INTRODUCTION

The educational environment can be described as the atmosphere perceived by the students and teachers. ¹ Hutchinson suggests in adult learning theories that teaching is more dependent on setting the atmosphere for learning rather than imparting and sharing knowledge. ² The significance of the learning environment on student's academic advancement, behavior, and overall well-being is a matter of great concern. ³ In the academic setting, regular teaching activities and teacher-student interactions are the important dimension. The learning environment available in educational campuses highly affects the learning ability and behaviour of students. ⁴ To improve the quality of education and effectiveness of educators in medical colleges, one must identify the best clinical teacher who is enthusiastic, well organized and adopt interactive teaching with students. ⁵ An ideal and positive educational environment prepares students for professional life in the future. The educational environment should promote the physical and mental status of students’ intellect. ^{6, 7} There is a strong relationship between the learning environment to the students’ satisfaction and success. To impart better results to improve learning quality, the strengths and weaknesses of the learning environment should be identified to help change, adjust, and manage training programs. ⁸ The educational environment impacts medical students’ motivation, satisfaction, and ability to study and thrust of knowledge. ⁹ Medical students participate in a lot of learning activities in the medical college’s surroundings. Students’ achievement, happiness, motivation, and success are all influenced by their educational environment, according to studies conducted around the world. ^{10, 11, 12}

In India, national accreditation agencies like the National Assessment and Accreditation Council (NAAC) emphasize the educational environment as one of the important criteria in improving the quality system of an institution. ¹³ Currently, the National Medical Commission has formed a Medical Assessment and Rating Board (MARB) to evaluate the educational environment of medical students.

The admission process in all the medical colleges is through an entrance exam conducted by the same competent authority and hence the students belong to different financial, sociocultural & environmental areas & their objectives towards the course are entirely different. ¹⁴ Students’ perception of the educational climate can be swayed by the growing diversity of the students’ population, educational infrastructure & their expectations. ¹⁵ Teaching and learning in effective clinical setup is a matter of interest in medical colleges and clinical attachments have a big influence in developing the budding doctors’ competencies. ¹⁶ Evaluating a learning environment facilitates quality improvement and innovation in the medical college and curriculum development. ¹⁷

The Dundee Ready Educational Environment Measure (DREEM) questionnaire is the most specific tool for the investigation of the unique environment experienced by students in medical and healthcare-related courses. ¹⁸ This instrument was developed by an international Delphi panel and has been applied to a number of undergraduate courses for health professionals worldwide. The DREEM tool is a widely accepted and globally validated instrument for assessing the educational environment in undergraduate medical institutions and has five sub-scales including perceptions of learning, perceptions of teachers, academic self-perceptions, perceptions of the environment and social self-perceptions. ^{19, 20} The study aimed to assess the student’s perception of the educational environment using the Dundee Ready Education Environment Measure (DREEM) questionnaire among undergraduate medical students. The objectives of the study were to assess the Educational Environment of Undergraduate Medical students using DREEM, compare students’ responses based on the year of study and gender and identify areas of strengths and weaknesses in the current educational environment.

MATERIALS and METHODS

A Cross-sectional study was conducted at Dr Shankarrao Chavan Government Medical College, Nanded from January 2022 to December 2022 among first to final-year MBBS students.

RESULTS

The mean global DREEM score of students of all years was 115 out of 200. Table 1 shows the demographic details of the participating students. Figure 1 shows the DREEM domain scores (converted to 100) for the first, second, third and fourth MBBS students. Evaluating the sub-domains of perception, students had a more positive perception of learning (Average mean score: 34.19), their perception of teachers moved in the right direction (Average mean score: 30.48), their academic self-perception was more on the positive side (Average mean score: 22.21), they had a more positive perception of atmosphere (Average mean score: 32.25) and their social self-perception could be graded as not too bad (Average mean score: 18.44).

The first-year students perceived the EE most positively, with the highest global DREEM score of 120/200. The global scores of the 4^th year students were lowest (112/200).The highest scores were recorded for the students’ perceptions of learning (SPL) domain (34.19/48, 71.23%), followed by Students’ academic self-perceptions (SASP) (22.21/32, 69.41%), Students’ perceptions of atmosphere (SPA) (32.25/48, 67.19%), Students’ perceptions of teachers (SPT) (30.48/44, 69.27%), and lastly Students’ social self-perceptions (SSSP) SPT (18.44/28, 65.86%). When comparing the global and different domain scores of all years were similar as shown in Table 2. Of these the three highest scored items were 31 (I have learnt a lot about empathy in my profession) 14 (I am rarely bored on this course) and 15 (I have good friends in this school), which received scores of 3.93, 3.83, and 3.71, respectively. The items that received the lowest scores were items 46 (My accommodation is pleasant), 49 (I feel able to ask the questions I want) and 3 (There is good support system for students who get stressed), with scores of 1.18, 1.56 and 1.6 respectively. The individual item scores of all semesters were tabulated in Table 3, Table 4, Table 5, Table 6, Table 7

DISCUSSION

DREEM questionnaire was used to assess the student’s perception about their educational environment. The total duration of an undergraduate medical course is four and a half years with a one-year internship. We only took 4 batches of MBBS students. From First MBBS to Fourth MBBS with mainly preclinical and paraclinical subjects in the first 2 years and clinical for 3^rd and 4^th years students.

The global DREEM score was 115.36±17.5 which indicates a more positive than negative educational environment. This was similar to various studies all over the world with a range from 101 to 150 which is comparable with findings from established international medical schools in the UK, South Africa, Ireland and Osman. ^{19, 20, 21, 22} Higher mean scores were reported from medical schools at the University of East Anglia, and the University of Birmingham in the UK and the University of Lund in Sweden. ^{23, 24, 25} Studies from India also showed similar mean score values. ^{26, 27, 28}

However, studies of medical schools in Korea, Germany and Spain have reported lower DREEM scores. ^{29, 30, 31} This could be due to potential differences in the learning preferences and social lives of these diverse student populations.

Comparisons between different year students revealed that the global DREEM score as well as the domain scores of first-year students were more positive than other semester students. Similar findings were reported by studies in India. ²⁶ The first-year students are fresh to the course and naïve and have less clinical exposure. They are more enthusiastic and excited for their future and perceive the EE more positively.

While taking into consideration the DREEM subscale score, of the individual domains, students scored highest in the domain of Student's perceptions of learning and felt it towards the positive side. This could be due to their interest in the medical field, that their learning is essential to provide health care needs and also that they are empathetic towards it. Other domains showed Students’ perceptions of the atmosphere (SPA) towards a more positive atmosphere, Students’ perceptions of teachers (SPT) were found to be moving in the right direction, Students’ academic self-perceptions (SASP) feeling more on the positive side and Students’ social self-perceptions (SSSP) was not very bad.

In terms of percentages of the total available score, the highest scores were recorded for the student’s perceptions of learning (SPL) domain followed by Students’ academic self-perceptions (SASP), Students’ perceptions of the atmosphere (SPA) Students’ perceptions of teachers (SPT), and lastly Students’ social self-perceptions (SSSP).

Even though overall there is a positive environment, improvement is still in needed in all domains especially students’ social self-perception and the social self-perception of teachers.

There are certain limitations of our study like the study tool; The DREEM Questionnaire and fixed options being used hence some aspects that affect the EE of our institution might have been missed. Also, for the study, a qualitative component could have been included that may have covered all the aspects of the EE that were overlooked in our study. Focused group discussions could have been included which could have given a clearer picture of their perceptions.

Our study being the first evaluation of students’ perception of the EE at our institution could be useful to monitor the effects of curricular transformation over a period of time in the future. To conclude, the overall perception of our students about the Educational Environment was positive. The first-year student’s perception was more positive than that of other batch students. The positive points were that the students are empathetic; students have good friends; and are rarely bored in courses. The most problematic fields were their accommodation, freedom to ask questions and no supportive system for students who are stressed.

The areas with scope for improvement and the areas of weakness will be addressed with a positive perspective to improve and strengthen the EE in our institute.

CONCLUSION

In our study, we can conclude that the undergraduate medical students’ perception of EE is positive in general and even though there is scope for improvement and some general measures like improvement of student accommodation, inclusion of stress relieving measures in the curriculum, encouragement of extra-curricular activities, provision of adequate security measures, etc., might be helpful to improve the students’ perception of the educational environment.

Sources of Support: None

Conflict of Interest: None