Perceptions of Medical Students about their Educational Environment in Community Medicine in a Medical College of Coastal Karnataka

Introduction

Curriculum is a holistic and comprehensive entity in education which extends beyond classroom teaching to all interactions in the medical school.(1) Educational environment is one of the most important determinants of an effective curriculum.(2)

With a shift in the teaching pattern from teacher-centric to student-centered teaching,(3) wherein the teacher is now more of a facilitator in the learning process than an imposed teacher, the educational environment and the students’ perceptions about the teaching pattern, the quality of teaching, the teachers, and their own assessment about their performance becomes imperative so as to ensure and maintain high-quality educational environments and optimum teaching to the students.

The present study was carried out to compare the quality of the educational environment in community medicine as perceived by the 6^th semester (MBBS Final year part 1) students who were undergoing training in community medicine and 8^th semester (MBBS Final year part 2) students who had finished their training in community medicine.

Methodology

This cross-sectional study was conducted in Kasturba Medical College, Mangalore, Karnataka, India. Data were collected using a 50 item Dundee Ready Education Environment Measure (DREEM),(4) a validated universal diagnostic inventory for assessing the quality of educational environment. The study was approved by the Departmental review board. It was administered to 450 medical students (225 from each batch) and 386 (207 from 6^th semester and 179 from 8^th semester) responded. For the items that scored less than 2, focus group discussion were carried out among few students in both the semesters to find out the reasons for the same. The data were analyzed using SPSS (Statistical Package for Social Sciences) version 11. Student t test was done to find out the difference between the mean scores, P<0.05 was considered as statistically significant.

Results

The overall response rate of students was 85.8%. The mean (Standard Deviation) age of the participants were 21.03 (1.14) and 52% were males and 48% females.

Table 1 shows the mean DREEM domain scores for both the groups. Overall, the students had positive perception and more positive scores than negative toward community medicine. The mean DREEM scores were 113/200 for 6^th semester students and 120/200 for the 8^th semester students. In general, the total DREEM domain scores were found to be higher for 8^th semester students.

Table 1.

Comparison of mean DREEM domain scores in community medicine for 6^th and 8^th semester medical students

Table 2 shows the comparison of mean DREEM scores where significant differences were observed between the 6^th and 8^th semester medical students.

Table 2.

Comparison of mean (SD) DREEM scores where significant differences were observed between 6^th and 8^th semester medical students (N=386)

According to DREEM inventory, items having a mean score of ≥3.5 are positive points, ≤2 indicate problem areas, and between 2 and 3 are aspects of the study environment that could be improved. The 6^th semester students scored less than 2 for 10 items (4, 9, 14, 25, 27, 39, 42, 43, 48, and 49) and above 3 for 3 items (2, 10, and 19), whereas 8^th semester students scored less than 2 for 10 items (3, 4, 9, 14, 17, 25, 27, 42, 48, and 49) and above 3 for 2 item (2 and 19). Scoring patterns in both the groups were similar except for 2 items (10 and 39). Seventeen items (3, 4, 5, 6, 7, 10, 11, 22, 25, 26, 36, 38, 41, 43, 44, 46, and 50) showed statistically significant difference between the two groups.

Discussion

The overall mean DREEM score for all domains in our study reflects the positive perception of the students. All students perceived that teaching overemphasizes factual learning, it is too teacher centered, and they were bored to enjoy this subject, which was consistent with other study findings.(2,5)

In focus group discussion, many students felt that the volume of the subject made the learning difficult, teaching could be made more student centered, more 6^th semester students felt the subject be made more practical oriented and interesting. However, students felt there was a difficulty in reducing the volume/bulk of the subject because of the importance given in competitive exams and the basic frame work of the subject itself. Higher number of 8^th semester students expressed the need for problem based learning in community medicine, which would help them in various aspects of clinical cases, similar to the observations made elsewhere.(5,6)

Most of our students opined that they were encouraged to participate in the class, teachers were knowledgeable in their subjects, teaching was focused, and it helped in developing their confidence and competence. This could perhaps be explained by the fact that lot of importance was given to practical teaching and good student–teacher interaction. Presentation of cases, seminars, etc., also helps in boosting the confidence of the students. Also, the items such as promptness in giving feedback to students, preparing for teaching sessions, and communicating with patients had a mean score between 2 and 3. Similar findings were also reported in other studies.(2,5)

Conclusion

Educational environment is one of the most important determinants of an effective curriculum. The students perceived the learning environment for community medicine to be positive. Also some gray areas were identified that needs remedial measures so as to ensure and maintain high-quality educational environment and optimum teaching to the students.