Psychometric evaluation of the Dundee Ready Educational Environment Measure: Swedish version

Clinical students' perception of educational environment in a Nigerian university: a mixed method study

BACKGROUND

Learning environment (LE) research has been given priority in higher education institutions globally because of its influence on learning processes and outcomes. Although studies reporting the perceptions of health science students about LE in Nigeria are available, none have compared the perceptions of students from different health professions. Therefore, this study aimed to assess final-year clinical students' perceptions of their LE from four programs (dentistry, medicine, nursing, and physiotherapy) and compared their LE perceptions.

METHODS

This study adopted a cross-sectional study design using a mixed method approach. The quantitative survey involved all the final-year clinical students at the University of Ibadan, and they completed the Dundee Ready Education Environment Measure (DREEM) questionnaire. The qualitative aspect involved 24 consenting students in four focus group discussions.

RESULTS

A total of 214 out of 223 copies of the DREEM questionnaire were duly completed and returned, yielding 96.0% response rate. The participants' mean age was 24 ± 2.3 years (ranged between 22 and 25 years, p = 0.001). The mean DREEM scores of the students from the four programs ranged between 119.68 ± 18.02 and 147.65 ± 15.89 out of a maximum of 200, interpreted as more positive than negative perceptions of LE. Physiotherapy students' DREEM score was significantly higher than those of medical, dental, and nursing students (p < 0.001). The DREEM scores of other students did not differ significantly (p > 0.05). Dental and medical students had similar positive perceptions. The qualitative aspect revealed that the students had positive perceptions of their teachers' knowledge base and self-acquisition of knowledge but negative perceptions of their teachers' communication skills, infrastructural facilities, lecturer-student relationships, and hostel accommodations.

CONCLUSION

Although the survey indicated that these clinical students had more positive than negative perceptions of their learning environment, the qualitative aspect of the study revealed many challenges that the students were confronted with. The clinical students' perception of their learning environment could be improved if the university authorities would address these challenges.

Development of a pharmacy educational environment questionnaire

INTRODUCTION

A robust instrument for measuring the educational environment in a pharmacy patient care setting is currently lacking. The authors aimed to develop a person-reported outcome measure to gauge trainee pharmacists' perceptions of their clinical workplace-based educational environment. This paper reports the various sources of validity evidence.

METHODS

A preliminary, three-domain (system, relationship, and personal), 36-item measurement instrument was developed by incorporating results from literature review, focus group interviews, iterative discussions among educators, and cognitive interviews. The preliminary instrument, together with the Dundee Ready Educational Environment Measure (DREEM) and Orientation to Happiness Scale (OHS), were administered to trainee pharmacists recruited from one pharmacy school and one healthcare cluster in Singapore. Rasch analysis was conducted on the overall instrument as well as three domains: System, Relationship, and Personal.

RESULTS

The 36-item instrument was administered to 145 learners, of which 66 were trainee pharmacists and 79 undergraduate interns. Upon removal of the middle "neutral" category to resolve poorly functioning categories and removal of five poorly functioning items, the overall instrument and its domains generally showed good fit with the Rasch model. Moreover, the overall 31-item Singapore Pharmacy Educational Environment Questionnaire (SPEEQ) and its three domains showed moderate to high convergent correlation with all the five DREEM domains and low to non-significant divergent correlation with the OHS Pleasure of Life subscale.

CONCLUSIONS

Among one sample of pharmacy trainees, the 31-item SPEEQ and its three component domains demonstrated notable validity evidence to gauge trainees' perceptions of their learning environment.

Validation of the Polish version of the DREEM questionnaire - a confirmatory factor analysis

AIM

The aim of our study was to translate and adapt the Dundee Ready Education Environment Measure (DREEM) questionnaire developed by Roff et al. to the cultural conditions in Poland and also to validate it. Studying the learning environment is beneficial because it can identify students' perceptions of their environment and support the staff in reflecting on, planning for and combining proper teaching approaches to improve it.

METHODS

The DREEM questionnaire was completed by students of all years (first-fifth) in the faculties of dental medicine at the Medical University of Lublin and the Medical University of Gdańsk. The total surveyed population consisted of 650 students. Validity was separated into four phases: (1) translation validity, (2) confirmatory factor analysis, (3) concurrent validity and (4) criterion-related validity.

RESULTS

Our study confirmed the original structure of the DREEM tool (GFI = 0.955, AGFI = 0.951, NFI = 0.931, TLI = 0.962, CFI = 0.964, RNI = 0.964, IFI = 0.964, RFI = 0.928, PNFI = 0.885, SRMR = 0.062, RMSEA = 0.043, 90% CI = 0.041-0.046) and obtained very good reliability rates, with Cronbach's alpha > 0.7 for all scales. Only Subscale V achieved a lower Cronbach's alpha of > 0.5. The study was conducted using the test-retest method, which is why the intraclass correlation coefficients for reliability were also calculated; individual items showed both medium and good correspondence.

CONCLUSIONS

Our study provided good evidence for the reliability and validity of the Polish version of the DREEM. In conclusion, the Polish-language version of the DREEM questionnaire is a reliable and valid instrument for analysing the learning environment for dental students and its factor structure is supported by the data.

Medical undergraduates' self-evaluation: before and after curriculum reform

BACKGROUND

In 2013, Taiwan launched a curriculum reform-the 7-year undergraduate medical education program was shortened to 6 years. This study explored the evaluation results from students regarding the curriculum reform and investigated graduates' perceptions regarding the curriculum organization of the two academic training programs affected by this curricular reform.

METHODS

A cross-sectional survey was conducted from May 14 to June 12, 2019. The 315 graduates from both the 7-year and 6-year curriculum programs in the same medical school in Taipei were invited to participate in this study. In total, 197 completed questionnaires were received, representing a response rate of 62.5%. The results of the principal component analysis confirmed the validity of the constructs employed in this self-administered questionnaire.

RESULTS

The t-test results yielded two main findings. First, the graduates from the 6-year program had significantly lower scores for preparedness for the upcoming postgraduate-year residency training than did their 7-year program counterparts. Additionally, the male graduates had significantly higher scores in terms of perceptions regarding curriculum organization and preparedness for postgraduate-year residency training than the female graduates. The results of stepwise regression also indicated that the sex difference was significantly correlated with graduates' readiness for their postgraduate-year residency training.

CONCLUSION

To avoid sex disparities in career development, a further investigation of female medical students' learning environment and conditions is necessary. In addition to the cross-sectional study of students' perceptions, further repeated measurements of the objective academic or clinical performance of graduates in clinical settings are desirable.

Public Health Graduates' Perceptions of the Educational Environment Measured by the DREEM

Objective

Students' perceptions of the educational environment have a significant impact on their behavior and academic progress. This study aims to measure medical graduates' perception of the educational environment within the School of Public Health at Wuhan University in China.

Methods

The survey was conducted by emails sent to 119 graduates, and 93 valid questionnaires were returned. The DREEM was used to assess the medical graduates' satisfaction with the educational environment.

Results

The average score on the scale was 126.02 (±18.27). The scoring rate of the areas ranged between 61.06 and 67.11%. The area with the highest score was “perception of teachers.” The area with the lowest score was “academic self-perception.” No difference was found between genders. Except for “perception of atmosphere,” the total scores and other areas showed differences in graduation time.

Conclusion

The educational environment at the School of Public Health at Wuhan University was satisfactory. The program contributed to the graduates' later careers. The information obtained in this study identified some areas for improvement.

Cross-Cultural Adaptation and Validation of the Korean Version of the Dundee Ready Education Environment Measure (DREEM)

Internationally, Dundee Ready Education Environment Measure (DREEM) is being used to evaluate and compare students' awareness regarding medical education environment. This study aimed to adapt DREEM into Korean, to evaluate the reliability and validity, and to compare its structure to the original DREEM structure. The DREEM was translated using 6 steps which were suggested in cross-cultural adaptation protocols: translation, synthesis, back translation, expert committee review, pilot test, and psychometric study (N = 451). We performed confirmatory factor analysis including basic analysis. For evaluating the original model's goodness of fit with the acquired dataset, model fit indices and construct validity were discussed. The Korean version was completed upon through cross-cultural adaptation protocols. Statistical analysis with 451 data sets showed that the root mean square error of approximation = 0.06, goodness-of-fit index = 0.75, and Tucker–Lewis index = 0.73. Almost construct reliabilities were all over 0.707. Except for just one pair, all squares of correlation coefficients were greater than the corresponding average variance extracted. In conclusion, we developed the Korean version of DREEM. Although the original 5-factor structure was acceptable, low convergent and discriminant validity indices suggested that further studies for the Korean environment are necessary for the respecified or modified factor structures.

-A cross-sectional study of clinical learning environments across four undergraduate programs using the undergraduate clinical education environment measure

BACKGROUND

The clinical learning environment (CLE) influences students' achievement of learning outcomes and the development of their professional behaviors. However, CLEs are not always optimal for learning because of clinical productivity expectations and a lack of support from supervisors. The purpose of this study was to describe and compare students' perceptions of their CLEs across four undergraduate programs.

METHODS

This study is cross-sectional. In total, 735 students who were registered in the medical, nursing, physiotherapy, and speech-language pathology (SLP) programs were invited to participate. Data were collected using an online survey, which included demographics and the Undergraduate Clinical Education Environment Measure (UCEEM). The UCEEM consists of 26 items congregated into two overarching dimensions-experiential learning and social participation-with four subscales: opportunities to learn in and through work and quality of supervision, preparedness for student entry, workplace interaction patterns and student inclusion, and equal treatment.

RESULTS

In total 280 students (median age 28; range: 20-52; 72% females) returned the questionnaire. The mean total UCEEM score was 98.3 (SD 18.4; range: 91-130), with physiotherapy students giving the highest scores and medical students the lowest. The mean scores for the dimensions experiential learning and social participation for all the students were 62.8 (SD 13.6; range 59-85) and 35.5 (SD 6.2; range 13-45), respectively. Medical students rated the lowest for all subscales. The items receiving the highest ratings concerned equal treatment, whereas those receiving the lowest ratings concerned supervisors' familiarity with the learning objectives. There were few statistically significant differences between the semesters within each program.

CONCLUSIONS

The students generally hold positive perceptions toward their CLEs. However, the students from the medical and nursing programs rated their learning environment lower than did the students from the physiotherapy and SLP programs. Importantly, in several aspects, the medical students provided significantly lower ratings for their CLE compared with the students from the other programs. The medical students' low ratings for their supervisors' familiarity with the learning objectives underscore the need to ensure that the prerequisites for optimal supervision are met.

Measuring Students' Perceptions of the Medical School Learning Environment: Translation, Transcultural Adaptation, and Validation of 2 Instruments to the Brazilian Portuguese Language

BACKGROUND

Although learning environment (LE) is an important component of medical training, there are few instruments to investigate LE in Latin American and Brazilian medical schools. Therefore, this study aims to translate, adapt transculturally, and validate the Medical School Learning Environment Scale (MSLES) and the Johns Hopkins Learning Environment Scale (JHLES) to the Brazilian Portuguese language.

METHOD

This study was carried out between June 2016 and October 2017. Both scales have been translated and cross-culturally adapted to Brazilian Portuguese Language and then back translated and approved by the original authors. A principal components analysis (PCA) was performed for both the MSLES and the JHLES. Test-retest reliability was assessed by comparing the first administration of the MSLES and the JHLES with a second administration 45 days later. Validity was assessed by comparing the MSLES and the JHLES with 2 overall LE perception questions; a sociodemographic questionnaire; and the Depression, Anxiety, and Stress Scale (DASS-21).

RESULTS

A total of 248 out of 334 (74.2%) first- to third-year medical students from a Brazilian public university were included. Principal component analysis generated 4 factors for MSLES and 7 factors for JHLES. Both showed good reliability for the total scale (MSLES α = .809; JHLES α = .901), as well as for each subdomain. Concurrent and convergent validity were observed by the strong correlations found between both scale totals (r = 0.749), as well as with both general LE questions: recommend the school to a friend (MSLES: r = 0.321; JHLES: r = 0.457) and overall LE rating (MSLES: r = 0.505; JHLES: r = 0.579). The 45-day test-retest comparison resulted in a Pearson correlation coefficient of 0.697 for the JHLES and 0.757 for the MSLES.

CONCLUSIONS

Reliability and validity have been demonstrated for both the MSLES and the JHLES. Thus, both represent feasible options for measuring LE in Brazilian medical students.

Improving students' learning environment by DREEM: an educational experiment in an Iranian medical sciences university (2011-2016)

BACKGROUND

Students' perception of the educational setting is an important source for improving and applying changes to the educational environment. In this study, we reassessed undergraduate students' perception of the educational environment at two colleges of RUMS-Iran in the academic years of 2011 and 2016.

METHODS

In the present prospective study, the DREEM inventory consisted of seven courses for undergraduate paramedical and nursing-midwifery students (n = 982). After the first stage, educational seminars and workshops were set up for academic members and faculty staff on deficiencies and the ideal climate for optimizing the educational environment. The results of students' responses in 2011 were compared with those assessed in 2016. For the data analysis, the independent t-test and the one-way ANOVA were utilized.

RESULTS

In the academic year of 2010-2011, the DREEM inventory scored 115.33/200 (57.66%); it also scored 123.47/200 (60.7%) in the academic year of 2015-2016 (p ≤ 0.01). There was an interesting feeling about the first-year education, and female students felt a more positively perceived learning environment during all courses than male students at both stages of the study. There were significant positive differences (2 to 7%) in all domains of the components of DREEM in all courses between the academic year of 2010-2011 and the academic year of 2015-2016, showing that the DREEM score had changed and increased (p < 0.05), in the latter case.

CONCLUSIONS

Positive differences were observed in DREEM scores between the two stages of the study. DREEM helped reduce the areas of deficiencies in students' perception of many aspects of the educational environment. It also helped identify problematic areas in the improvement. In addition, DREEM could be used to optimize and make modifications to the educational environment.

Student-Based Analysis of Perception Regarding the Educational Environment Using the Dundee Ready Education Environment Measure Questionnaire at Chattagram Maa-O-Shishu Hospital Medical College, Bangladesh

Aim

The educational environment is the most significant manifestation of the curriculum. The Dundee Ready Education Environment Measure questionnaire is the precise quantitative assessment tool for the EE for medical- and health-related professional schools.

Method

This was a cross-sectional study conducted in Chattagram Maa-O-Shishu Hospital Medical College, Chittagong, Bangladesh during the study period of 2017-2018. The DREEM questionnaire was distributed to the paraclinical and clinical students in their regular classes. Data were analyzed using SPSS version 19.

Results

A total of 170 students responded to the questionnaire, of which 27.6% were male, and 72.4% were female. The mean total Dundee Ready Education Environment Measure score of the present study was 130.46. Paraclinical students scored statistically significantly higher than clinical students (p=0.040). Students' social self-perceptions were significantly higher for male than for female students (p<0.05). Most of the students opined that a positive learning experience (80.6%), appropriate teaching method (81.2%), and academic self-perceptions were positive (77.1%), and positive learning atmosphere (65.9%) as well as social surroundings were in acceptable range (70.6%) in Chattagram Maa-O-Shishu Hospital Medical College.

Conclusion

The findings and evidences of the present study will hopefully provide the basis to take effective measures to improve teaching and learning environment of this medical school.

Perceptions of the educational environment among undergraduate physical therapy students in a competency-based curriculum at the University of Chile

PURPOSE

This study aimed to assess the educational environment (EE) among students in a physical therapy undergraduate program, to identify patterns in EE perceptions among the students by year, and to determine issues that should be addressed.

METHODS

The Dundee Ready Education Environment Measure (DREEM) questionnaire was used to explore the relationships among the total mean score, subscales, and items in a competency-based curriculum in the physical therapy program at the University of Chile. The DREEM questionnaire was filled out by 166 of 244 students (68.03%), of whom 56.6% were men and 43.4% were women, with 75.9% between 19 and 23 years of age.

RESULTS

The total mean score (120.9/200) indicated that the EE was perceived as 'more positive than negative.' There were significant differences (P<0.05) between first-year students (113.41), who reported the lowest total mean score, and fourth-year students (126.60), who had the highest total mean score. Students rated their EE favorably on each subscale except social self-perceptions, which second-year students rated as 'not too bad,' and for which first-, third-, and fourth-year students gave a rating corresponding to 'not a nice place.' On the perceptions of teachers subscale, there were significant differences (P<0.05) between first-year students (28.05/44) and fourth-year students (32.24/44) and between second-year students (28.72/44) and fourth-year students (32.24/44). On the academic self-perceptions subscale, there were significant differences (P<0.05) between first-year students (18.12/32) and second-year (21.68/32), third-year (22.33/32), and fourth-year students (21.87/32).

CONCLUSION

Physical therapy students at the University of Chile had positive perceptions of their EE. First-year students rated the largest number of items as problematic. Improvements are required across the program in the specific subscales mentioned above.

Investigating psychometric properties and dimensional structure of an educational environment measure (DREEM) using Mokken scale analysis - a pragmatic approach

BACKGROUND

Questionnaires and surveys are used throughout medical education. Nevertheless, measuring psychological attributes such as perceptions of a phenomenon among individuals may be difficult. The aim of this paper is to introduce the basic principles of Mokken scale analysis (MSA) as a method for the analysis of questionnaire data and to empirically apply MSA to a real-data example.

METHODS

MSA provides a set of statistical tools for exploring the relationship between items and latent traits. MSA is a scaling method of item selection algorithms used to partition an array of items into scales. It employs various methods to probe the assumptions of two nonparametric item response theory models: the monotone homogeneity model and the double monotonicity model. The background and theoretical framework underlying MSA are outlined in the paper. MSA for polytomous items was applied to a real-life data example of 222 undergraduate students who had completed a 50-item self-administered inventory measuring the educational environment, the Dundee Ready Educational Measure (DREEM).

RESULTS

A pragmatic and parsimonious approach to exploring questionnaires and surveys from an item response theory (IRT) perspective is outlined. The use of MSA to explore the psychometric properties of the Swedish version of the DREEM failed to yield strong support for the scalability and dimensional structure of the instrument.

CONCLUSIONS

MSA, a class of simple nonparametric IRT models - for which estimates can be easily obtained and whose fit to data is relatively easily investigated - was introduced, presented, and tested. Our real-data example suggests that the psychometric properties of DREEM are not adequately supported. Thus, the empirical application depicted a potential and feasible approach whereby MSA could be used as a valuable method for exploring the behavior of scaled items in response to varying levels of a latent trait in medical education research.

Medical school clinical placements - the optimal method for assessing the clinical educational environment from a graduate entry perspective

BACKGROUND

Educational environment is a strong determinant of student satisfaction and achievement. The learning environments of medical students on clinical placements are busy workplaces, composed of many variables. There is no universally accepted method of evaluating the clinical learning environment, nor is there consensus on what concepts or aspects should be measured. The aims of this study were to compare the Dundee ready educational environment measure (DREEM - the current de facto standard) and the more recently developed Manchester clinical placement index (MCPI) for the assessment of the clinical learning environment in a graduate entry medical student cohort by correlating the scores of each and analysing free text comments. This study also explored student perceptionof how the clinical educational environment is assessed.

METHODS

An online, anonymous survey comprising of both the DREEM and MCPI instruments was delivered to students on clinical placement in a graduate entry medical school. Additional questions explored students' perceptions of instruments for giving feedback. Numeric variables (DREEM score, MCPI score, ratings) were tested for normality and summarised. Pearson's correlation coefficient was used to measure the strength of the association between total DREEM score and total MCPI scores. Thematic analysis was used to analyse the free text comments.

RESULTS

The overall response rate to the questionnaire was 67% (n = 180), with a completed response rate for the MCPI of 60% (n = 161) and for the DREEM of 58% (n = 154). There was a strong, positive correlation between total DREEM and MCPI scores (r = 0.71, p < 0.001). On a scale of 0 to 7, the mean rating for how worthwhile students found completing the DREEM was 3.27 (SD 1.41) and for the MCPI was 3.49 (SD 1.57). 'Finding balance' and 'learning at work' were among the themes to emerge from analysis of free text comments.

CONCLUSIONS

The present study confirms that DREEM and MCPI total scores are strongly correlated. Graduate entry students tended to favour this method of evaluation over the DREEM with the MCPI prompting rich description of the clinical learning environment. Further study is warranted to determine if this finding is transferable to all clinical medical student cohorts.

Perception Study of Traditional Korean Medical Students on the Medical Education Using the Dundee Ready Educational Environment Measure

Background. In Korea, a few studies regarding traditional Korean medicine (TKM) education have been conducted. The aim of this study is to evaluate students' perceptions regarding TKM education in Korea and compare them with those of other countries using a quantitative scale, Dundee Ready Educational Environment Measure (DREEM). Materials and Methods. We conducted a survey using DREEM in a TKM college. Totally, 325 students responded to this survey and we performed the descriptive statistics of scores in all items, subscales, and total. Additionally, subgroup comparisons according to gender, school year, and academic achievement were analyzed. Results. Mean overall DREEM score was 94.65 out of 200, which is relatively low compared to previous studies. Particularly, perceptions regarding subscales of learning, atmosphere, and self-perceptions were interpreted as problematic. There was no statistically significant difference between genders in spite of some differences among groups based on school year or academic achievement. Conclusions. We could examine students' perceptions regarding TKM education at a TKM college using DREEM for which validity and reliability were verified. TKM education was perceived relatively poor, but these quantitative indicators suggested which parts of education need improvement. We expect DREEM to be used widely in TKM or traditional medical education field.

Comparing dental students' perceptions of their educational environment in Northwestern Saudi Arabia

Objectives:

To compare the perceptions of dental students over a 5-year period.

Methods:

This cohort study was carried at Taibah University, College of Dentistry, Al-Madinah Al-Munawwarah, Saudi Arabia between 2009 and 2014. Data was obtained using the Dundee Ready Education Environment Measure (DREEM), which consists of 50 items, 4 of these were irrelevant to this cohort and were excluded. All students registered in 2009 were included and followed up in 2014. Their responses were compared using the paired student’s t-test.

Results:

Thirty-four students completed the questionnaire in 2009, and 30 of them participated in 2014 (12% drop out rate). The mean domain and total scores decreased over time. The mean scores for 6 items decreased significantly, while 4 of them had a significant increase. The lowest mean score in 2009 regarding support for stressed students increased (p=0.004) in 2014. However, the highest mean score in 2009 related to having a good social life, reduced (p=0.007) in 2014. This could be an indication of the high workload and its impact on their social lives.

Conclusion:

Student’s perceptions were relatively low at the beginning, and remained low throughout the study. There were no significant changes in mean domain, and total scores and although scores of some items improved, most decreased over the study period.

Evaluating the educational environment of an international animal model-based wet lab course for undergraduate students

Background

Essential Skills in the management of Surgical Cases – ESMSC is an International Combined Applied Surgical Science and Wet Lab course aimed at the undergraduate level. ESMSC combines interactive basic science workshops and case-based learning, with basic surgical training modules (BST) on Ex Vivo and In Vivo swine model. In Vivo Dissections include more advanced modules i.e. Abdominal Anatomy Dissections and Cardiac Transplant.

Aim

To evaluate the educational environment of a novel course, as well as to compare Medical students' perceptions across various groups.

Materials and Methods

83 Delegates from King's College London (KCL) and several Hellenic Medical Schools attended the ESMSC course. The DREEM inventory was distributed upon completion of the modules.

Results

The mean overall score for DREEM inventory was 148.05/200(99–196, SD = 17.90). Cronbach's Alpha value was 0.818, indicating good internal consistency of the data. Year 3/4 Students have a significantly positive “Perception of Learning”, when compared to Year 5/6 (36.43 vs. 33.75, p = 0.017). KCL Students have a more positive view of the course compared to their Greek counterparts (155.19 vs. 145.62/200, p = 0.034). No statistical significant difference was noted when comparing male vs. female students (p > 0.05).

Conclusions

Students seem to positively rate the ESMSC educational environment. Junior as well as KCL students appear to be more enthusiastic. Further research should focus on the optimal strategy for early involvement and motivation of various students' groups in BST.

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ESMSC is an International Surgical Science and Wet Lab course aimed at undergraduates.

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Students seem to positively rate the ESMSC educational environment.

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Year 3/4 Students have a significantly positive “Perception of Learning”, when compared to Year 5/6.

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KCL Students gave a more feedback on the course compared to their Greek counterparts.

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Further research should focus on involving and motivating students early in BST.

Evaluation of Educational Environment for Medical Students of a Tertiary Pediatric Hospital in Tehran, Using DREEM Questionnaire

BACKGROUND

Tertiary pediatric hospitals usually provide excellent clinical services, but such centers have a lot to do for educational perfection.

OBJECTIVES

This study was performed to address under-graduate educational deficits and find feasible solutions.

PATIENTS AND METHODS

This cross-sectional study was done in a target population of 77 sixth year undergraduate medical students (response rate = 78%) who spent their 3-month pediatric rotation in the Children's Medical Center, the Pediatrics Center of Excellence in Tehran, Iran. The Dundee ready educational environment measure (DREEM) instrument was used for assessing educational environment of this subspecialized pediatric hospital.

RESULTS

Among 60 students who answered the questionnaires, 24 were male (40%). Participants' age ranged from 23 to 24 years. The mean total score was 95.8 (48%). Comparison of scores based on students' knowledge showed no significant difference. Problematic areas were learning, academic self-perception, and social self-perception.

CONCLUSIONS

Having an accurate schedule to train general practitioner, using new teaching methods, and providing a non-stressful atmosphere were suggested solutions.

A web-based survey of the motivations and challenges faced by emerging researchers in the chiropractic profession

OBJECTIVE

To investigate the motivations, challenges and perceptions of the educational environment of emerging researchers in chiropractic.

METHODS

A descriptive web-based survey of higher-degree chiropractic research students was performed between October and November 2013. The survey consisted of open and closed questions and the Dundee Ready Education Environment Measure.

RESULTS

Twenty-two students currently enrolled in a higher-degree research program participated. Students were most commonly enrolled in a doctor of philosophy program at a part-time rate. Motivations of research were desire to improve the clinical care aspects of chiropractic for the public and belief that chiropractic research is lacking. The greatest challenges were the negative attitudes towards chiropractic, finding enough time to do everything required, and feelings of isolation. The higher-degree research educational environment was perceived to be more positive than negative, with the stimulating nature of research a positive feature. A negative feature of the educational environment was poor undergraduate preparation for higher-degree research.

CONCLUSION

This study is the first study to describe higher-degree chiropractic research students. Primary motivations included building research, while challenges included not only negative attitudes toward the chiropractic profession but also negative attitudes toward researchers from within the profession. The higher-degree research educational environment was perceived to be positive. By acknowledging the issues that surround emerging researchers in chiropractic, the profession is better placed to foster academics and build research capacity.

Reassessing the educational environment among undergraduate students in a chiropractic training institution: A study over time

OBJECTIVE

The aim of the study was twofold: (1) to compare the perceived educational environment at 2 points in time and (2) to longitudinally examine potential changes in perceptions of the educational environment over time.

METHODS

The validated Dundee Ready Educational Environment Measure (DREEM), a 50-item, self-administered Likert-type inventory, was used in this prospective study. Employing convenience sampling, undergraduate chiropractic students were investigated at 2 points in time: 2009 (n = 124) and 2012 (n = 127). An analysis of 2 matching samples was performed on 27% (n = 34) of the respondents in 2009.

RESULTS

A total of 251 students (79%) completed the inventory, 83% (n = 124) in 2009 and 75% (n = 127) in 2012. The overall DREEM scores in both years were excellent: 156 (78%) and 153 (77%), respectively. The students' perceptions of teachers differed significantly between the 2 cohort years, decreasing from 77% to 73%. Three items received deprived scores: limited support for stressed students, authoritarian teachers, and an overemphasis on factual learning; the latter significantly decreased in 2012. In the longitudinal sample these items also displayed scores below the expected mean.

CONCLUSION

Students viewed the educational environment as excellent both in 2009 and 2012. The perceptions of teachers declined with time; however, this could be attributed to teachers' new roles. Certain aspects of the educational environment factored prominently during the comparative points in time, as well as longitudinally, and these ought to be further investigated and addressed to provide an enhanced educational environment.

Measuring the clinical learning environment in anaesthesia

The learning environment describes the way that trainees perceive the culture of their workplace. We audited the learning environment for trainees throughout Australia and New Zealand in the early stages of curriculum reform. A questionnaire was developed and sent electronically to a large random sample of Australian and New Zealand College of Anaesthetists trainees, with a 26% final response rate. This new instrument demonstrated good psychometric properties, with Cronbach's α ranging from 0.81 to 0.91 for each domain. The median score was equivalent to 78%, with the majority of trainees giving scores in the medium range. Introductory respondents scored their learning environment more highly than all other levels of respondents (P=0.001 for almost all comparisons). We present a simple questionnaire instrument that can be used to determine characteristics of the anaesthesia learning environment. The instrument can be used to help assess curricular change over time, alignment of the formal and informal curricula and strengths and weaknesses of individual departments.

Psychometric validation of the Spanish version of the Dundee Ready Education Environment Measure applied to dental students

AIM

To carry out a psychometric evaluation of the Spanish-language version of the Dundee Ready Education Environment Measure (DREEM) applied to dental students.

METHODS

A total of 1,391 students from nine Spanish public schools of dentistry responded to the DREEM questionnaire. To analyse the reliability of the DREEM questionnaire, the internal consistency was assessed and a 'test-retest' carried out. Validity was evaluated through analysis of item response rate, floor and ceiling effects, corrected item-total and item-subscale correlations and factor structure. A confirmatory factor analysis was performed to analyse the structure of the original DREEM scale.

RESULTS

Cronbach's alpha coefficient for the 'Educational Climate' (EC) global scale was 0.92. In the subscales, the 'observed' Cronbach's alpha coefficients ranged between 0.57 and 0.79 and were higher than the 'expected' ones; except for the Social subscale. In the DREEM questionnaire, all of the corrected correlation coefficients between the items and the EC global scale, and the items and their corresponding subscales, were >0.2; except for items 50 and 17. All goodness-of-fit indices of confirmatory factor analysis showed acceptable values (close to one or zero, depending on the case), and there was consistency in the results.

CONCLUSIONS

The Spanish-language version of the DREEM questionnaire is a reliable and valid instrument for analysing the EC for dental students and its factor structure is supported by the data. Although our findings indicate that the DREEM may be as culturally independent as was originally stated, more research should be directed at verifying the factor structure in various languages and cultural environments.

Exploring perceptions of the educational environment among undergraduate physiotherapy students

OBJECTIVE

The aim of this study was to explore areas of strength and weakness in the educational environment as perceived by undergraduate physiotherapy students and to investigate these areas in relation to the respondents' demographic characteristics.

METHODS

This study utilized a cross-sectional study design and employed the Dundee Ready Education Environment Measure, a 50-item, self-administered inventory relating to a variety of topics directly pertinent to educational environments. Convenience sampling was used, and the scores were compared across demographic variables. All undergraduate physiotherapy students in their first five terms of the programme in a major Swedish university were invited to participate in the study.

RESULTS

A total of 222 students (80%) completed the inventory. With an overall score of 150/200 (75%), the students rated the educational environment in this institution as "more positive than negative". Two items consistently received deprived scores - authoritarian teachers and teaching with an overemphasis on factual learning. Students in term 4 differed significantly from others, and students with earlier university education experience perceived the atmosphere more negatively than their counterparts. There were no significant differences with regards to other demographic variables.

CONCLUSIONS

This study provides valuable insight into how undergraduate physiotherapy students perceive their educational environment. In general, students perceived that their educational programme fostered a sound educational environment. However, some areas require remedial measures in order to enhance the educational experience.

The DREEM, part 2: psychometric properties in an osteopathic student population

BACKGROUND

The Dundee Ready Educational Environment Measure (DREEM) is widely used to assess the educational environment in health professional education programs. A number of authors have identified issues with the psychometric properties of the DREEM. Part 1 of this series of papers presented the quantitative data obtained from the DREEM in the context of an Australian osteopathy program. The present study used both classical test theory and item response theory to investigate the DREEM psychometric properties in an osteopathy student population.

METHODS

Students in the osteopathy program at Victoria University (Melbourne, Australia) were invited to complete the DREEM and a demographic questionnaire at the end of the 2013 teaching year (October 2013). Data were analysed using both classical test theory (confirmatory factor analysis) and item response theory (Rasch analysis).

RESULTS

Confirmatory factor analysis did not demonstrate model fit for the original 5-factor DREEM subscale structure. Rasch analysis failed to identify a unidimensional model fit for the 50-item scale, however model fit was achieved for each of the 5 subscales independently. A 12-item version of the DREEM was developed that demonstrated good fit to the Rasch model, however, there may be an issue with the targeting of this scale given the mean item-person location being greater than 1.

CONCLUSIONS

Given that the full 50-item scale is not unidimensional; those using the DREEM should avoid calculating a total score for the scale. The 12-item 'short-form' of the DREEM warrants further investigation as does the subscale structure. To confirm the reliability of the DREEM, as a measure to evaluate the appropriateness of the educational environment of health professionals, further work is required to establish the psychometric properties of the DREEM, with a range of student populations.

The DREEM, part 1: measurement of the educational environment in an osteopathy teaching program

BACKGROUND

Measurement of the educational environment has become more common in health professional education programs. Information gained from these investigations can be used to implement and measure changes to the curricula, educational delivery and the physical environment. A number of questionnaires exist to measure the educational environment, and the most commonly utilised of these is the Dundee Ready Educational Environment Measure (DREEM).

METHODS

The DREEM was administered to students in all year levels of the osteopathy program at Victoria University (VU), Melbourne, Australia. Students also completed a demographic survey. Inferential and correlational statistics were employed to investigate the educational environment based on the scores obtained from the DREEM.

RESULTS

A response rate of 90% was achieved. The mean total DREEM score was 135.37 (+/- 19.33) with the scores ranging from 72 to 179. Some subscales and items demonstrated differences for gender, clinical phase, age and whether the student was in receipt of a government allowance.

CONCLUSIONS

There are a number of areas in the program that are performing well, and some aspects that could be improved. Overall students rated the VU osteopathy program as more positive than negative. The information obtained in the present study has identified areas for improvement and will enable the program leaders to facilitate changes. It will also provide other educational institutions with data on which they can make comparisons with their own programs.

Veterinary students' perceptions of their learning environment as measured by the Dundee Ready Education Environment Measure

BACKGROUND

The Dundee Ready Education Environment Measure (DREEM) has been widely used to evaluate the learning environment within health sciences education, however, this tool has not been applied in veterinary medical education. The aim of this study was to evaluate the reliability and validity of the DREEM tool in a veterinary medical program and to determine veterinary students' perceptions of their learning environment.

METHODS

The DREEM is a survey tool which quantitatively measures students' perceptions of their learning environment. The survey consists of 50 items, each scored 0-4 on a Likert Scale. The 50 items are subsequently analysed within five subscales related to students' perceptions of learning, faculty (teachers), academic atmosphere, and self-perceptions (academic and social). An overall score is obtained by summing the mean score for each subscale, with an overall possible score of 200. All students in the program were asked to complete the DREEM. Means and standard deviations were calculated for the 50 items, the five subscale scores and the overall score. Cronbach's alpha was determined for the five subscales and overall score to evaluate reliability. Confirmatory factor analysis was used to evaluate construct validity.

RESULTS

224 responses (53%) were received. The Cronbach's alpha for the overall score was 0.93 and for the five subscales were; perceptions of learning 0.85, perceptions of faculty 0.79, perceptions of atmosphere 0.81, academic self-perceptions 0.68, and social self-perceptions 0.72. Construct validity was determined to be acceptable (p < 0.001) and all items contributed to the overall validity of the DREEM. The overall DREEM score was 128.9/200, which is a positive result based on the developers' descriptors and comparable to other health science education programs. Four individual items of concern were identified by students.

CONCLUSIONS

In this setting the DREEM was a reliable and valid tool to measure veterinary students' perceptions of their learning environment. The four items identified as concerning originated from four of the five subscales, but all related to workload. Negative perceptions regarding workload is a common concern of students in health education programs. If not addressed, this perception may have an unfavourable impact on veterinary students' learning environment.

Development and psychometric evaluation of the Undergraduate Clinical Education Environment Measure (UCEEM)

BACKGROUND

There is a paucity of instruments designed to evaluate the multiple dimensions of the workplace as an educational environment for undergraduate medical students.

AIM

The aim was to develop and psychometrically evaluate an instrument to measure how undergraduate medical students perceive the clinical workplace environment, based on workplace learning theories and empirical findings.

METHOD

Development of the instrument relied on established standards including theoretical and empirical grounding, systematic item development and expert review at various stages to ensure content validity. Qualitative and quantitative methods were employed using a series of steps from conceptualization through psychometric analysis of scores in a Swedish medical student population.

RESULTS

The final result was a 25-item instrument with two overarching dimensions, experiential learning and social participation, and four subscales that coincided well with theory and empirical findings: Opportunities to learn in and through work & quality of supervision; Preparedness for student entry; Workplace interaction patterns & student inclusion; and Equal treatment. Evidence from various sources supported content validity, construct validity and reliability of the instrument.

CONCLUSION

The Undergraduate Clinical Education Environment Measure represents a valid, reliable and feasible multidimensional instrument for evaluation of the clinical workplace as a learning environment for undergraduate medical students. Further validation in different populations using various psychometric methods is needed.

Family medicine and sports medicine students' perceptions of their educational environment at a primary health care center in Germany: using the DREEM questionnaire

The medical learning environment is changing progressively due to its crucial importance in clinical learning and educational performance. The purpose of this study was to investigate student perceptions of the medical learning environment at a primary health care center outside of a university hospital using the Dundee Ready Educational Environment Measure (DREEM) questionnaire. Various aspects of the environment were compared between family medicine (FM) and sports medicine (SM) students to assess the role of these different rotations and their effect on student perceptions. The DREEM questionnaire, a validated tool for measuring perceptions of educational environments in medical educational environments, was completed by 110 students who were enrolled in FM and SM rotations at Wuppertal Primary Health Care and Research Center in Wuppertal, Germany. Other than 9 of the 50 items, there were no statistically significant differences in DREEM questionnaire scores between these 2 groups, indicating that students' perceptions of the educational environment were not remarkably affected by their rotations. Scores across the sample were fairly high (FM students, 139.45/200; SM students, 140.05/200; overall total score, 139.85/200). These high scores suggest that students enrolled in FM and SM health science programs generally hold positive perceptions of their course environment outside of the university hospital. The positive perception of the educational environment at this primary health care center is hopefully indicative of similar rotations' perceptions internationally. While future studies are needed to confirm this, the current findings offer a chance to identify and explore the areas that received low scores in greater detail.

A psychometric appraisal of the DREEM

BACKGROUND

The quality of the Educational environment is a key determinant of a student centred curriculum. Evaluation of the educational environment is an important component of programme appraisal. In order to conduct such evaluation use of a comprehensive, valid and reliable instrument is essential. One of most widely used contemporary tools for evaluation of the learning environment is the Dundee Ready Education Environment Measure (DREEM). Apart from the initial psychometric evaluation of the DREEM, few published studies report its psychometric properties in detail. The aim of this study was to examine the psychometric quality of the DREEM measure in the context of medical education in Ireland and to explore the construct validity of the device.

METHODS

239 final year medical students were asked to complete the DREEM inventory. Anonymised responses were entered into a database. Data analysis was performed using PASW 18 and confirmatory factor analysis performed.

RESULTS

Whilst the total DREEM score had an acceptable level of internal consistency (alpha 0.89), subscale analysis shows that two subscales had sub-optimal internal consistency. Multiple group confirmatory factor analysis (using Fleming's indices) shows an overall fit of 0.76, representing a weak but acceptable level of fit. 17 of the 50 items manifest fit indices less than 0.70. We sought the best fitting oblique solution to the 5-subscale structure, which showed large correlations, suggesting that the independence of the separate scales is open to question.

CONCLUSIONS

There has perhaps been an inadequate focus on establishing and maintaining the psychometric credentials of the DREEM. The present study highlights two concerns. Firstly, the internal consistency of the 5 scales is quite variable and, in our sample, appears rather low. Secondly, the construct validity is not well supported. We suggest that users of the DREEM will provide basic psychometric appraisal of the device in future published reports.