Abstract
Objectives
This study aimed to assess perceptions of the educational environment in Oman among medical undergraduate students and interns using the Dundee Ready Education Environment Measure (DREEM) tool.
Methods
This cross-sectional study was conducted between October 2016 and April 2017 at the Oman Medical College (OMC), Sohar, Oman. A total of 737 medical undergraduate students and interns from the OMC and College of Medicine & Health Sciences of Sultan Qaboos University in Muscat, Oman, were invited to complete the DREEM questionnaire in the form of an online survey. Mean overall scores, subscale scores and individual item scores were subsequently compared between undergraduate students and interns.
Results
A total of 418 undergraduate students and interns completed the survey (response rate: 56.7%). The mean overall DREEM score was 130.75 ± 12.69. While interns had higher mean DREEM scores than undergraduate students, this difference was not significant (133.00 ± 17.64 versus 128.50 ± 15.53; P = 0.326). The mean score percentages for the perceptions of learning (66.7% versus 58.3%; P = 0.028) and perceptions of teachers (75% versus 68.2%; P = 0.038) subscales were significantly higher among OMC interns compared to undergraduate students from the same college. The perceptions of the environment subscale received the lowest mean score percentages among undergraduate students and interns from both colleges.
Conclusion
Overall, medical undergraduate students and interns viewed the educational environment in Oman in a positive light. It is possible that undergraduate students’ perceptions of the educational environment may become more favourable as they progress with their medical career and become interns.
Keywords: Medical Education, Undergraduate Medical Students, Internships, Perceptions, Oman
Advances in Knowledge.
- To the best of the authors’ knowledge, this is the first study reporting undergraduate students’ and interns’ perceptions of the medical educational environment in Oman. The findings of the study suggest that undergraduate students’ perceptions of their educational environment may become more favourable as they advance to their internship.
Application to Patient Care
- This study serves as an important initial step in identifying strengths and weaknesses in the current medical learning climate of Oman. This knowledge may help educational administrators identify underlying factors that hamper medical students’ learning experiences, ultimately improving the overall quality of medical education and clinical care in Oman.
The goal of medical education is to produce graduates with the necessary knowledge, clinical skills and professional attributes to be successful doctors.1 To a certain extent, a physician’s level of competence in these areas reflects the educational institution they attended and the medical education they received.2 Therefore, it is vital to appraise the educational environment in which medical students learn, including the institutional culture, curriculum and learning climate.3 Meaningful learning correlates positively with students’ perceptions of their educational environment, as this can influence how, why and what students learn.4,5
While various tools are available to allow medical educators to evaluate students’ perceptions of their educational environments, the 50-item Dundee Ready Education Environment Measure (DREEM) tool is currently most frequently utilised.6–8 The DREEM tool is a widely accepted and globally validated instrument for assessing the educational environment in undergraduate medical institutions and has five subscales including perceptions of learning, perceptions of teachers, academic self-perceptions, perceptions of the environment and social self-perceptions.5–7 The internal consistency of the questionnaire has been validated in previous research.9 Such tools can help educational administrators identify problem areas at the curricular or institutional level and make necessary changes, resulting in significant improvements in the learning environment and, therefore, student performance.
In Oman, the Ministry of Health recognises the importance of developing health education and training programmes so as to ensure a high level of clinical care.10 However, to the best of the authors’ knowledge, no studies to date have analysed medical undergraduates’ and interns’ perceptions of the educational environment in Oman. As such, this study aimed to assess undergraduate students’ and medical interns’ perceptions of various aspects of the educational environment in Oman, including a range of topics directly related to the educational climate and every day learning. In addition, this study aimed to identify specific problem areas for elucidation and improvement.
Methods
This prospective descriptive cross-sectional study took place at the Oman Medical College (OMC) in Sohar, Oman, between October 2016 and April 2017. Students in the clinical phase of the OMC medical degree programme (i.e. years 5 and 6) and phase III of the medical degree programme at the College of Medicine & Health Sciences of Sultan Qaboos University (SQU) in Muscat, Oman, were eligible to participate in the study. In addition, former medical students who had graduated from either institution during the 2016–2017 academic year and begun internships were also included. As all 737 eligible students and interns at these institutions could be contacted and were given an opportunity to participate in the study, a precision-based sample size calculation was not performed.
The original English-language version of the 50-item DREEM tool was incorporated into an online survey using QuestionPro™ software (QuestionPro Inc., San Francisco, California, USA).7 Subsequently, a link to the survey was forwarded to the institutional e-mails of all eligible students, with a three-week timeframe to complete the questionnaire. Responses to the questionnaire were monitored in real time using the QuestionPro™ software (QuestionPro Inc.). Reminders to complete the survey were sent to previously established WhatsApp groups (WhatsApp Inc., Menlo Park, California, USA), whenever available, and follow-up e-mails were sent every fifth day. The QuestionPro Inc. online assistance team was consulted to overcome any technical difficulties in the electronic delivery of the questionnaire and data collection. In cases where these issues remained unresolved, printed questionnaires were hand-delivered to the participants.
Responses to each individual item in the DREEM survey were scored on a five-point Likert scale from four to zero as either strongly agree, agree, uncertain, disagree or strongly disagree, respectively.7 Nine negatively-worded items (items #4, #8, #9, #17, #25, #35, #39, #48 and #50) were reverse scored. In total, the maximum overall DREEM score was 200, indicating an ideal educational environment.7,9 All questionnaires with incomplete data were excluded from the analysis. The overall total scores and those of each subscale were calculated separately for students and interns at each college, with average scores tabulated for each group. Agreement or disagreement with individual items was calculated by combining responses in the agree and strongly agree categories and the disagree and strongly disagree categories, respectively.11 The total scores, subscale scores and individual item scores were expressed as means ± standard deviation. The mean scores of undergraduate students and interns were compared using a Student’s t-test. The Statistical Package for the Social Sciences (SPSS), Version 17.0 (IBM Corp., Armonk, New York, USA) was used for the data analysis. The level of statistical significance was set at P <0.050.
This study received ethical approval from the Institutional Proposal Evaluation Committee of the OMC. All participants gave informed consent, either via digital acknowledgement during completion of the online survey or by signing a written consent form. The privacy and anonymity of the participants were ensured at all times during the delivery and collection of the questionnaires.
Results
Of the 737 medical undergraduate students and interns at OMC and SQU invited to participate in the study, a total of 418 completed the questionnaire (response rate: 56.7%). Of these, there were 326 undergraduate students (response rate: 58%) and 92 interns (response rate: 52.2%). There were significantly higher response rates among the OMC undergraduate students (74.3% versus 65%; P = 0.001) and medical interns (47.8% versus 51.7%; P = 0.002) compared to those from SQU.
The mean overall total DREEM score was 130.75 ± 12.69 [Figure 1]. While interns had higher mean DREEM scores than undergraduate students, this difference was not significant (133.00 ± 17.64 versus 128.50 ± 15.53; P = 0.326). The mean score percentages per subscale (i.e. the percentage out of the total available score per subscale) among medical undergraduate students and interns from both colleges is shown in Figure 2 and Table 1. According to subscale, the mean score was 30.50 ± 5.90 for perceptions of learning (63.5%), 34.00 ± 5.80 for perceptions of teachers (77.2%), 27.25 ± 3.32 for academic self-perceptions (85.1%), 28.00 ± 6.20 for perceptions of atmosphere (58.3%) and 20.25 ± 5.80 for social self-perceptions (72.3%) items. The mean scores of individual items of the DREEM tool are shown in Table 2. The percentage of positive, neutral and negative responses for individual items of the DREEM tool are shown in Table 3.
Figure 1.
Mean total Dundee Ready Education Environment Measure scores of medical undergraduate students and interns at the Oman Medical College and Sultan Qaboos University, Oman (N = 418).
SQU = Sultan Qaboos University; OMC = Oman Medical College.
Figure 2.
Mean Dundee Ready Education Environment Measure scores per subscale among medical undergraduate students and interns at the Oman Medical College and Sultan Qaboos University, Oman (N = 418).
DREEM = Dundee Ready Education Environment Measure.
*Out of the total available score for the subscale.
Table 1.
Mean Dundee Ready Education Environment Measure subscale scores according to institution among medical undergraduate students and interns at the Oman Medical College and Sultan Qaboos University, Oman (N = 418)
| Subscale | Mean percentage* | P value | Mean percentage* | P value | ||
|---|---|---|---|---|---|---|
| OMC students (n = 162) | OMC interns (n = 52) | SQU students (n = 164) | SQU interns (n = 40) | |||
| Perceptions of learning | 58.3 | 66.7 | 0.028 | 62.5 | 62.5 | 0.771 |
| Perceptions of teachers | 68.2 | 75 | 0.038 | 68.2 | 72.7 | 0.585 |
| Academic self-perceptions | 78.1 | 75 | 0.342 | 84.4 | 87.5 | 0.283 |
| Perceptions of the environment | 50 | 52.1 | 0.278 | 52.1 | 54.2 | 0.294 |
| Social self-perceptions | 64.3 | 60.7 | 0.403 | 71.4 | 67.9 | 0.783 |
OMC = Oman Medical College; SQU = Sultan Qaboos University.
Out of the total available score for the subscale.
Table 2.
Mean Dundee Ready Education Environment Measure scores for individual items among medical undergraduate students and interns at the Oman Medical College and Sultan Qaboos University, Oman (N = 418)
| Item | Mean score ± SD | ||||
|---|---|---|---|---|---|
| OMC students (n = 162) | OMC interns (n = 52) | SQU students (n = 164) | SQU interns (n = 40) | ||
| Perceptions of learning | 1. I am encouraged to participate in class. | 3.12 ± 1.05 | 3.22 ± 1.21 | 3.02 ± 1.16 | 3.12 ± 1.03 |
| 7. Teaching is often stimulating. | 3.18 ± 1.22 | 3.28 ± 1.08 | 3.28 ± 1.03 | 3.19 ± 1.06 | |
| 13. Teaching is student-centred. | 1.96 ± 0.92 | 2.06 ± 1.08 | 2.16 ± 0.86 | 2.26 ± 1.18 | |
| 16. The teaching helps to develop my competence. | 2.23 ± 1.04 | 2.13 ± 1.03 | 2.20 ± 1.12 | 2.53 ± 1.03 | |
| 20. The teaching is well focused. | 2.63 ± 1.05 | 2.13 ± 1.12 | 2.60 ± 0.98 | 2.58 ± 0.94 | |
| 21. The teaching helps to develop my confidence. | 2.30 ± 1.17 | 2.28 ± 1.02 | 2.42 ± 1.04 | 2.16 ± 0.97 | |
| 24. The teaching time is put to good use. | 1.92 ± 1.07 | 2.12 ± 0.97 | 2.92 ± 1.07 | 3.12 ± 1.07 | |
| 25. The teaching overemphasises factual learning. | 2.98 ± 0.96 | 3.21 ± 1.12 | 3.17 ± 1.06 | 3.08 ± 1.20 | |
| 38. I am clear about the learning objectives of the course. | 3.50 ± 1.12 | 3.58 ± 1.06 | 3.82 ± 1.03 | 3.63 ± 1.14 | |
| 44. The teaching encourages me to be an active learner. | 3.25 ± 0.79 | 3.55 ± 1.13 | 3.89 ± 0.96 | 3.62 ± 0.79 | |
| 47. Long-term learning is emphasised over short-term learning. | 2.18 ± 1.21 | 2.26 ± 0.87 | 3.18 ± 1.02 | 3.05 ± 1.01 | |
| 48. The teaching is too teacher-centred. | 1.52 ± 0.87 | 1.87 ± 1.12 | 2.11 ± 0.92 | 2.82 ± 1.02 | |
| Perceptions of teachers | 2. The teachers are knowledgeable. | 3.11 ± 0.92 | 3.2 ± 1.01 | 3.21 ± 1.02 | 3.11 ± 1.04 |
| 6. The teachers are patient with students. | 3.23 ± 1.21 | 3.23 ± 0.92 | 3.17 ± 1.27 | 3.2 ± 0.89 | |
| 8. The teachers make fun of their students. | 2.48 ± 1.31 | 3.08 ± 0.91 | 2.58 ± 1.21 | 2.31 ± 0.96 | |
| 9. The teachers are strict and controlling. | 2.43 ± 1.09 | 3.04 ± 1.21 | 2.22 ± 1.02 | 2.52 ± 0.94 | |
| 18. The teachers appear to have effective communication skills with students. | 2.59 ± 1.23 | 2.43 ± 1.07 | 2.6 ± 1.72 | 2.49 ± 0.98 | |
| 29. The teachers are good at providing feedback to students. | 2.29 ± 1.12 | 2.28 ± 1.21 | 2.42 ± 1.02 | 2.26 ± 1.12 | |
| 32. The teachers provide constructive criticism. | 2.21 ± 1.02 | 2.12 ± 0.92 | 2.91 ± 1.08 | 3.03 ± 0.97 | |
| 37. The teachers give clear examples. | 3.03 ± 1.71 | 3.87 ± 0.97 | 2.17 ± 1.21 | 3.1 ± 0.87 | |
| 39. The teachers get angry in teaching sessions. | 3.01 ± 1.36 | 3.31 ± 1.28 | 2.42 ± 1.29 | 3.33 ± 0.86 | |
| 40. The teachers are well prepared for their classes. | 2.95 ± 1.58 | 3.55 ± 1.22 | 3.29 ± 0.98 | 3.62 ± 0.85 | |
| 49. The students irritate and annoy the teachers. | 3.17 ± 1.75 | 3.22 ± 1.09 | 3.11 ± 0.92 | 3.05 ± 0.85 | |
| Social self-perceptions | 3. There is a good support system for students who get stressed. | 1.15 ± 0.67 | 1.67 ± 0.76 | 1.92 ± 0.86 | 1.95 ± 0.96 |
| 4. I am too tired to enjoy this course. | 2.23 ± 1.08 | 2.28 ± 0.85 | 3.28 ± 0.91 | 3.12 ± 1.03 | |
| 14. I am rarely bored in this course. | 3.96 ± 0.89 | 3.23 ± 1.04 | 3.16 ± 0.92 | 3.29 ± 1.06 | |
| 15. I have good friends in this school. | 3.97 ± 0.85 | 4.21 ± 1.07 | 4.22 ± 0.95 | 4.53 ± 1.06 | |
| 19. My social life is good. | 2.2 ± 0.87 | 2.13 ± 0.98 | 2.72 ± 0.87 | 2.58 ± 0.96 | |
| 28. I seldom feel lonely. | 3.52 ± 0.85 | 2.28 ± 0.98 | 3.42 ± 0.92 | 2.06 ± 0.91 | |
| 46. My accommodation is pleasant. | 1.21 ± 0.77 | 1.33 ± 0.78 | 2.01 ± 0.67 | 1.98 ± 0.62 | |
| Academic self-perceptions | 5. Learning strategies which worked for me before continue to work for me now. | 1.89 ± 1.02 | 2.12 ± 0.84 | 3.02 ± 0.89 | 3.12 ± 0.93 |
| 10. I am confident about passing this year. | 3.92 ± 1.04 | 3.11 ± 1.07 | 4.12 ± 0.88 | 4.32 ± 0.96 | |
| 22. I feel I am being well prepared for my profession. | 1.86 ± 0.89 | 3.21 ± 1.03 | 2.12 ± 0.99 | 2.18 ± 0.89 | |
| 26. Last year’s work was good preparation for this year’s work. | 4.23 ± 0.94 | 4.11 ± 0.97 | 4.24 ± 1.04 | 4.02 ± 1.02 | |
| 27. I am able to memorise all I need. | 1.54 ± 0.95 | 1.76 ± 0.88 | 1.98 ± 0.87 | 2.01 ± 0.94 | |
| 31. I have learned a lot about empathy in my profession. | 4.87 ± 0.78 | 4.32 ± 0.81 | 4.22 ± 0.77 | 4.18 ± 1.03 | |
| 41. My problem-solving skills are being well developed. | 3.76 ± 1.06 | 3.12 ± 0.79 | 4.02 ± 0.95 | 4.13 ± 0.98 | |
| 45. Much of what I have to learn seems relevant to a career in healthcare. | 3.12 ± 0.89 | 3.01 ± 0.86 | 3.82 ± 0.96 | 4.09 ± 0.96 | |
| Perceptions of the environment | 11. The atmosphere is relaxed during ward teaching. | 3.16 ± 0.96 | 3.29 ± 1.07 | 3.02 ± 0.87 | 3.19 ± 1.12 |
| 12. This school is well time-tabled. | 1.92 ± 0.95 | 1.82 ± 0.79 | 1.95 ± 0.94 | 2.03 ± 1.19 | |
| 17. Cheating is a problem in this school. | 1.22 ± 0.87 | 1.38 ± 1.08 | 1.43 ± 1.02 | 1.52 ± 1.02 | |
| 23. The atmosphere is relaxed during teaching. | 2.83 ± 0.78 | 2.81 ± 1.04 | 2.29 ± 0.92 | 2.23 ± 1.05 | |
| 30. There are opportunities for me to develop interpersonal skills. | 2.08 ± 0.83 | 2.89 ± 0.77 | 2.6 ± 0.93 | 2.58 ± 0.97 | |
| 33. I feel comfortable in teaching sessions socially. | 1.32 ± 0.93 | 1.54 ± 0.92 | 1.92 ± 0.88 | 2.04 ± 0.92 | |
| 34. The atmosphere is relaxed during tutorials. | 2.11 ± 0.78 | 2.12 ± 0.95 | 2.32 ± 1.05 | 2.51 ± 0.82 | |
| 35. I find the experience disappointing. | 1.98 ± 1.03 | 2.02 ± 0.93 | 2.38 ± 0.79 | 2.44 ± 1.02 | |
| 36. I am able to concentrate well. | 1.21 ± 0.82 | 1.32 ± 0.79 | 1.23 ± 0.95 | 1.2 ± 0.84 | |
| 42. The enjoyment outweighs the stress of the course. | 1.82 ± 0.86 | 1.88 ± 0.82 | 2.08 ± 0.88 | 2.11 ± 0.86 | |
| 43. The atmosphere motivates me as a learner. | 1.87 ± 0.89 | 2.29 ± 1.07 | 2.11 ± 1.03 | 2.42 ± 0.86 | |
| 50. I feel able to ask the questions I want. | 3.21 ± 1.02 | 2.18 ± 0.79 | 2.03 ± 0.92 | 2.1 ± 0.97 | |
SD = standard deviation; OMC = Oman Medical College; SQU = Sultan Qaboos University.
Table 3.
Responses to individual items of the Dundee Ready Education Environment Measure among medical undergraduate students and interns at the Oman Medical College and Sultan Qaboos University, Oman (N = 418)
| Item | Percentage of responses | ||||||
|---|---|---|---|---|---|---|---|
| Undergraduate students (n = 326) | Interns (n = 92) | ||||||
| Agree/Strongly agree | Uncertain | Disagree/Strongly disagree | Agree/Strongly agree | Uncertain | Disagree/Strongly disagree | ||
| Perceptions of learning | 7. Teaching is often stimulating. | 40.2 | 30.4 | 29.4 | 44.3 | 25.2 | 30.5 |
| 13. Teaching is student-centred. | 41.2 | 29.2 | 29.6 | 32.1 | 28.2 | 39.7 | |
| 25. The teaching over emphasises factual learning. | 50.3 | 25.1 | 24.6 | 45.3 | 32.1 | 22.6 | |
| 38. I am clear about the learning objectives of the course. | 40.2 | 20.2 | 39.6 | 33.8 | 38.2 | 28 | |
| 44. The teaching encourages me to be an active learner. | 30.7 | 40.1 | 29.2 | 38.2 | 31.6 | 30.2 | |
| 48. The teaching is too teacher-centred. | 33.5 | 39.2 | 27.3 | 39.1 | 38.1 | 22.8 | |
| Perceptions of teachers | 6. The teachers are patient with patients. | 45.3 | 35.2 | 19.5 | 40.7 | 39.1 | 20.2 |
| 8. The teachers make fun of their students. | 35.8 | 39 | 25.2 | 40.1 | 44.1 | 15.8 | |
| 9. The teachers are strict and controlling. | 44.5 | 30.2 | 25.3 | 30.6 | 49.2 | 20.2 | |
| 37. The teachers give clear examples. | 44.8 | 29.1 | 26.1 | 35.2 | 39.6 | 25.2 | |
| 39. The teachers get angry in teaching sessions. | 40.4 | 33.2 | 26.4 | 43.8 | 32 | 24.2 | |
| Social self-perceptions | 3. There is a good support system for students who get stressed. | 15.1 | 20.7 | 64.2 | 17.8 | 19.1 | 63.1 |
| 4. I am too tired to enjoy this course. | 35.1 | 49.3 | 15.6 | 30.9 | 51 | 18.1 | |
| 14. I am rarely bored in this course. | 43.8 | 30.9 | 25.3 | 35.2 | 39.6 | 25.2 | |
| 19. My social life is good. | 30.3 | 54.1 | 15.6 | 32.5 | 49.2 | 18.3 | |
| 28. I seldom feel lonely. | 34.3 | 22.4 | 43.3 | 40.7 | 21.1 | 38.2 | |
| 46. My accommodation is pleasant. | 27.4 | 48.4 | 24.2 | 43.2 | 30.6 | 26.2 | |
| Academic self-perceptions | 10. I am confident about passing this year. | 33.4 | 39.3 | 27.3 | 41.7 | 38.1 | 20.2 |
| 22. I feel I am being well prepared for my profession. | 35.2 | 25.2 | 39.6 | 41.6 | 29.2 | 29.2 | |
| 27. I am able to memorise all I need. | 22.2 | 48.2 | 29.6 | 26.2 | 41.3 | 32.5 | |
| Perceptions of the environment | 11. The atmosphere is relaxed during ward teaching. | 40.7 | 30.8 | 28.5 | 40.4 | 25.2 | 34.4 |
| 17. Cheating is a problem in this school. | 20.2 | 30.2 | 49.6 | 29.2 | 32.2 | 38.6 | |
| 23. The atmosphere is relaxed during teaching. | 31.3 | 48.3 | 20.4 | 35.8 | 40.9 | 23.3 | |
| 33. I feel comfortable in teaching sessions socially. | 24.4 | 38.2 | 37.4 | 41.2 | 28.5 | 30.3 | |
| 34. The atmosphere is relaxed during tutorials. | 33.5 | 43.3 | 23.2 | 41.4 | 29.3 | 29.3 | |
| 36. I am able to concentrate well. | 24.3 | 39.9 | 35.8 | 36.3 | 38 | 25.7 | |
| 42. The enjoyment outweighs the stress of the course. | 20.7 | 29.8 | 49.5 | 35.6 | 25.7 | 38.7 | |
OMC = Oman Medical College; SQU = Sultan Qaboos University.
Discussion
To the best of the authors’ knowledge, this study is the first to report the perceptions of medical undergraduate students and interns regarding the educational environment in Oman using the validated DREEM tool. Overall total DREEM scores have been reported to range from 45.0–72.5%.11,12 The overall total DREEM score observed in the present study was high and comparable with findings from established international medical schools in the UK, South Africa and Ireland.1,12,13 However, mean scores reported from medical schools at the University of East Anglia and University of Birmingham in the UK and the University of Lund in Sweden were higher.14–16 In contrast, studies of medical schools in Korea, Germany and Spain have reported lower DREEM scores.17–19 Such varied results could be due to potential differences in the learning preferences and social lives of these diverse student populations. Additionally, variations in students’ and interns’ perceptions may also reflect the complex construct of the learning environment at any educational institute.
According to standard interpretations of DREEM subscale scores, the mean score for the perceptions of learning subscale in the current study was deemed “more positive”, while the score for the perceptions of teachers subscale suggested “movement in the right direction”. In addition, the mean scores for the academic self-perceptions, perceptions of the environment and social self-perceptions subscales indicated “confident feelings”, “a more positive attitude” and “not too bad”, respectively.7 In terms of percentages of the total available score, the academic self-perceptions subscale had the highest mean score percentage, followed by the perceptions of teachers subscale for all participants, apart from SQU undergraduate students. Similarly, a study from the United Arab Emirates (UAE) conducted among faculty members found that the perceptions of teachers and perceptions of learning subscales had the highest mean scores, whereas the lowest mean score was noted in the social self-perceptions subscale.20
The psychological wellbeing of medical undergraduate students and interns is of paramount importance in terms of ensuring learning retention and quality healthcare delivery.3 Although the mean subscale scores observed in the current study were highly encouraging, an analysis of the mean scores for individual items in the DREEM tool indicated a need to improve student accommodation services and recreational facilities. In addition, there was a need to improve the atmosphere in the classroom during teaching, which might be more conducive to students asking questions during class. Very few of the students and interns were of the opinion that their medical colleges had a good support system for stressed students, implying that these institutions had inadequate facilities to cope with academic and/or social life-related stress. Therefore, the authors of the current study recommend prioritising the establishment of organised student support systems and psychological counselling centres at both the OMC and SQU so as to address the issue of stress among undergraduate students and interns. Further studies should be conducted to evaluate the effects of stress on academic performance during medical training in Oman and elucidate underlying factors that may lead to stressful conditions.
Other studies from the Middle Eastern region have addressed students’ perceptions of the educational environment at various medical colleges [Table 4].11,21–33 In general, the scores of medical schools in previous studies from 2004–2010 were much lower compared to those reported from more recent studies.11,21–33 This observation suggests that significant improvements have been made to the learning environments of medical schools in the region. The results of a study from the UAE found that the use of an integrated curriculum led to significantly more positive perceptions compared to a discipline-based curriculum.20 A previous study conducted in Ireland reported similar results.12 These findings highlight the importance of curricular reforms in improving the overall learning environment of medical schools.
Table 4.
Literature review of recent studies using the Dundee Ready Education Environment Measure tool at institutions in the Middle East11,21–33
| Author and year of study | Institution and setting | Type of participants | Mean overall total score |
|---|---|---|---|
| Karim et al.11 (2015) | Kuwait University, Kuwait | Undergraduates | 108.7 |
| Al Sheikh25 (2014) | University of Dammam, Dammam, Saudi Arabia | Undergraduates | 106 |
| AlFarsi et al.27 (2014) | King Saud University, Riyadh, Saudi Arabia | Undergraduates | 118.5 |
| El-Sobkey28 (2015) | King Saud University, Riyadh, Saudi Arabia | Physiotherapy trainees | 135.6 |
| Soliman et al.24 (2017) | King Saud University, Riyadh, Saudi Arabia | Undergraduates | 171.5* |
| Al-Ayed et al.23 (2008) | King Saud University, Riyadh, Saudi Arabia | Undergraduates | 89.9 |
| Al-Hazimi et al.22 (2002) | King Abdulaziz University, Jeddah, Saudi Arabia | Undergraduates | 102 |
| Al-Hazimi et al.21 (2002) | Umm Al-Qura University, Mecca, Saudi Arabia | Undergraduates | 107 |
| Sana’a University, Yemen | Undergraduates | 100 | |
| Shehnaz et al.29 (2012) | Gulf Medical College, Ajman, UAE | Teaching faculty | 139 |
| Undergraduates | 135 | ||
| Farahmand et al.30 (2014) | Imam-Khomeini Hospital, Tehran, Iran | Emergency medicine interns | 133.72 |
| Imanipour et al.31 (2015) | Tehran University of Medical Sciences, Tehran, Iran | Nursing or midwifery students | 104.39 |
| Andalib et al.32 (2015) | Tehran University of Medical Sciences Children’s Medical Center, Tehran, Iran | Undergraduates | 95.8 |
| Bakhshialiabad et al.33 (2015) | Rafsanjan University of Medical Sciences, Rafsanjan, Iran | Undergraduates | 113.5 |
| Taheri26 (2009) | Gilan University of Medical Sciences, Gilan, Iran | Basic science students | 100.96 |
| Clinical students | 94.19 |
UAE = United Arab Emirates.
Out of a total score of 250, instead of 200.
In the current study, interns on the whole had more positive perceptions of the educational environment compared to the undergraduate students. In contrast, investigators from Saudi Arabia and Iran have reported that second-year undergraduate students had higher DREEM scores compared to third-year students.25,26 It is possible that curricular differences and the use of heterogeneous samples from different sociocultural backgrounds could result in these varying observations. Curriculum planners in Oman should heed the feedback of medical students and interns, as their opinions may be valuable in determining potential areas for and methods of improving the learning climate at specific institutions, thus ensuring the students’ and interns’ preparedness for clinical work.34
The findings of the current study are limited by pre-existing constraints and criticisms of the DREEM tool, particularly its psychometric properties, as items included in the DREEM subscales may not be wholly independent. In addition, there is some scope for cultural bias with use of this tool.35 Other limitations include lack of analysis of the effect of demographic factors such as age, gender and nationality on the overall DREEM and subscale scores. However, it should be noted that approximately 80–90% of the sample consisted of Omani females; as such, nationality and gender were unlikely to have affected the results. Another limitation was the overall lower response rate of interns compared to their undergraduate counterparts; this was due to difficulties in locating interns providing clinical services at different hospitals in Oman. Additionally, there was a higher response rate among students and interns at OMC compared to those from SQU; this was probably due to the fact that the study itself was conducted at OMC, potentially resulting in greater awareness of the study among the OMC-affiliated participants.
Conclusion
Overall, the findings of this study suggest that medical undergraduate students and interns at the OMC and SQU viewed the educational environment in Oman in a positive manner. Moreover, it is possible that undergraduate students’ perceptions of the educational environment may become more positive once they graduate and become interns.
ACKNOWLEDGMENTS
This study received ethical approval from OMC and was reviewed by The Research Council (TRC) Oman. While no individuals from SQU were involved in conducting the study, a copy of the questionnaire was sent to administrators at the Student Section and Internship Programme Office of SQU before the SQU students’ and interns’ contact details were provided to the researchers. The SQU student class representatives were then contacted by OMC students. The authors wish to express their sincere gratitude to the Student Section of SQU for their cooperation, as well as the team of OMC students led by Ms. Sara F. Tejani for their help in coordinating the data collection process.
Footnotes
CONFLICT OF INTEREST
The authors declare no conflicts of interest.
FUNDING
This study was funded with the aid of a grant from the Faculty Mentored Undergraduate Research Award Program of TRC Oman (grant #FRP/OMC/16/012).
References
- 1.Dunne F, McAleer S, Roff S. Assessment of the undergraduate medical education environment in a large UK medical school. Health Educ J. 2006;65:149–58. doi: 10.1177/001789690606500205. [DOI] [Google Scholar]
- 2.Brown T, Williams B, Lynch M. The Australian DREEM: Evaluating student perceptions of academic learning environments within eight health science courses. Intl J Med Educ. 2011;2:94–101. doi: 10.5116/ijme.4e66.1b37. [DOI] [Google Scholar]
- 3.General Medical Council. Promoting excellence: Standards for medical education and training. [Accessed: Feb 2018]. From: www.gmc-uk.org/-/media/documents/promoting-excellence-standards-for-medical-education-and-training-0715_pdf-61939165.pdf.
- 4.Mayya S, Roff S. Students’ perceptions of the educational environment: A comparison of academic achievers and underachievers at Kasturba Medical College, India. Educ Health (Abingdon) 2004;17:280–91. doi: 10.1080/13576280400002445. [DOI] [PubMed] [Google Scholar]
- 5.Roff S, McAleer S, Ifere OS, Bhattacharya S. A global diagnostic tool for measuring educational environment: Comparing Nigeria and Nepal. Med Teach. 2001;23:378–82. doi: 10.1080/01421590120043080. [DOI] [PubMed] [Google Scholar]
- 6.Soemantri D, Herrera C, Riquelme A. Measuring the educational environment in health professions studies: A systematic review. Med Teach. 2010;32:947–52. doi: 10.3109/01421591003686229. [DOI] [PubMed] [Google Scholar]
- 7.Roff S, McAleer S, Harden RM, Al-Qahtani M, Ahmed AU, Deza H, et al. Development and validation of the Dundee Ready Education Environment Measure (DREEM) Med Teach. 1997;19:295–9. doi: 10.3109/01421599709034208. [DOI] [Google Scholar]
- 8.Miles S, Swift L, Leinster SJ. The Dundee Ready Education Environment Measure (DREEM): A review of its adoption and use. Med Teach. 2012;34:e620–34. doi: 10.3109/0142159X.2012.668625. [DOI] [PubMed] [Google Scholar]
- 9.Swift L, Miles S, Leinster SJ. The analysis and reporting of the Dundee Ready Education Environment Measure (DREEM): Some informed guidelines for evaluators. Creat Educ. 2013;4:340–7. doi: 10.4236/ce.2013.45050. [DOI] [Google Scholar]
- 10.Oman Ministry of Health. Organization and health policy of the Ministry of Health. [Accessed: Feb 2018]. From: www.moh.gov.om/en/about-moh.
- 11.Karim J, Al-Halabi B, Marwan Y, Sadeq H, Dawas A, Al-Abdulrazzaq D. The educational environment of the undergraduate medical curriculum at Kuwait University. Adv Med Educ Pract. 2015;6:297–303. doi: 10.2147/AMEP.S81729. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Finn Y, Avalos G, Dunne F. Positive changes in the medical educational environment following introduction of a new systems-based curriculum: DREEM or reality? Curricular change and the environment. Ir J Med Sci. 2014;183:253–8. doi: 10.1007/s11845-013-1000-4. [DOI] [PubMed] [Google Scholar]
- 13.Dreyer A, Gibbs A, Smalley S, Mlambo M, Pandya H. Clinical associate students’ perception of the educational environment at the University of the Witwatersrand, Johannesburg. Afr J Prim Health Care Fam Med. 2015;7:a778. doi: 10.4102/phcfm.v7i1.778. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Varma R, Tiyagi E, Gupta JK. Determining the quality of educational climate across multiple undergraduate teaching sites using the DREEM inventory. BMC Med Educ. 2005;5:8. doi: 10.1186/1472-6920-5-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Edgren G, Haffling AC, Jakobsson U, McAleer S, Danielsen N. Comparing the educational environment (as measured by DREEM) at two different stages of curriculum reform. Med Teach. 2010;32:e233–8. doi: 10.3109/01421591003706282. [DOI] [PubMed] [Google Scholar]
- 16.Miles S, Leinster SJ. Medical students’ perceptions of their educational environment: Expected versus actual perceptions. Med Educ. 2007;41:265–72. doi: 10.1111/j.1365-2929.2007.02686.x. [DOI] [PubMed] [Google Scholar]
- 17.Park KH, Park JH, Kim S, Rhee JA, Kim JH, Ahn YJ, et al. [Students’ perception of the educational environment of medical schools in Korea: Findings from a nationwide survey]. Korean J Med Educ. 2015;27:117–30. doi: 10.3946/kjme.2015.27.2.117. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Rotthoff T, Ostapczuk MS, De Bruin J, Decking U, Schneider M, Ritz-Timme S. Assessing the learning environment of a faculty: Psychometric validation of the German version of the Dundee Ready Education Environment Measure with students and teachers. Med Teach. 2011;33:e624–36. doi: 10.3109/0142159X.2011.610841. [DOI] [PubMed] [Google Scholar]
- 19.Palés J, Gual A, Escanero J, Tomás I, Rodríguez-de Castro F, Elorduy M, et al. Educational climate perception by preclinical and clinical medical students in five Spanish medical schools. Int J Med Educ. 2015;6:65–75. doi: 10.5116/ijme.5557.25f9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Shehnaz SI, Sreedharan J. Students’ perceptions of educational environment in a medical school experiencing curricular transition in United Arab Emirates. Med Teach. 2011;33:e37–42. doi: 10.3109/0142159X.2011.530312. [DOI] [PubMed] [Google Scholar]
- 21.Al-Hazimi A, Zaini R, Al-Hyiani A, Hassan N, Gunaid A, Ponnamperuma G, et al. Educational environment in traditional and innovative medical schools: A study in four undergraduate medical schools. Educ Health (Abingdon) 2004;17:192–203. doi: 10.1080/13576280410001711003. [DOI] [PubMed] [Google Scholar]
- 22.Al-Hazimi A, Al-Hyiani A, Roff S. Perceptions of the educational environment of the medical school in King Abdul Aziz University, Saudi Arabia. Med Teach. 2004;26:570–3. doi: 10.1080/01421590410001711625. [DOI] [PubMed] [Google Scholar]
- 23.Al-Ayed IH, Sheik SA. Assessment of the educational environment at the College of Medicine of King Saud University, Riyadh. East Mediterr Health J. 2008;14:953–9. [PubMed] [Google Scholar]
- 24.Soliman MM, Sattar K, Alnassar S, Alsaif F, Alswat K, Alghonaim M, et al. Medical students’ perception of the learning environment at King Saud University Medical College, Saudi Arabia, using DREEM Inventory. Adv Med Educ Pract. 2017;8:221–7. doi: 10.2147/AMEP.S127318. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Al Sheikh MH. Educational environment measurement, how is it affected by educational strategy in a Saudi medical school? A multivariate analysis. J Taibah Univ Med Sci. 2014;9:115–22. doi: 10.1016/j.jtumed.2013.11.005. [DOI] [Google Scholar]
- 26.Taheri M. Students’ perceptions of learning environment in Guilan University of Medical Sciences. J Med Educ. 2009;13:127–33. doi: 10.22037/jme.v13i4.4524. [DOI] [Google Scholar]
- 27.AlFaris EA, Naeem N, Irfan F, Qureshi R, van der Vleuten C. Student centered curricular elements are associated with a healthier educational environment and lower depressive symptoms in medical students. BMC Med Educ. 2014;14:192. doi: 10.1186/1472-6920-14-192. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.El-Sobkey SB. Effect of a new campus, educational level, and instructional mode on the students’ perceptions of educational environment of physical therapy program, King Saud University. Pyrex J Educ Res Rev. 2015;1:17–30. [Google Scholar]
- 29.Shehnaz SI, Sreedharan J, Gomathi KG. Faculty and students’ perceptions of student experiences in a medical school undergoing curricular transition in the United Arab Emirates. Sultan Qaboos Univ Med J. 2012;12:77–85. doi: 10.12816/0003091. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Farahmand S, Bagheri-Hariri S, Moghanloo S, Basir Ghafouri H, Saeedi M, Afzalimoghadam M, et al. Evaluating the quality of the educational environment for medical interns in an emergency department using the DREEM inventory. Acta Med Iran. 2014;52:631–7. [PubMed] [Google Scholar]
- 31.Imanipour M, Sadooghiasl A, Ghiyasvandian S, Haghani H. Evaluating the educational environment of a nursing school by using the DREEM inventory. Glob J Health Sci. 2015;7:211–16. doi: 10.5539/gjhs.v7n4p211. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Andalib MM, Malekzadeh MM, Agharahimi Z, Daryabeigi M, Yaghmaei B, Ashrafi MR, et al. Evaluation of educational environment for medical students of a tertiary pediatric hospital in Tehran, using DREEM questionnaire. Iran J Pediatr. 2015;25:e2362. doi: 10.5812/ijp.2362. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Bakhshialiabad H, Bakhshi M, Hassanshahi G. Students’ perceptions of the academic learning environment in seven medical sciences courses based on DREEM. Adv Med Educ Pract. 2015;6:195–203. doi: 10.2147/AMEP.S60570. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Al Sinawi H, Al Alawi M, Al Qubtan A, Al Lawati J, Al Habsi A, Jose S. Perception of preparedness for clinical work among new residents: A cross-sectional study from Oman. Oman Med J. 2017;32:201–6. doi: 10.5001/omj.2017.38. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Hammond SM, O’Rourke M, Kelly M, Bennett D, O’Flynn S. A psychometric appraisal of the DREEM. BMC Med Educ. 2012;12:2. doi: 10.1186/1472-6920-12-2. [DOI] [PMC free article] [PubMed] [Google Scholar]