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educational environment in medical schools (Primparyon et al. 2000; Bassaw et ..... Faculty of Medicine, Dentistry and Nursing, University of Dundee. Bassaw B ...
2011; 33: e37–e42

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Students’ perceptions of educational environment in a medical school experiencing curricular transition in United Arab Emirates SYED ILYAS SHEHNAZ & JAYADEVAN SREEDHARAN Gulf Medical University, United Arab Emirates

Abstract Background: Gulf Medical College, UAE, underwent a major curriculum change from a discipline-based to an organ-based integrated curriculum. Aim: To compare students’ perception of the educational environment in the discipline-based curriculum with that in the integrated curriculum. Methods: Data was collected from second-year students (Group 1) in the discipline-based curriculum and in the subsequent year from second year students in the integrated curriculum (Group 2). The instrument used was Dundee Ready Education Environment Measure (DREEM). Scores were compared using Wilcoxon Rank Sum test. Data from second, third and fourth year students in the discipline-based curriculum were used to determine the total DREEM score for the school. Results: The total DREEM score was significantly higher ( p50.001) for Group 2 (135/200) when compared to Group 1(116/200). Both groups unanimously perceived a positive educational environment. Although Group 2 showed significantly more satisfaction, they perceived an over-emphasis of factual learning and a problem of cheating. Total DREEM score for the school was 120/200. Conclusion: This study shows that the organ system-based integrated curriculum is perceived to provide better educational environment than the discipline-based curriculum. However, areas like curriculum load and assessment strategies still require further fine tuning.

Introduction

Practice points

Educational environment strongly influences the students’ learning experiences. A good educational environment is essential for effective learning (Genn 2001; Roff et al. 2001; Hutchinson 2003; Till 2004). Positive environment and positive learning outcomes go hand in hand. Learning environment is primarily affected by the curriculum. ‘‘Curriculum’s most significant manifestation and conceptualization is the environment, educational, and organizational which embraces everything that is happening in the medical school’’ (Genn 2001). Gulf Medical College, Ajman, United Arab Emirates (UAE), offered a traditional discipline-based undergraduate curriculum for over 10 years. In-depth reviews of the existing curriculum revealed major weaknesses which undermined the effectiveness of the educational process. Also, the awareness of regional, local, and global changes in the health care delivery systems and guidelines from accreditation body (Ministry of Higher Education) highlighted a need for curricular change. Hence in 2007, a modular, organ-based integrated curriculum with elements of problem-based learning was introduced. The new curriculum emphasized a more studentcentered approach to promote active learning among the students using less didactics and more interactive teaching/

. Students’ perceptions of the educational environment are essential for curriculum assessment. . DREEM questionnaire identified the weaknesses and strengths of newly introduced integrated curriculum. . Satisfaction was significantly perceived with the curricular change as indicated by students’ perception of a positive learning environment. . Reduction of core curriculum and introduction of new assessment strategies are areas of remedial interventions.

learning sessions like small group learning, computer aided learning, case-based learning and problem-based learning. Although, there are many reports of studies measuring the educational environment in medical schools (Primparyon et al. 2000; Bassaw et al. 2003; Al-Hazimi et al. 2004; Mayya & Roff 2004; Zamzuri et al. 2004; Jiffry et al. 2005), we were unable to find any studies comparing the changes in the educational environment in the same medical school during an evolving curriculum. In our study, an attempt has been made to measure the students’ perceptions of the learning environment before and after the new curriculum was introduced in our

Correspondence: S. I. Shehnaz, Department of Pharmacology, Gulf Medical University, PO Box 4184, Ajman, United Arab Emirates. Tel: 971 67431333; fax: 971 67431222; email: [email protected] ISSN 0142–159X print/ISSN 1466–187X online/11/010037–6 ß 2011 Informa UK Ltd. DOI: 10.3109/0142159X.2011.530312

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medical school. A flexible curriculum can be constantly improved by identifying its weaknesses and strengths. The findings from this study will help in defining them so as to justify and improve our newly introduced curriculum.

Objectives (1)

(2)

To compare the students’ perceptions of the educational environment in the discipline-based curriculum with that in the newly introduced integrated curriculum at Gulf Medical College. To measure the students’ perceptions of the educational environment at our school.

Materials and methods Instrument The 50-item Dundee Ready Education Environment Measure (DREEM) questionnaire was administered to students in Gulf Medical College. The DREEM questionnaire has been found to have universal face validity (Primparyon et al. 2000; Bassaw et al. 2003; Al-Hazimi et al. 2004), cultural non-specificity (Roff et al. 1997; Roff 2005), and high reliability in a variety of settings (Mayya & Roff 2004; Riquelme et al. 2009). The DREEM questionnaire (Roff et al. 1997) has been used by a number of medical colleges to: (1)

(2)

(3) (4)

(5)

Assess the quality of learning environment as perceived by the students (Primparyon et al. 2000; Bassaw et al. 2003; Al-Hazimi et al. 2004; Mayya & Roff 2004; Zamzuri et al. 2004; Jiffry et al. 2005). ‘‘Diagnose’’ the positive or negative aspects of individual institutions (Primparyon et al. 2000; Bassaw et al. 2003; Mayya & Roff 2004; Jiffry et al. 2005). Identify the perceived weaknesses of a new curriculum (Till 2004). Compare the educational environment in medical schools with discipline-based curriculum versus those with innovative curriculum (Al-Hazimi et al. 2004). Ensure and maintain high quality educational environments when students of the same institution were placed at different teaching centers (Varma et al. 2005).

The DREEM inventory involves 50 items divided into five domains which are: (1) (2) (3) (4) (5)

Students’ perceptions of learning (SPL) – 12 items; maximum score is 48. Students’ perceptions of teachers (SPT) – 11 items; maximum score is 44. Students’ academic self-perceptions (SAP) – 8 items; maximum score is 32. Students’ perceptions of atmosphere (SPA) – 12 items; maximum score is 48. Students’ social self-perceptions (SSP) – 7 items; maximum score is 28.

The total score for all domains is 200. Each item is scored from 0 to 4 with 4 ¼ strongly agree, 3 ¼ agree, 2 ¼ unsure, e38

1 ¼ disagree, and 0 ¼ strongly disagree. Nine negative items are scored in reverse for analysis. The DREEM questionnaire was first pilot tested on a small sample of our students. Following the pilot study, descriptive phrases were added to some items of the questionnaire for better understanding.

Sample The questionnaire was administered to the student groups of Gulf Medical College on different occasions prior to a lecture class at the beginning of the academic year. Brief explanations of the objectives and the method of filling out the questionnaire were given. Voluntary participation was stressed upon. All students present in the class on the day of the survey took part in the study. The time taken for filling out the questionnaire was about 20 min. DREEM questionnaire was answered anonymously by all the students of second year (n ¼ 51) (Group 1), third year (n ¼ 55), and fourth year (n ¼ 40) in the discipline-based curriculum in September 2008. In the subsequent year, the questionnaire was administered to second year students in the integrated curriculum (n ¼ 44) (Group 2). The first years were not included in the study as they had recently joined the institution and were not in a position to comment on the educational environment. The final year students, on the other hand, were omitted from the study due to inability to contact all of them as they were in various clinical rotations. The study was approved by the Ethics Review Committee of the institution.

Statistical analysis Data was analyzed using the statistical package PASW-17. The mean Global scores, domain scores, and individual item scores were expressed as mean  standard deviation (SD). Comparison of scores between groups was done using Wilcoxon rank sum test. The ‘‘p’’ value less than 0.05 was considered as statistically significant.

Results The DREEM questionnaire was administered to a total of 190 students (response rate 83%). Of the 51 students in year 2 of discipline-based curriculum (Group 1), 49% were males and 51% females with a mean age of 20.3 years (SD ¼ 1.9) and 19.4 years (SD ¼ 1.4), respectively. Of the 44 students in year 2 of integrated curriculum (Group 2), 39% were males and 61% were females; their mean age being 20.6 (SD ¼ 2.2) years and 19.5 (SD ¼ 1.7) years, respectively. For this batch, the response rate for age was 93%. The two batches were homogeneous with respect to mean age and gender distribution. Data were also collected from third year and fourth year students in discipline-based curriculum. The total DREEM scores for Groups 1 and 2 were 117/200 and 135/200, respectively. The total DREEM scores for third and fourth year students in discipline-based curriculum were found to be 121/200 and 123/200, respectively. The data from

Student perception of integrated curriculum

second, third, and fourth year students (n ¼ 146) in the discipline-based curriculum were used to determine the total DREEM score for the school, which was 120/200. The mean domain scores obtained by Groups 1 and 2 are shown in Table 1. The interpretation of each domain was done as suggested by Roff et al. (1997). Both the groups perceived ‘‘a more positive approach’’ for their learning ‘‘moving in the right direction’’ for their teachers; ‘‘feeling more on the positive side’’ for their academic self perception; ‘‘a more positive atmosphere’’ for their atmosphere and ‘‘not too bad’’ for their

Table 1. Mean  SD DREEM domain scores (% of maximum score) for Groups 1 and 2.

Domain

Group 1

Group 2

SPL SPT SAP SPA SSP

29.57  5.80 26.14  3.99 19.29  4.77 26.08  6.00 15.43  3.57

(61.6%) (59%) (60%) (54%) (55%)

Total DREEM score for the group

116.5  18.7 (58%)

33.36  5.21 29.98  5.08 22.41  4.13 31.45  7.17 18.20  4.66

(69.5%) (68%) (70%) (65.5%) (65%)

135.4  22.1 (67%)

p-value 50.005 50.001 50.005 50.001 50.005 50.001

social self-perceptions. However, the mean domain scores for Group 2 were significantly more as compared to Group 1. Group 1 identified ‘‘perception of learning’’ as the domain with highest mean score, whereas Group 2 gave highest scores to the domains ‘‘perception of learning’’, and ‘‘academic selfperceptions’’. Both groups gave low mean scores to the domains ‘‘perceptions of atmosphere’’ and ‘‘social selfperceptions.’’ On analysis of the mean scores of individual items, mean scores 3 and above were considered as areas of strength; mean scores between 2 and 3 were considered as areas that could be improved and mean scores of 2 and below were areas of weaknesses. Group 1 gave the highest score for the item ‘‘the teachers are knowledgeable’’. Group 2 also supported this by ranking this second. Group 1 felt that ‘‘the teachers ridicule the students’’ and so this item had the least score. Group 2 gave low scores to items stating ‘‘the teaching over-emphasizes factual learning’’ and ‘‘cheating is a problem in this school’’ (Tables 2 and 3). For Group 1, there were 8 items (16%) indicating the areas of weaknesses; 1 item in the positive area (2%) and the remaining items were in the areas that could be improved (82%). The domains ‘‘perceptions of atmosphere’’ and ‘‘social self-perceptions’’ had maximum items in the areas of weaknesses.

Table 2. Mean (SD) DREEM item scores with significant differences between second year students in discipline-based curriculum and second year students in integrated curriculum.

Domain SPL

Serial no.

Item

7 13 24 25

The teaching is often stimulating (interesting) The teaching is ‘‘student centered’’ The teaching time is put to good use The teaching overemphasizes factual learning (a method of learning which concentrates on memorizing information) The teaching encourages me to be an active learner Long-term learning is given importance over short term learning The teachers are patient with the hospital patients The teachers ridicule (make fun of) the students The teachers have good communication skills with hospital patients The students irritate the teachers The teaching is sufficiently concerned to develop my confidence Last year work has been a good preparation for this year’s work In my profession, I have learned a lot about empathy (ability to understand somebody’s feelings/difficulties) My problem-solving skills are being well developed here (ability to solve medical problems) Much of what I have to learn seems relevant (having some sensible or logical connection) to a career in medicine The atmosphere is relaxed during the hospital ward teaching The atmosphere is relaxed during lectures There are opportunities for me to develop interpersonal skills (skills involving relationships between people) The atmosphere is relaxed during seminars/tutorials I find the experience (of studying here) disappointing I am able to concentrate well The atmosphere motivates (encourages) me as a learner There is a good support system (help) for students who get stressed I have good friends in this school My accommodation is pleasant

44 47 SPT

SAP

6 8 18 50 22 26 31 41 45

SPA

SSP

11 23 30 34 35 36 43 3 15 46

Discipline-based curriculum

Integrated curriculum

p-value

2.91 2.91 2.91 1.77

(0.802) (0.709) (0.709) (1.159)

50.001 50.001 50.05 50.01

2.31 (1.068) 2.35 (1.055)

2.89 (0.722) 2.77 (0.937)

50.005 50.05

2.04 (0.564) 1.47 (1.206) 2.06 (0.645)

3 (0.747) 2.86 (1.091) 2.91 (0.884)

50.001 50.001 50.001

2.75 (1.23) 2.43 (0.944)

2.32 (1.095) 3 (0.482)

50.05 50.001

2.25 (1.163)

3.07 (0.695)

50.001

2.47 (1.222)

3.05 (0.888)

50.01

2.45 (1.006)

2.89 (0.754)

50.05

2.59 (0.963)

3.11 (0.579)

50.01

1.92 (0.523) 2.24 (1.159) 2.14 (1.149)

2.77 (0.912) 2.7 (0.93) 2.68 (0.983)

50.001 50.05 50.01

2.39 1.78 2.14 1.78 1.67

3.02 2.3 2.66 2.68 2.14

(0.849) (1.231) (1.077) (0.909) (1.112)

50.01 50.05 50.01 50.001 50.05

3.36 (0.81) 2.91 (1.235)

50.05 50.001

2.24 2.2 2.45 2.45

(1.088) (0.825) (1.045) (0.966)

(1.168) (1.119) (1.096) (1.064) (1.089)

2.9 (1.1) 1.65 (1.426)

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S. I. Shehnaz & J. Sreedharan

Table 3. Mean (SD) DREEM item scores without significant differences between second year students in discipline-based curriculum and second year students in integrated curriculum.

Domain SPL

Serial no.

Item

1 16

I am encouraged to participate in class The teaching is sufficiently concerned to develop my competence (the ability to do something well) The teaching is well focused (concentrated well on topic being taught) I am clear about the learning objectives (goals) of the course The teaching is too ‘‘teacher-centered’’ The teachers are knowledgeable The teachers are authoritarian (strict) The teachers are good at providing feedback to students (comments in the form of opinions about students performance) The teachers provide constructive criticism (carefully considered, helpful opinion of what is wrong about somebody) The teachers give clear examples The teachers get angry in class The teachers are well prepared for their classes Learning strategies (methods) which worked for me before continue to work for me now I am confident about my passing this year I feel I am being well prepared for my profession I am able to memorize all I need The timetable of this school is appropriate (is correct) Cheating is a problem in this school I feel comfortable in class socially The enjoyment (of studying medicine) outweighs the stress of studying medicine I feel able to ask the questions I want I am too tired to enjoy this course (MBBS) I am rarely bored in this course (MBBS) My social ( personal) life is good I very rarely feel lonely (I don’t feel lonely)

20

SPT

38 48 2 9 29 32

SAP

SPA

SSP

37 39 40 5 10 21 27 12 17 33 42 49 4 14 19 28

100%

Discipline-based curriculum

Integrated curriculum

2.82 (0.713) 2.67 (0.952)

3.07 (0.695) 2.95 (0.645)

2.76 (1.031)

2.91 (0.563)

2.45 2.43 3.31 2.22 1.88

2.68 2.59 3.16 2.34 2.2

(1.222) (0.964) (0.648) (1.064) (1.211)

(0.829) (0.897) (0.68) (0.888) (0.978)

2.43 (1.118)

2.75 (0.781)

2.65 2.43 2.9 2.31

(0.89) (1.204) (0.964) (0.905)

2.89 2.66 2.89 2.52

(0.538) (1.077) (0.689) (0.902)

2.86 2.47 1.88 2.08 2.31 2.73 2.1

(0.825) (0.833) (1.107) (1.339) (1.14) (0.981) (1.237)

3.02 2.66 2.09 2.48 1.98 3 2.3

(0.792) (0.834) (1.053) (1.045) (1.303) (0.863) (1.231)

2.47 2.1 2.04 2.67 2.41

(1.172) (1.153) (1.248) (1.16) (1.314)

2.89 2.14 2.09 2.98 2.59

(0.813) (1.212) (1.309) (1.023) (1.3)

1 Item 11 Items

90% 80% 70% 60%

41 Items

50% 37 Items

40% 30% 20% 10% 0%

8 items 2 Items

Group 1

Group2