Comparison of the Educational Environment at a Medical College under Two Different Curricula

Ayesha Younas,1 Robina Mushtaq,2 Rafia Minhas,3 Moatter Jahan4

1-2: Department of Medical Education1/Department of Community Medicine2,Wah Medical College, Wah Cantt Punjab, Pakistan.

3: Department of Dental Education, Avicenna Medical College Lahore, Punjab, Pakistan.

4: Fatima Jinnah Dental Hospital & College Karachi, Pakistan.

Correspondence to: Dr. Ayesha Younas, Email: ayeshajawwad@gmail.com, ORCiD: 0000-0003-1508-1395

ABSTRACT

Objective: To compare the perception of students regarding the educational environment at a medical college which underwent a curricular change using the Dundee Ready Education Environment Measure (DREEM) at two different points in time.

Methods: A comparative cross-sectional study was conducted at Wah Medical College, Punjab, Pakistan. The DREEM instrument was distributed in 2015 to students in all five years of the MBBS program and in 2019 to students in years 1-3 of the MBBS program.The DREEM questionnaire comprised of five categories which included learning, teaching, academic self-perception, atmosphere, and social self-perception.

Results: A total 692 students, participated in the study (400 (57.8%) students in 2015 and 292 (42.2%) in 2019). The total median DREEM score in 2015 was 122 (134-111) whereas in 2019, the overall median DREEM score slightly increased up to 126 (142-103) (p-value 0.850). The comparison of the two different curricula with categories of DREEM inventory score showed that a significant association of two curricula was observed with students perception about learning (p-value <0.001), positive perception about course organizer (p-value <0.001), atmosphere (p-value <0.001), and academic self-perception (p-value 0.031).

Conclusion: Curricular shift had not made a significant impact on the overall educational environment and the institute was able to maintain a healthy learning environment

Keywords: Educational environment, student perceptions, Undergraduate medical education, curriculum shift, hidden curriculum.

 

INTRODUCTION

The educational environment refers to the contexts, the cultures and the physical environments that are unique to an educational institute.1-2 Being used as a synonym with learning environment and educational climate, it is a broad concept. Educational or Learning environments are constructed in particular ways, with choices made at institutional and classroom levels about pedagogic measures, assessment and evaluation measures, relations between teacher and learner, relations between types of learners, the physical infrastructure arrangements and the overall atmosphere of the institute. It comprises of all things that surrounds the educational organization and is characterized by its policies, its reward and consequence equation, and the pressure students face as a result of their educational experience in the institute.3 Student learning is greatly affected by the educational environment they experience.4 It contributes to their overall wellbeing, satisfaction with their education and future aspirations of the students. The educational environment is a dynamic entity and is continuously evolving. It is a measurable element that has the potential to improve the quality of education itself.

It is recommended that routine assessment of the educational environment should be a policy of an institution s educational practice. Diversity in medical student s demographics have further strengthened this need. The improvements that are being made in medical curricula also call for a periodic reassessment of the educational environment. DREEM inventory is a validated, widely used tool to assess the learning environment especially in medical field.5

Wah Medical College is a private sector medical college in Punjab Pakistan. For almost 15 years, the college remained affiliated with one of the largest public sector universities of the country. Students, at the college have performed exceptionally well, with various academic achievements to their name and over 1467 students have graduated. However, a recent paradigm shift took place in 2017 when the college changed its affiliation and became registered under a new university. Thus, currently we, at WMC are in a unique time in our history as we have students in our earlier years of medical school (year 1 to 3) under an integrated curriculum with a different curricular style and those in their last two years (4 and 5) under an older university with a traditional style of teaching and assessment. This study aims to gauge the educational environment at the college in this time of our history and identify the differences if any (identified by the students). Thus, trying to determine whether a new university with its different curriculum, newer teaching & changed assessment strategies, created a difference in our educational environment.

 

METHODS

The study is a comparative cross-sectional study conducted at Wah Medical College, Wah Cantonment, Punjab, Pakistan. Ethical approval from the institutional review board of Wah Medical College was obtained prior conduction of the study (WMC/ERC/IRB/005). The MBBS program at the college runs over five years. In 2015, the educational environment at the college was assessed using the DREEM questionnaire.6 Data was collected from students in all five years of the MBBS program. The college underwent a change in university affiliation in 2017 resulting in a change in curriculum implementation and assessment. Keeping this in mind, in 2019, the educational environment was again evaluated and students from year 1 to year 3 who were studying the new university curriculum were included. Students from year 4 and 5 were excluded as they were not affiliated with the new university. All willing students who signed the consent form were included in the study.

The DREEM inventory questionnaire was used to assess the perception of students regarding the educational environment under two different educational curricula. DREEM is a 50-items, self-administered, closed-ended questionnaire based on students recognitions of five main aspects related to their educational environment. These include learning, teaching, academic self-perception, atmosphere, and social self-perception. The 50 items questionnaire includes 12 questions for students perception about learning, 11 questions about faculty/course organizers, 8 about academic self-perception, 12 about atmosphere, and 7 about social self-perception. Students mark answers on a Likert scale of 1 to 5. Higher scores for each category are demonstrative of the perfect educational environment with a total conceivable score of 200. However, 9 of the 50 items (number 4, 8, 9, 17, 25, 35, 39, 48 and 50) are negatively phrased statements and are scored reversely. McAleer and Roff 7-8 have described a practical guide for interpreting the overall and subscale scores, and the number of items in each subscale. This guide (Table 1) has also been used for interpretation of scores in this study.

Data analysis was performed using statistical packages for social sciences (SPSS) software 21.0. Median and inter-quartile ranges were reported for quantitative variable scores after checking normality by Shapiro-Wilk test. Frequencies and percentages were computed for categories of five subscales of DREEM inventory, gender, year of study and number of students studying in two different curricula (2015, 2019). Inferential statistics were explored using Chi-square test. Moreover, Mann-Whitney U test was applied to compare the median difference of five subscales of DREEM inventory with two different years of data. p-values ≤ 0.05 taken as significant.

 

Table 1: Guide for interpreting and Subscale Scores

Domain

No. of
items

Scores

Interpretations

Students
Perception of Learning

12

0 - 12

Very poor

13 - 24

Teaching is viewed negatively

25 - 36

A more positive perception

37 - 48

Teaching highly thought of

Students
Perception of Faculty/Course
Organizers

11

0 - 11

Abysmal

12 - 22

In need of some retraining

23 - 33

Moving in the right direction

34 - 44

Model course organizers

Students
Academic Self
Perception

8

0 - 8

Feelings of total failure

9 - 16

Many negative aspects

17 - 24

Feeling more on the positive side

25 - 32

Confident

Students
Perception or
Atmosphere

12

0 - 12

A terrible environment

13 - 24

There are many issues that need changing

25 - 36

A more positive attitude

37 - 48

A good feeling overall

Students Social
Self Perception

7

0 - 7

Miserable

8 - 14

Not a nice place

15 - 21

Not too bad

22 - 28

Very good socially

Overall

50

0 - 50

Very poor environment

51 - 100

Plenty of problems in the environment

101 - 150

More positive than negative environment

151 - 200

Excellent environment

 

RESULTS

A total of 692 students participated in the study. 400 (57.8%) students in 2015 and 292 (42.2%) students in 2019. There were 338 (48.8%) males and 354 (51.2%) females.

The total median DREEM score in 2015 was 122 (134-111) whereas in 2019, the overall median DREEM score slightly increased up to 126 (142-103) with a p-value of 0.850 which indicating that the learning environment at the college almost remained the same and no significant difference was observed between 2015 and 2019 cohorts of MBBS students (Table 2).

The median difference of five sub scales of DREEM inventory showed statistically significant difference regarding students perception of course organizers (p-value <0.001) and students perception of atmosphere (p-value <0.001) with respect to two different curricula. In particular, there was a higher median score for students perception of course organizers in 2019 as compared to the students of 2015, i.e. 27 (31-24) and 25 (28-22) respectively. According to effect size the difference is higher in students perception of atmosphere and students perception of course organizers as compare to others (0.388, 0.326). However, the median score of students perceptions about atmosphere was higher among students of 2015 batch as compared to students of 2019 batch, i.e. 31 (33-26) and 29 (32-21). (Table 2)

The comparison of the two different curricula with categories of DREEM inventory score showed that a significant association of two curricula was observed with students perception about learning (p-value <0.001), positive perception about course organizer (p-value <0.001), atmosphere (p-value <0.001), and academic self-perception (p-value 0.031). (Table 3)

 

Table 2: Quantitative analysis of five subscales of the DREEM inventory with two different curricula (n=692)

 

Year of data
collection

Mean +- SD

Effect Size

Median (IQR)

p-value

Students perception
of learning

2015

30.09 +- 6.275

0.016

30 (34-27)

0.10

2019

30.21 +- 8.131

32 (36-25)

Student s perception
of course organizers

2015

24.97 +- 5.442

0.326

25 (28-22)

<0.001*

2019

26.92 +- 6.648

27 (31-24)

Students academic
self-perception

2015

20.92 +- 4.864

0.214

21 (24-18)

0.04

2019

19.77 +- 5.971

21 (24-17)

Students perception
of atmosphere

2015

29.78 +- 6.301

0.388

31 (33-26)

<0.001*

2019

26.76 +- 9.412

29 (32-21)

Students social
self-perceptions

2015

17.35 +- 3.984

0.146

17 (20-15)

0.15

2019

16.73 +- 4.537

17 (20-14)

Total DREEM score

2015

123.10 +- 20.506

0.107

122 (134-111)

0.85

2019

120.40 +- 30.500

126 (142-103)

DREEM: Dundee Ready Education Environment Measure, IQR: Inter Quartile Range
Mann-Whitney U Test applied, *p-value ≤0.05

 

 

 

 

 

 

 

 

 

Table 3: Association of five subscales of the DREEM inventory with two different curricula

Year of data collection

 

2015 (n=398)

2019 (n=292)

 

Total

n (%)

n (%)

p-value

Students perception of learning

 

 

 

Very poor

9

3 (0.8)

6 (2.1)

<0.001*

Teaching is viewed neg

121

56 (14.1)

65 (22.3)

Move positive perception

457

295 (74.1)

162 (55.5)

Teaching highly thought of

103

44 (11.1)

59 (20.2)

Students perception of course organizers

Abysmal

11

1 (0.3)

10 (3.4)

<0.001*

In need of some retraining

167

117 (29.4)

50 (17.1)

Moving in right direction

459

263 (66.1)

196 (67.1)

Model course organizers

53

17 (4.3)

36 (12.3)

Students perception of atmosphere

A terrible environment

34

6 (1.5)

28 (9.6)

<0.001*

Many issues that need changing

122

61 (15.3)

61 (21.0)

A more positive attitude

457

291 (72.8)

166 (57.0)

A good feeling overall

78

42 (10.5)

36 (12.4)

Students academic self-perception

Feelings of total failure

21

6 (1.5)

15 (5.1)

0.031*

Many negative aspects

122

66 (16.5)

56 (19.2)

Feeling more on the positive side

408

244 (61.0)

164 (56.2)

Confident

141

84 (21.0)

57 (19.5)

Students social self-perceptions

Miserable

13

4 (1.0)

9 (3.1)

0.090

Not a nice place

158

84 (21.0)

74 (25.3)

Not too bad

427

258 (64.5)

169 (57.9)

Very good socially

94

54 (13.5)

40 (13.7)

DREEM: Dundee Ready Education Environment Measure

All data presented as number (%), chi-square test applied, *p-value ≤0.05


 

DISCUSSION

This study aims to evaluate and appraise the educational environment of Wah Medical college through the lens of undergraduate student s experiences. The college being affiliated with two different universities at the same time, presented a unique opportunity to identify the strengths and weaknesses of the educational environment. This would be an initial step in formulating ways to improve the learning experience of the graduating students of the institute. Traditionally, the DREEM questionnaire has been used for evaluating the educational environment at a particular time as shown in various studies conducted in the UK, Sudan, Iran and Australia.7,9-11 In Pakistan a study conducted by Sarwar et al12 demonstrated the relationship between academic performance and the educational environment. Another study conducted by Sattar et al13 focused on final year students and measured their perceptions of their educational environment. Our study took a comparative approach, similar to studies conducted by Edgren et al 14 and Zawai et al.15

The most important factor for the perception of learning environment, is the curriculum. Any change in it trickles down to all elements of the educational environment. Curriculum changes also affect the behavior of all stake holders and thus it is very important to ensure involvement of all affected participants in the decision-making process. Before the change in university affiliation, Wah Medical College had been following a traditional undergraduate medical curriculum with very little integration. However, the new curriculum demanded a sudden jump up the integration ladder from level 1(Isolation) to level 5 (Temporal Coordination).16 In temporal co-ordination, each subject remains responsible for its own teaching program. The teaching of topics within a subject, is coordinated with other disciplines and the timetable is adjusted so that topics within the subjects or disciplines which are related, are scheduled at the same time.16-18 At Wah Medical College, the new university curriculum helped to achieve temporal integration and themes were developed by the Department of Medical Education for various modules within each block after consultation with designated faculty members. A lot of dedicated effort was required on part of the faculty to adapt to the new curricular changes and student representatives were also involved to make the transition smooth for all stake holders. The new curriculum was introduced gradually, and changes were made for each incoming class. The decision to evaluate the educational environment of the institute at this time was thus a very feasible idea to understand student perceptions and provide a source for decision making for further improvements in the curriculum.

The assessment of micro and macro climates of the medical institute was done by using DREEM inventory. The total DREEM scores were on the positive side in both 2015 and 2019 and indicated that the student s perception of learning environment was positive. These scores signified the student-centered approach being followed in the institution and students participation in classes, relaxed atmosphere and confidence in passing the annual exams were the strengths of the institute. Measures need to be taken to create a positive impact on the student s achievement, satisfaction and success. The student s perception of learning increased from 2015 to 2019 depicting an overall improvement in the environment. This was a positive finding, depicting that the students had welcomed the change of affiliated university.

Two domains showed a statistically significant difference in scores, these included student s perception of atmosphere and student s perception of course organizers. This was representative of need of reforms to address the arising issues in the institution and informal discussions with the students led to the conclusion that the change in affiliation had created a feeling of uncertainty among the students as they were not used to this new system. This had resulted in the fear of unknown. Students tend to take guidance from their seniors and the role of the hidden curriculum also comes into play here. The hidden curriculum can be communicated through human behaviors as well as the structures and practices of institutions.17,19 Students tend to adopt and transmit the behavior patterns and values they observe around them.20 The senior students were a source of guidance and comfort for their juniors. The students at the same college who were now studying a different curricular format, were unable to seek their senior s guidance as their seniors had not experienced the different teaching and assessment methodologies introduced by the new curriculum. They were thus confused and unsure of themselves. This resulted in a decrease in their perception of atmosphere. The hidden curriculum of the institute had changed, and the students were unable to comprehend the demands of this change and were stressed. The norms of the old method were not applicable in their new situation and the students were unsure of themselves.

The faculty had anticipated the difficulties in shifting to a new university and had put in extra effort and this is depicted as an increase in the student s perception of course organizers after the change in affiliation. Faculty role was appreciated by their students and this had a positive effect on them. Thus, we can see that despite a significant difference in two domains of the educational environment, the total DREEM score was statistically insignificant. However, it shows a statistically significant association in all five subscales of DREEM inventory. It is thus postulated that it is the responsibility of the institutes to ensure that their students are happy and comfortable in the learning process at their institute and do the best they can in order to maintain this standard.

CONCLUSION

Comparison of student perceptions about the educational environment at two different points in time provided a clear picture of how students perceived the change in university affiliation. The results proved that the change in curriculum had not made a significant impact on the overall educational environment of Wah Medical College. This indicated that the institute was itself able to establish and maintain a healthy learning environment for its students where learning activities could foster and flourish adequately. The individual domains of the inventory showed a slight decline in the 2019 cohort of students, which showed that the change in curriculum did in fact effect student perceptions about the educational environment. Further research in this direction can help identify the causes for these perceptions. However, it must be understood that each student has a different reaction to academic change. The institutional staff and faculty efforts resulted in students accepting this change easily and their academic performance did not deteriorate very drastically. The fall in individual scores could be expected as different personalities react differently to the new circumstances but institutional assistance aided in the adjustment process resulting in improved perception of course organizers.

Disclaimer: The current manuscript has been presented in the International Conference on Medical Education in October 2019 at Islamabad.

 

ETHICAL APPROVAL: This study was approved by Institutional Review Board of the Wah Medical College, Wah Cantt Punjab, Pakistan.

 

AUTHORS CONTRIBUTION: AY: Substantial contributions to the conception or design of the work. RM: the acquisition & analysis, of data for the work. RM: Drafting the work or revising it critically for important intellectual content. MJ: Interpretation of data and drafting of manuscript tables.

 

CONFLICT OF INTEREST: The Authors report no conflict of interest in preparation and publication of this manuscript.

 

FUNDING: No funding was received from any source for conduction of this study.

 

Received: July 29, 2020

Accepted: October 22, 2020

 

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