AMEE Guide no 32: Measuring the educational environment in health professions studies: a systematic review

Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Indonesia.
Medical Teacher (Impact Factor: 1.68). 12/2010; 32(12):947-52. DOI: 10.3109/01421591003686229
Source: PubMed


One of the determinants of the medical student's behaviour is the medical school learning environment.
The aim of this research was to identify the instruments used to measure the educational environment in health professions education and to assess their validity and reliability.
We performed an electronic search in the medical literature analysis and retrieval system online (MEDLINE) and Timelit (Topics in medical education) databases through to October 2008. The non-electronic search (hand searching) was conducted through reviewing the references of the retrieved studies and identifying the relevant ones. Two independent authors read, rated and selected studies for the review according to the pre-specified criteria. The inter-rater agreement was measured with Kappa coefficient.
Seventy-nine studies were included with the Kappa coefficient of 0.79, which demonstrated a reliable process, and 31 instruments were extracted. The Dundee Ready Education Environment Measure, Postgraduate Hospital Educational Environment Measure, Clinical Learning Environment and Supervision and Dental Student Learning Environment Survey are likely to be the most suitable instruments for undergraduate medicine, postgraduate medicine, nursing and dental education, respectively.
As a valid and reliable instrument is available for each educational setting, a study to assess the educational environment should become a part of an institution's good educational practice. Further studies employing a wider range of databases with more elaborated search strategies will increase the comprehensiveness of the systematic review.

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    • "Due to the significance of the learning climate for resident education, a key role has been assigned to evaluation and improvement of the learning climate (WFME 2003; Nasca et al. 2010). In order to accurately evaluate the learning climate, literature has stressed the importance of enhancing the validity of instruments used in measuring the learning climate (Soemantri et al. 2010; Colbert-Getz et al. 2014). One instrument that has been increasingly used to measure the learning climate is the Dutch Resident Educational Climate Test (D-RECT). "
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    ABSTRACT: Introduction: Credible evaluation of the learning climate requires valid and reliable instruments in order to inform quality improvement activities. Since its initial validation the Dutch Residency Educational Climate Test (D-RECT) has been increasingly used to evaluate the learning climate, yet it has not been tested in its final form and on the actual level of use – the department. Aim: Our aim was to re-investigate the internal validity and reliability of the D-RECT at the resident and department levels. Methods: D-RECT evaluations collected during 2012–2013 were included. Internal validity was assessed using exploratory and confirmatory factor analyses. Reliability was assessed using generalizability theory. Results: In total, 2306 evaluations and 291 departments were included. Exploratory factor analysis showed a 9-factor structure containing 35 items: teamwork, role of specialty tutor, coaching and assessment, formal education, resident peer collaboration, work is adapted to residents’ competence, patient sign-out, educational atmosphere, and accessibility of supervisors. Confirmatory factor analysis indicated acceptable to good fit. Three resident evaluations were needed to assess the overall learning climate reliably and eight residents to assess the subscales. Conclusion: This study reaffirms the reliability and internal validity of the D-RECT in measuring residency training learning climate. Ongoing evaluation of the instrument remains important.
    Full-text · Article · Jul 2015 · Medical Teacher
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    • "It plays a significant role in relation to the student’s behavior, academic development and well-being. The literature suggests that although the concept is rather intangible, the effects of the EE are substantial, real and influential [2, 4]. "
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    ABSTRACT: Background: Any curriculum change is essentially an environmental change; therefore there is a need to assess the impact of any change in the curriculum on the students' perception of the Educational Environment (EE) and psychological well-being. The objectives of the current study are to (i) compare the EE perceptions of medical students studying in a System Based Curriculum (SBC) with those studying in a traditional curriculum (ii) compare the rate of depressive symptoms among the same students studying in both types of curricula (iii) determine whether there is a difference in the EE perception and depressive symptoms based on gender and year of study. Methods: A cross sectional survey was conducted in a Saudi Medical School from 2007-2011, a period in which the school transitioned from a traditional to a SBC. A bilingual version of the Dundee Ready Educational Environment Measure (DREEM) inventory was used for measuring the EE; the Beck Depression Inventory (BDI II) was used for screening of depressive symptoms. A separate demographic questionnaire was also used. Mean scores and percentages were calculated. Continuous variables were summarized as means and standard deviation. For comparison of means, the effect size and student t test (with significance level of <0.05) were used. The percentages of the categorical data were compared using chi square test. Results: The mean total DREEM score of positive perception of the EE in the SBC students was significantly higher (better) than the traditional curriculum students (p < 0.01) with an effect size of 0.472. The mean total score on the BDI-II inventory for depressive symptoms was higher (sicker) 21.3 among the female traditional curriculum students than 16.7 among the male traditional curriculum students and the difference was statistically significant (p = 0.001). The BDI score of the female SBC students (14.7) was significantly lower (healthier) than the female traditional curriculum students (21.3). No similar change was noted for the male students. Conclusion: The current study adds to the advantages of the SBC indicating not only healthier EE for both genders but also healthier emotional well-being for female students only.
    Full-text · Article · Sep 2014 · BMC Medical Education
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    • "The questionnaire was developed through the use of a Delphi approach involving a range of health professional educators in different settings and different countries. As such, the DREEM is reported to be appropriate for use within health professional programs, not just medicine, and is not culture or context specific [10,14,15]. "
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    ABSTRACT: 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.
    Full-text · Article · May 2014
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