investigations such as MRI and microbiological culture services, which can limit the ability to confirm diagnoses and apply evidence-based management strategies. Diagnostic constraints have been widely documented in resource-limited health systems and may influence both patient care and educational experiences [5, 16]. Nevertheless, the participating residents described several adaptive approaches that functioned as facilitators within this context. These included relying more heavily on clinical assessment skills, maximizing the use of available diagnostic tools, and engaging in collaborative discussions during morning sessions and case presentations. Such adaptive learning strategies may help residents develop strong clinical reasoning skills, despite technological limitations.

The learning environment is also influenced by infrastructural constraints within the educational setting. Participants reported limited teaching space, small seminar and morning presentation rooms, and restricted access to audiovisual equipment and academic resources. Similar challenges have been reported in other medical training institutions, where educational programs have expanded more rapidly than infrastructure development [16–19]. However, residents emphasized that regular academic activities, such as morning sessions, seminars, and bedside teaching with senior pediatricians served as important facilitators that supported ongoing learning. Faculty involvement and structured academic schedules helped maintain educational continuity even in the presence of limited physical infrastructure.

Human resource capacity also emerged as a key factor affecting residency training in this study. Residents noted that staffing levels were sometimes insufficient relative to patient workload, resulting in demanding clinical schedules and reduced time for self-directed learning. In addition, the absence of pediatric subspecialists in areas such as cardiology and neurology was perceived as a limitation that may affect the breadth of training. Similar shortages of subspecialty expertise have been documented in many low-resource settings and may affect the implementation of comprehensive residency curricula [11, 16]. Despite these challenges, the participants described several facilitators that supported learning within the program. Supportive supervision by available pediatric specialists, active faculty engagement in clinical rounds and academic sessions, and collaborative learning among residents were frequently mentioned as positive aspects of the training environment by the participants. Peer learning and mentorship may help mitigate some of the limitations associated with subspecialty shortages.

Workload and resident welfare were also highlighted as important contextual factors influenced training experiences. Residents reported extended working hours and challenges related to housing and financial support issues. Heavy workload has been widely recognized as a potential contributor to fatigue and reduced study time among residents [5]. At the same time, participants emphasized the importance of teamwork and peer support in managing these challenges.

Informal collaboration among residents, shared responsibilities during clinical duties, and mutual assistance in daily activities were described as important facilitators that helped sustain motivation and resilience. Implementation of the national harmonized pediatric residency curriculum was generally viewed positively by the participants. A standardized curriculum provides a structured framework that guides teaching activities, clinical rotations, and learning objectives. However, residents noted that certain aspects of the curriculum could be difficult to implement fully when resources such as specialized equipment, diagnostic services, or subspecialty faculty are limited. Similar gaps between curriculum design and implementation have been reported in other rapidly expanding residency programs [11].

Nevertheless, the harmonized curriculum itself was perceived as an important facilitator, as it provided clear expectations for training and promoted consistency across residency programmes. Similar challenges have been reported in other settings, where barriers to implementing quality improvement and patient safety training include competing educational demands, limited faculty expertise, institutional culture, and difficulties in aligning curricula with hospital priorities [20, 21]. Simultaneously, evidence suggests that strengthening organizational practices, recognizing residents’ contributions, fostering supportive relationships within clinical teams, and creating opportunities for meaningful social engagement can enhance residency experiences and overall well-being [22].

Overall, the findings suggest that pediatric residency training in this resource-limited and post-conflict setting is shaped by dynamic interactions between barriers and facilitators. Structural limitations such as the absence of a PICU, limited diagnostic capacity, and inadequate educational infrastructure present important challenges to training implementation. At the same time, several enabling factors including existing clinical services, committed faculty supervision, structured academic activities, resident motivation, and strong peer support networks help sustain the educational process. Addressing key infrastructural and resource gaps while strengthening existing facilitators may contribute to improving the quality and sustainability of pediatric residency training programs in Ethiopia and similar settings.

Strengths and limitations

This study had several strengths. To our knowledge, this is one of the first studies to explore the implementation of pediatric residency training in Ethiopia from the perspective of residents in a newly established program within a resource-limited and post-conflict setting. By applying the Consolidated Framework for Implementation Research (CFIR), this study provides a structured analysis of factors influencing training implementation across multiple domains. This framework allowed the identification of both barriers and facilitators affecting residency training, including resource limitations, infrastructure constraints, workforce challenges, and contextual factors within the training environment.

Another strength of the study is the use of in-depth interviews, which enabled a detailed exploration of residents’ experiences and perceptions of the training program. This qualitative approach allowed participants to describe the challenges they encountered and the adaptive strategies and supportive elements within the program that facilitated learning. Including all currently enrolled pediatric residents helped ensure that the findings reflected the full range of perspectives within the residency program and provided valuable contextual insights into training in a newly established program.

Nevertheless, several limitations should be considered when interpreting the findings. The study was conducted in a single institution, which may limit the transferability of the findings to other residency programs in Ethiopia or similar settings. Although the sample size was appropriate for qualitative research and included all active residents in the program, the relatively small number of participants may limit the diversity of experiences captured. In addition, the findings are based on self-reported experiences of residents, which may be subject to recall bias or social desirability bias. The study relied primarily on individual interviews without incorporating additional qualitative methods such as focus group discussions, document review, or direct observation, which could have strengthened methodological triangulation. Furthermore, perspectives from faculty members, administrators, and other stakeholders were not included, and their inclusion might have provided a more comprehensive understanding of the barriers and facilitators influencing program implementation. Despite these limitations, the study offers useful preliminary insights into the implementation of pediatric residency training in resource-limited settings.

Conclusion and recommendation

This study explored the experiences of pediatric residents in a newly established residency program at Aksum University College of Health Sciences and identified several interrelated barriers and facilitators influencing training implementation. Key barriers included limitations in infrastructure such as the absence of a Pediatric Intensive Care Unit, restricted diagnostic services, shortages of subspecialty expertise, and challenges related to educational infrastructure and workload. These constraints may affect the breadth of clinical exposure and learning opportunities available to residents.

At the same time, the findings highlight several facilitators that support the functioning of the training program despite these challenges. These include the presence of functional clinical services such as the Neonatal Intensive Care Unit and pediatric emergency unit, supportive supervision by available pediatric specialists, structured academic activities such as morning sessions and seminars, a nationally harmonized residency curriculum, and strong peer collaboration among residents. These enabling factors appear to play an important role in sustaining clinical learning and supporting resident engagement within a resource-limited training environment.

Overall, the study suggests that pediatric residency training in resource-constrained settings is shaped by a dynamic interaction between structural barriers and contextual facilitators. Addressing key resource and infrastructure gaps while strengthening existing supportive elements may contribute to improving the quality and sustainability of pediatric residency training programs in Ethiopia and similar settings.

Based on the identified barriers and facilitators, several recommendations may help strengthen pediatric residency training programs in similar resource-limited settings. First, investments in clinical infrastructure and diagnostic capacity may enhance training opportunities and improve patient care. Expanding pediatric critical care services, strengthening laboratory and imaging capacity, and improving access to essential medical equipment could broaden clinical exposure and support evidence-based practice. Second, strengthening faculty capacity and subspecialty mentorship may help improve the breadth of training experiences. Collaborative partnerships with other institutions, visiting faculty programs, or tele-education initiatives may provide additional opportunities for subspecialty teaching and academic mentorship.

Third, improving educational infrastructure may enhance the learning environment. Expanding teaching spaces, improving access to learning resources, and strengthening internet and digital learning platforms could support academic activities and independent learning among residents.

Fourth, institutional efforts to support resident well-being may help address challenges related to workload and living conditions. Providing adequate housing support, ensuring reasonable work schedules, and promoting supportive learning environments may contribute to improved resident satisfaction and training outcomes.

Finally, future research could expand on these findings by including multiple training institutions and incorporating perspectives from faculty members, administrators, and policymakers. Such studies may provide a broader understanding of the systemic barriers and facilitators influencing postgraduate medical education in Ethiopia and other resource-limited settings.

Abbreviations

CFIR

Consolidated frame work for implementation research

CPAP

Continuous Positive Airway Pressure

NICU

Neonatal Intensive Care Unit

PICU

Pediatric Intensive Care Unit

Authors' contributions

YL: Conceptualization, Visualization, Supervision, Writing- Original draft preparation. HHH : Data curation, Writing- Original draft preparation. MGK; Writing review and editing , BKR: Visualization, Investigation, Writing review and editing.

Funding

This study did not receive any grants or funding from either for-profit or nonprofit organizations.

Data availability

The data set is available upon reasonable request to the corresponding author.

Declarations

Ethics approval and consent to participate

Ethical clearance was obtained from the Aksum University Institutional Review Board (IRB) with a Reference No: 031/2025. This study was conducted in accordance with the Declaration of Helsinki, and written informed consent—including consent to publish the data was obtained from all participants.

Consent for publication

Informed written consent was obtained from participants for publication.

Competing interests

The authors declare no competing interests.