INTRODUCTION:

“I never teach my pupils, I only attempt to provide the conditions in which they can learn.” It was a popular quote of the genius, Albert Einstein. As he indicated, the educators need to provide the suitable learning condition to get the students prosper. It is realized as an educator that they have to provide a convenient learning environment so the learners can enjoy the whole process and can be comfortable with.

An excellent learning environment indicates what should be learned by stressing on the learning outcomes and what the students gain in the process of learning, while at the same time helping students to set their own learning objectives and plan their education.

Generally, this kind of approach provides opportunities for students to assess their own capability and learning skills [1]. Defining the strengths and weaknesses via students’ perceptions of their learning environment is important for continuous improvement of the educational environment and curriculum.

To investigate educational climate, the DREEM (Dundee Ready Educational Environment Measure) questionnaire is a universally recognised diagnostic inventory used for assessing the quality and effectiveness of educational environment. DREEM was developed by an international Delphi panel, and had been applied to a number of undergraduate courses for health professionals worldwide [2]. It was published and introduced in the year of 1997 [3] as an implementation to assess undergraduate educational environments in medical and nursing schools in most countries. This method is a legal and validated instrument that is also used by other countries in Asia to quantify diverse aspects of teaching and learning environment [4,5].

The main objective of this inventory is to assess students’ perceptions of their educational environment and to identify the problems regarding the teaching and learning methods used.

MATERIALS AND METHODS:

This was a cross-sectional, questionnaire based study. Data was collected from ninety-Year two medical students studying at the Faculty of Medicine and Health Sciences, University Malaysia Sarawak (UNIMAS), Kota samarahan, Malaysia. DREEM questionnaire was distributed after a lecture to all the students present with a brief introduction regarding the aim and purpose of the study being conducted. The anonymous questionnaire was to be voluntarily self-administered.

DREEM, consists of a 50-item inventory with subdomains covering 5 areas:

a) Students’ Perception of Learning (SPoL) – 12 items (Maximum score of 48)

b) Students’ Perception of Teachers (SPoT)– 11 items (Maximum score of 44)

c) Students’ Academic Self Perception (SASP)– 8 items (Maximum score of 32)

d) Students’ Perception of Atmosphere (SPoA)– 12 items (Maximum score of 48)

e) Students’ Social Self Perception (SSSP)– 7 items (Maximum score of 28)

All the items will be scored based on a Likert scale with a score ranging from 0 – 4, with ‘strongly agree’ scored 4 while ‘strongly disagree’ is awarded a score of 0. Items number 4, 8, 9, 17, 25, 35, 39, 48 and 50 are collectively negative statements, will be reverse-scored to reflect proper scores from each subdomain. The total score after addition of all the scores from each subdomain is 200, with the following basic interpretation where: 0-50 = very poor: 51-100 = plenty of problems; 101-150 = more positive than negative and 151-200 = excellent.

To know the more specific strengths and weaknesses within the educational climate, we need to look at the responses to individual items. Items that have a mean score of 3.5 or over are real positive points. Any item with a mean of 2 or less should be examined more closely as they indicate problem areas. Items with a mean between 2 and 3 are aspects of the climate that could be enhanced. The data was analysed by SPSS ver. 22.0. Mean and standard deviation were calculated accordingly for each of the items; and for each of the five sub-domains. Scores were calculated based on the cumulative total of individual responses residing in that domain. For easier comparison between sub-domains, the scores were also expressed as percentage of the possible maximum score.

RESULTS AND DISCUSSION:

The total mean score of all domains was 124.05 out of 200. The total mean score for SPoL subdomain is 29.65 out of 48. Item 25 and 48 of this subdomain scored < 2. In SPoT subdomain, the total mean score is 28.81/44, however the negative statement item 9 scored <2. The total mean score for SASP is 19.99 out of 32. But one of the items, 27 scored 1.74 (<2). The total mean score belonging in SPoA subdomain is 29.29 out of the total of 48, putting the atmosphere on a more positive attitude but item 17, the negative statement also scored <2. The total mean score of SSSP was 16.32 out of 28.00, in which item 3, item 4 and item 14 scored less than 2.00 which indicates problem areas and thus, need investigation (Table 1 and 2). The rest of the items in all subdomains scored between 2.13 to 3.12.

Table 1. Mean score of each subdomain and total score of all domains

Subdomains	Mean score	Maximum score
Students’ Perception of Learning (SPoL)	29.65	48
Students Perception of Teachers (SPoT)	28.81	44
Students’ Academic Self Perception (SASP)	19.99	32
Students’ Perception of Atmosphere (SPoA)	29.29	48
Students’ Social Self Perception (SSSP)	16.32	28
Total score	124.05	200

Table 2. Score of item <2 in each subdomain

No.	Items	Mean	SD
*SPoL domain*
25*	The teaching over emphasizes factual learning which requires memorization	1.05	0.847
48*	The teaching is too teacher centred	1.95	0.834
SPoT domain
9*	The lecturers are authoritarian	1.94	0.759
SASP domain
27	I am able to memorise all I need	1.74	0.867
SPoA domain
17*	Cheating is a problem on this course	1.74	1.383
SSSP domain
3	There is a good support system for students who get stressed	1.91	0.935
4*	I am too tired to enjoy the course	1.91	0.980
14	I am rarely bored on this course	1.78	0.929

* Negative statement

Based on figure.1, subdomains SPoL, SPoT, SASP and SPoA scored a total mean score of higher than 60%, SSSP scored 58.29% which denoted a better than average perception across different aspects from the students. For SPoL, year two medical students had a more positive approach and opinion of it as they scored 29.65/48. But item 48, was found a mean scoring of 1.95 (< 2), indicating that this aspect need to be examined more closely. This finding is consistent with the findings of [6] Mayya and Roff (2004). Lower scores for this aspect was also reported in University College of Medical Sciences of India with the scores of 1.58. Item 25, also scored 1.05. In the preclinical phase (year one and two), the students have to learn anatomy, physiology, pathology and biochemistry in an integrated way. These subjects consist of more factual knowledge, and less in number of independent leaning. These two problems can be overcome by redesigning the course based on student-centred curriculum that could enhance active learning and self-study [7]. In this transformation, development of meta-cognition competencies such as critical thinking, problem solving and independent learning abilities in students are emphasized. These abilities are necessary in dealing with changes in the world nowadays and lifelong learning [8]. The Medical Education Unit of the institution could also train the teaching staffs of the faculty on appropriate teaching and assessment methods that might drive active learning process. Making such a change might provide students with stimulating opportunities for learning, thereby building confidence as well among the students [9].

In SPoT, the total mean score is 28.81 out of 44 which shows that the teachers are capable to guide the students in the right direction. In this subdomain, item 9 (<2) indicates that most of the students believed that their teachers were being professional and reasonable during teaching session. The rest items, scored between 2 and 3 are aspects of the climate that could be enhanced. These results indicate most of the students were satisfied with their lecturers’ ability to interact during teaching and practical session. They were consistent with the results of Nahar et al. (2011) [10], where most of the items were scored in between 2.00 and 3.00. The teachers should be evaluated from time to time in order to improve the effectiveness of learning among medical students.

In SASP, the total mean score is 19.99 out of 32 showed that students have feeling more on the positive side. Item 27, indicates problem area and needs to be examined closely. Zawawi and Elzubeir (2012) [4] conducted in Saudi Arabia also showed that the students have high perception in other academic items except that item. Kohli and Dhaliwal (2013) [9] also pointed out that students in University of Delhi also had problems in memorising. This indicates that it is a widespread problem among medical students in different universities. To improve this area, student centred approach should be implied more. This would further improve in how the students can memorise all that is needed. Hands on learning would allow for a more vivid experience and a more thorough understanding on the subject in hand.

In SPoA, item 17, with a mean score of 1.74, denotes that the students believed cheating to be a problem in this particular course. A study done in India correlated the cause of problem with the stress faced by students to excel academically [11] by Tripathy and Dudani (2013). Based on the results of the rest items which scored between 2 and 3, the classroom environment is adequate enough for students to develop their interpersonal skills, which includes developing efficient ways of communication or nurturing good etiquettes as shown by the lecturers during teaching session. Generally, the atmosphere is also perceived to be generally positive across different class settings, from lectures in auditoriums to practical sessions in laboratories and anatomy museums. This can be partly attributed to the newly built faculty building completed in year 2014 providing a conducive learning environment, with the abundance of cutting edge medical equipment and facilities. A good physical learning environment definitely helps to foster a strong sense of belonging and increase the academic morale among the students. Focusing on medical institutions present in Asia, both Manipal Medical College and Management and Science University, Malaysia reported a generally positive atmosphere, with scores in SPoA subdomain being 29.7 and 28 respectively out of the total of 48. With a mean score of 29.29 out of 48 for this domain in this study, the physical learning environment of UNIMAS medical faculty is sufficient enough in helping students acquire vital medical knowledge and clinical skills in order to be a competent medical graduate.

SSSP subdomain evaluates on students’ social life in this environment. Social life is important in any medical students in this world. It can help or worsen the learning process in someone’s life. A good social life that can support the learning process leads to ensure a better learning environment whereas a bad social life would cause unproductive learning environment. The mean score was 16.32 out of 28.00, which indicates the students’ social self-perception is not too bad. Item 3, scored 1.91 shows that the current social support system, which includes the mentor-mentee system, peer guidance does not suffice for majority of the students. A score of 1.19 is achieved for the same item in a medical college located in Bangladesh [10]. This calls for a good support system for the stressed students to help cope with their studies. An intervention program is needed to help alleviate the stress faced by medical students and enhance the level of stress management. With appropriate social support and guidance from the lecturers and peers, the students will be able to manage stress more efficiently via healthy interactions with one another. For item 4, scored 1.91 shows that the students agreed that it is too tiring for them to enjoy this course. The medical course which contains multiple disciplines to be covered causes the students to be tired. Tripathy and Dudani (2013) [11] showed that students of the Army College of Medical Sciences also agreed that it is a tiring course. Item 14 held a score of 1.78, indicated that majority of students agree the course to be boring. Lots of things to be remembered and learned within a short amount of time induce stress among the students. Guidance from seniors or mentors would help students to further improve learning styles catered to the different needs of multiple students. The unreliable hostel WiFi and lack lustre environment were among the main complaints. In the eye of a medical student, a sustainable accommodation goes a long way in providing an efficient studying environment.

CONCLUSION:

As a deduction, by using DREEM Method, it is achieved the main objective of this research which is to assess students’ perceptions of their educational environment and to identify the problems regarding the learning climate. Based on the result, the total mean scores for each subdomain yielded as ‘More positive perception and moving in the right direction’. The grand total scored 124.06 out of 200, which is placed within the consensus of “More positive than negative”, showing that the learning environment of the medical faculty in UNIMAS suffice in providing a platform for the medical students in acquiring medical knowledge and clinical skills, however some of the aspects still need to be improved on in the near future. This study can be used as a pivoting point to help produce more competent medical graduates in the future with the implementation of an efficient learning environment.

ACKNOWLEDGEMENT:

The authors would like to thank to Year 2 medical students who had participated in our research project especially to Tiong Hong Jian, Mohd Azmi Anwar bin Jahan, Beh Li Zi, Maizatul Azween Binti Morni. Their support and continuous commitment have contributed significantly towards the accomplishment of this research. They are also very grateful to those who developed the DREEM to assess the undergraduate educational environments in medical schools and other health professions institutes.

REFERENCES:

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Received on 12.06.2019 Modified on 26.07.2019

Research J. Pharm. and Tech 2019; 12(9):4095-4098.

DOI: 10.5958/0974-360X.2019.00705.4