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

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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.

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