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Assessment of the educational environment among medical undergraduate students in a government medical college.

INTRODUCTION: The improved health of all people is the ultimate goal of medical education. The World Federation for Medical Education is the international body representing all medical teachers and medical teaching institutions. It works to promote highest standards in medical education. (1) Learning environment plays a critical role in how students learn and determines the quality of outcome. (2, 3, 4)

Every student works hard to get into the best educational institution in order to pursue a successful and competent career. Every institution has its core objective as imparting high standards of education and bringing out well trained students. The environment in which a student learns and grows is crucial to the overall development. Teaching and learning must be in a climate of mutual respect. (5) A conducive environment will not only instill great interest in the student, but it will also bring out the best in them.

The turning point in a student's career is considered just before she/he opts for a career choice. It goes without saying that it is at this stage that rigorous training in terms of coaching classes, extended lecture hours and multiple entrance exams form the integral part of every student's life.

A medical degree is one of the most sought after courses among the various professional courses. Young students prepare hard with dedication and commitment to land up in their dream college. There is four and half years of training in medical school followed by one year of compulsory rotatory internship. During this phase medical students need not only hands on experience with different types of clinical cases but they also need sound theoretical knowledge of basics.

A good academic and social environment is required in their training to ensure good quality doctors. The best way to assess an educational environment is to obtain a feedback from the students who live and experience it. What the students need to derive from their medical education is an appreciation of the unity of biological sciences, recognition of the requirements of health and the knowledge to promote health, prevent disease and treat when it occurs.

This reflects the main doctrine of medicine. Hence this study was taken up with the main objective of assessing the perceptions among medical undergraduate students of their educational environment.

MATERIALS & METHODS:

Study Design: This is a descriptive cross sectional study.

Study Subjects: All the third year medical undergraduate students were included in the study.

Study Period: The study was done between August 2012 to October 2012.

Study Setting: Government Medical College, Bangalore.

Questionnaire: The students were given a self-administered questionnaire.

Study Tool: Internationally validated and accepted 50 item Dundee Ready Education Environment Measure (DREEM) 6 7 was used. This questionnaire is particularly suited to assess the educational environment in undergraduate medical students. The students responded to each question on a 5 point Likert scale ranging from Strongly Agree to Strongly Disagree.

Assessment of DREEM Tool: The scores ranged from 4 for Strongly Agree, 3 for Agree, 2 for Uncertain, 1 for Disagree and 0 for Strongly Disagree. 9 of the 50 questions (numbers 4, 8, 9, 17, 25, 35, 39, 48 and 50) are negative statements and the scoring is reversed for them.

The overall score assessing the educational environment can be interpreted as follows: 8

0-50 [right arrow] Very Poor

51-100 [right arrow] Plenty of Problems

101-150 [right arrow] More Positives than Negatives

151-200 [right arrow] Excellent

In addition to the total score there are five subscales in the DREEM (Table 1). Listed below are the subscales with the interpretation of the scoring.

Students' Perception of Learning:

0-12 [right arrow] Very Poor

13-24 [right arrow] Teaching is viewed negatively

25-36 [right arrow] A more positive perception

37-48 [right arrow] Teaching highly thought of

Students' Perception of the Teachers:

0-11 [right arrow] Abysmal

12-22 [right arrow] In need of some retraining

23-33 [right arrow] Moving in the right direction

34-44 [right arrow] Model teachers

Students' Academic Self Perception:

0-8 [right arrow] Feelings of total failure

9-16 [right arrow] Many negative aspects

17-24 [right arrow] Feeling more on the positive side

25-32 [right arrow] Confident

Students' Perception of the Atmosphere:

0-11 [right arrow] A terrible environment

13-24 [right arrow] There are many issues which need changing

25-36 [right arrow] A more positive attitude

37-48 [right arrow] A good feeling overall

Students' Social Self Perception:

0-7 [right arrow] Miserable

8-14 [right arrow] Not a nice place

15-21 [right arrow] Not too bad

22-28 [right arrow] Very good socially

Data Collection and Analysis: All the students of third year medical undergraduate students were informed about the purpose of conducting such a study. Informed consent was taken and students were assured of strict confidentiality. The students were instructed and then given fifteen minutes to complete the questionnaire. Statistical Analysis was done using Microsoft Word Excel 2007 and SPSS Version 16.

RESULTS: A total of 136 students participated in the study. Among the third year medical students 94 (69.1%) were males and 42 (30.9%) were females. The students were in the age group of 18-22years. The mean age being 20.71 [+ or -] 0.759 (SD).

Currently 91 students (66.9%) were travelling from home to college, 24 (17.6%) were living in the college hostel and the rest 21 students (15.4%) were living in a paying guest accommodation. The marks secured by students to enter medical college ranged from a Minimum of 80% to Maximum of 97.8%, the Mean Score was 91.355% [+ or -] 3.76 (SD), the Median value being 92.00%. The most repeated percentage was around 94% scored by 20 (14.7%) of the students.

In the DREEM questionnaire the five subscales were averaged and classified based on their scores. (Table 2) A score of 27.07 [+ or -] 5.523 (SD) (56.39% of total score) for students' perception of the learning environment indicates 'A more positive perception', a score of 23.18 [+ or -] 3.129(SD) (52.68% of total score) for students' perception of their teachers shows 'Moving in the right direction', a score of 18.64 [+ or -] 3.069(SD) (58.25% of total score) for students' perception of their confidence in academics signals 'Feeling more on the positive side', a score of 27.35 [+ or -] 4.365(SD) (56.98% of total score) for students' perception of atmosphere in college refers to a 'A more positive attitude', and a score of 18.56 [+ or -] 3.769(SD) (66.28% of total score) for students' social self-perception points towards a social life that is 'Not too bad'.

All the subscales were totaled and an average score was calculated to be 114.79/200. As per the classification in DREEM Scale a score between 101-150 certifies an environment with 'More Positives than Negatives'.

DISCUSSION: About 45 (33%) undergraduate medical students who participated in the study are living away from the comfort of home for the first time. These students have to cope with a new living environment, in addition to a new academic environment.

The average score of 114.79 from the study shows an environment of 'More Positives than Negatives'. This is in comparison with a study done in 2003 with an average score of 107.44 (S. S. Mayya et al). (9) Another study done by B. Unnikrishnan et al got an average score of 113 / 200 for 6th term(third year) and 120 / 200 for 8th term(fourth year) group of medical students. (10)

In Subscale 1, students have a 'positive perception' to their learning environment. From the scores we find that the students find the teaching stimulating and are encouraged to participate and become competent in their subject. They feel that the teaching emphasizes long term retention of facts and concepts, which is essential in this field of work.

In Subscale 2, students find the teaching 'Moving in the right direction'; they find teachers knowledgeable with good communication skills in order to impart tough concepts in an easily understood way. The examples are clear and the teaching is patient oriented.

In Subscale 3, the students have good self confidence in their academics 'Feeling more on the positive side'. They are confident of passing exams and have learnt the importance of empathy in this profession. At some instances they find memorizing the numerous facts difficult. But with continued training the students will definitely learn to retain more.

In Subscale 4, students have 'A more positive attitude' towards the college atmosphere. The surrounding to learn during lectures or in the hospital is relaxed and encouraging. The students realize that vast opportunities exist to learn and grow.

In Subscale 5, students find their social life 'Not too bad'. They have a fairly good circle of friends to socialize and are comfortable in their accommodation. At times they do get lonely, bored or at other times stressed due to exams and hectic schedules. Students should try and interact more with teachers and come out with the issues they are facing. The teachers are always open to help whether the problem is a professional or personal one.

CONCLUSION: The overall scores are also good. The students have expressed positive perceptions of their educational environment as they are being trained to become responsible, able and competent doctors of tomorrow's society.

DOI: 10.14260/jemds/2014/3036

ACKNOWLEDGMENT: We thank all the students and teachers for having given us an opportunity to study the pains and pleasures of medical schooling.

Our sincere gratitude to Dr. Sean McAleer and Mrs. Sue Roff, School of Medicine, DUNDEE, for the development and validation of the Dundee Ready Education Environment Measure (DREEM) Tool.

REFERENCES:

(1.) World Federation for Medical Education. Basic Medical Education WFME Global Standards for Quality Improvement. University of Copenhagen Denmark 2003.

(2.) Konings K, Brand-Gruwel S, Merrienboer J. Towards more powerful learning environments through combining the perspectives of designers, teachers and students. Br J Psychol Medicine 2005; 75: 645-660.

(3.) Hutchison L. Educational Environment. BMJ 2003; 326: 810-812.

(4.) Hoffman KG, Donaldson JF. Contextual tensions of the clinical environment and their influence on teaching and learning. Med Educ 2004; 38: 448-454.

(5.) Policy on the teacher-learner relationship and the learning environment in medical education. New Jersey Medical School. University of Medicine and Dentistry of New Jersey.

(6.) Roff S, Mc Aleer S, Hardeen R, Al-Qahtani M, Ahmed A, Deza H, Groenen G, Primparyon P. Development and validation of the Dundee Ready Education Environment Measure(DREEM). Med Teach 1997; 19 (4): 295-9.

(7.) Roff S. The Dundee Ready Educational Environment Measure (DREEM)--a generic instrument for measuring students' perceptions of undergraduate health professions curricula. Med Teach. 2005; 27 (4): 322-325.

(8.) Genn JM. AMEE Medical Education Guide No. 23 (Part 1): Curriculum, environment, climate, quality and change in medical education--a unifying perspective. Med Teach 2001; 23: 337-44.

(9.) Mayya S, Roff S. Students' perception of educational environment: a comparison of academic achievers and under achievers at Kasturba medical college, India. Education for Health 2004 Nov; 17 (3): 280-291.

(10.) Unnikrishnan B, Rekha T, Mithra PP, Kumar N, Reshmi B. Perceptions of medical students about their educational environment in community medicine in a medical college of coastal Karnataka. Indian J of Community Medicine 2012 Apr; 37 (2): 130-2.

Ramamurthy M. B [1], Lilian D' Souza [2], Ranganath T. S [3], Arun Mohan M. V [4]

AUTHORS:

1. Ramamurthy M. B.

2. Lilian D' Souza

3. Ranganath T. S.

4. Arun Mohan M. V.

PARTICULARS OF CONTRIBUTORS:

1. Assistant Professor, Department of Community Medicine, Bangalore Medical College and Research Institute, Bangalore.

2. Post Graduate, Department of Community Medicine, Bangalore Medical College and Research Institute, Bangalore.

3. Professor and HOD, Department of Community Medicine, Bangalore Medical College and Research Institute, Bangalore.

4. Post Graduate, Department of Community Medicine, Bangalore Medical College and Research Institute, Bangalore.

NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:

Dr. Lilian D' Souza, #842, 5th Main, 1st Stage, Indiranagar, Bangalore-560038. Email: lilian842@gmail.com

Date of Submission: 07/07/2014. Date of Peer Review: 08/07/2014. Date of Acceptance: 15/07/2014. Date of Publishing: 21/07/2014.
Table 1: DUNDEE READY EDUCATION ENVIRONMENT MEASURE (DREEM)

Subscale 1: Students' Perception of Learning (12 items /     Average
Maximum 48)                                                   Score

1. I am encouraged to participate during teaching sessions    2.304
7. The teaching is often stimulating
13. The teaching is student centred
16. The teaching helps to develop my competence
20. The teaching is well focused
21.I feel I am being well prepared for my profession
24. The teaching time is put to good use
25. The teaching emphasizes learning facts over concepts
38. I am clear about the learning objectives of the course
44. The teaching encourages me to be an active learner
47. Long term learning is emphasized over short term
  learning
48. The teaching is too teacher centred

Subscale 2: Students' Perception of Teachers (11 items /
Maximum 44)

2. The teachers are knowledgeable                             2.301
6. The teachers are patient with the patients
8. The teachers ridicule the students.
9. The teachers are authoritarian
18. The teachers have good communication skills with
  patients
29. The teachers are good at providing feedback to
  students
32. The teachers provide constructive criticism here
37. The teachers give clear examples
39. The teachers get angry in teaching sessions
40. The teachers are well prepared for their teaching
  sessions
49. I feel able to ask the questions I want

Subscale 3: Students' Academic Self/Perception (8 items /
Maximum 32)

5. Learning strategies which worked for me before continue    2.377
  to work for me now
10. I am confident about my passing this year
22.The teaching helps to develop my confidence
26. Last year's work has been a good preparation for this
  year's work
27. I am able to memorise all I need
31. I have learnt a lot about empathy in my profession
41. My problem solving skills are being well developed
  here
45. Much of what I have to learn seems relevant to a
  career in healthcare

Subscale 4: Students' Perceptions of Atmosphere (12 items
/Maximum 48)

11. The atmosphere is relaxed during hospital teaching        2.316
12. Our academic course is well time tabled
17. Cheating is a problem in this course
23. The atmosphere is relaxed during lectures
30. There are opportunities for me to develop
  interpersonal skills
33. I feel socially comfortable in teaching sessions
34. The atmosphere is relaxed during seminars / tutorials
35. I find the experience disappointing
36. I am able to concentrate well
42. The enjoyment outweighs the stress of the course
43. The atmosphere motivates me as a learner
50. The students irritate the teachers

Subscale 5: Students' Social Self Perceptions (7 items/
Maximum 28)

3. There is a good support system for students who get        2.262
  stressed
4. I am too tired to enjoy the course
14. I am rarely bored in this course
15. I have good friends in this course
19. My social life is good
28. I seldom feel lonely
46. My accommodation is pleasant

Table 2: Subscale Percentage Scores

Subscales                              Minimum   Maximum     Mean/
                                        Score     Score      Total

1.Students Perception of Learning        13        39      27.07/ 48
2.Students Perception of Teachers        14        29      23.18/ 44
3.Students Academic Self-Perception      11        28      18.64/ 32

4.Students Perceptions of Atmosphere     11        37      27.35/ 48
5.Students Social Self Perceptions        7        28      18.56/ 28
Total Score                              74        144     114.79/200

Subscales                              Result

1.Students Perception of Learning      A more positive perception
2.Students Perception of Teachers      Moving in the right direction
3.Students Academic Self-Perception     Feeling more on the positive
                                         side
4.Students Perceptions of Atmosphere   A more positive attitude
5.Students Social Self Perceptions     Not too bad
Total Score                            More positives than negatives
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Title Annotation:ORIGINAL ARTICLE
Author:Ramamurthy, B.M.; D'Souza, Lilian; Ranganath, T.S.; Arun, Mohan M.V.
Publication:Journal of Evolution of Medical and Dental Sciences
Date:Jul 21, 2014
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