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   Table of Contents      
ORIGINAL ARTICLE
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 18-25

Medical Students’ Opinion and Perception of the Education Environment in a Medical College of Delhi, India


Department of Community Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India

Date of Web Publication27-Mar-2018

Correspondence Address:
Sandeep Sachdeva
Department of Community Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi 110007
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_51_17

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  Abstract 


Objective: To assess students’ opinion and perception regarding education environment in a government medical college of Delhi, India. Materials and Methods: Dundee Ready Educational Environment Measure (DREEM), a universal, culturally nonspecific, generic 50-item inventory tool was used. Each item is rated on a five-point Likert scale with score ranging from 0 to 4 where 0 = strongly disagree, 1 = disagree, 2 = unsure, 3 = agree, and 4 = strongly agree. MBBS students of three batches (2nd, 3rd, and 4th year) were considered in the present cross-sectional study. Results: A total of 117 (84.1%) available students could be contacted in person, out of whom 71 (60.7%) were males; 94 (80.3%) passed their 12th class from private/convent school; nearly 88 (75.2%) students opined that administration is student-supportive; and 111 (94.8%) were in self-assessment state of “happiness.” The overall mean DREEM inventory score (range, 0–200) among all the respondents was 130.34 (±15.76), which is suggestive of “more positive than negative.” Statistically (P < 0.05) higher DREEM score was found among senior medical students [score, 136.5 (4th year) vs. 131.9 (3rd year) vs. 123.6 (2nd year)]; those medical students who were globally satisfied (score, 131.2 vs. 119.3); satisfied getting admitted in current medical college (score, 133.0 vs. 115.7); and who opined that administration is student-supportive (score, 133.4 vs. 120.9). Gender, type of school, marks in 12th class, native place, current residence, supplementary (extra attempt) in university exam, current mental state (sad/happy), and professional satisfaction had no statistical bearing on overall DREEM score. Overall, none of the inventory item (score range, 0–4) had an avg. score more than 3.5, but the score of the majority (42/50, 84.0%) of question items in the present study was in the range of 2–3 points indicating the aspects of the environment that could be improved or enhanced. Conclusion: Within limitations, the study gauges the experiential learning environment from the students’ perspective indicating overall positive results and moving in right direction. Some challenges inherent with medical education and critical areas requiring strengthening were listed including social and leisure time student involvement.

Keywords: Academics, audit, communication, DREEM instrument, evaluation, faculty feedback, health research, pedagogy, quality control, medical education, satisfaction, social life, students, teachers, teaching, training


How to cite this article:
Sachdeva S, Dwivedi N. Medical Students’ Opinion and Perception of the Education Environment in a Medical College of Delhi, India. MAMC J Med Sci 2018;4:18-25

How to cite this URL:
Sachdeva S, Dwivedi N. Medical Students’ Opinion and Perception of the Education Environment in a Medical College of Delhi, India. MAMC J Med Sci [serial online] 2018 [cited 2018 Oct 20];4:18-25. Available from: http://www.mamcjms.in/text.asp?2018/4/1/18/228650




  Introduction Top


Optimal education climate is an important determinant for effective learning to occur.[1],[2] Evidences exist which indicate that the educational environment experienced by students has an impact on satisfaction with the study course, perceived well being, aspirations, and academic achievement.[3],[4] Students’ opinion and the perception of the quality of their teaching environment are now recognized as valid indicators of the appropriateness of curricula and educational settings.[5] In this context, a study was undertaken to evaluate the quality of education environment in a medical college as perceived by medical students using globally accepted Dundee Ready Educational Environment Measure (DREEM) inventory tool. This study would provide an opportunity for the sensitization of stakeholders for a timely and apt feedback for corrective intervention and resource mobilization.


  Materials and Methods Top


The Dundee Ready Educational Environment Measure instrument

The DREEM, a universal, culturally nonspecific, generic, reliable, and diagnostic inventory tool was used to assess students’ perceptions about the educational environment. DREEM has been widely used to gather information about the quality of education environment in many institutions across the globe.[6],[7],[8],[9]

DREEM is a 50-item inventory questionnaire, consisting of five subscales:
  1. Students’ perceptions of learning (SPL) − 12 items; maximum score is 48;
  2. Students’ perceptions of atmosphere (SPA) − 12 items; maximum score is 48;
  3. Students’ perceptions of teachers (SPT) − 11 items; maximum score is 44;
  4. Students’ academic self-perceptions (SASP) − 8 items; maximum score is 32;
  5. Students’ social self-perceptions (SSSP) − 7 items; maximum score is 28.


Each item is rated on a five-point Likert scale with score ranging from 0 to 4 where 0 = strongly disagree, 1 = disagree, 2 = unsure, 3 = agree, and 4 = strongly agree. There are nine negative items (items 4, 8, 9, 17, 25, 35, 39, 48, and 50), for which correction is made by reversing the scores; thus after correction, higher scores indicate disagreement with that item. Items with a mean score of ≥3.5 are true positive points; those with a mean of ≤2 are problem areas; scores in-between these two limits indicate the aspects of the environment that could be enhanced. The maximal global score for the ques­tionnaire is 200, and the global score is interpreted as follows: 0–50 = very poor; 51–100 = many problems; 101–150 = more positive than negative; and 151–200 = excellent.[10] The guide to interpreting DREEM score is given in [Table 1]. The examination of the individual items by looking at the mean score obtained across all participants enables the identification of specific strengths and weakness within the educational environment.
Table 1: The guide to interpreting DREEM score

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In addition, the sociodemographic details of students such as gender, native place, type of school, percentage of marks obtained in 12th class, supplementary attempt in previous university examination, and current residence (hostel/day scholar) were also taken. The subjective (self) assessment of satisfaction (yes/no) with regard to medical profession, admission in current college, and global (overall) satisfaction was also documented.

Background information

The current government medical college under the aegis of North Delhi Municipal Corporation started in the year 2013 following approval from Medical Council of India (MCI), and it is affiliated to Guru Gobind Singh Inderprastha University and admits 50 students per batch through a competitive entrance examination. The 1000-bedded multispecialty hospital attached to this college was established way back in the year 1958 that has evolved and expanded over the years.

Data collection

MBBS students of three batches (2nd, 3rd, and 4th year) were considered in the present cross-sectional study. Students were briefed about the study objectives, voluntary nature of participation, and confidentiality of data collection. However, none of them declined to participate. Out of the 150 permitted (50 per batch) seats, only 139 were filled. Thus, a total of 117 (84.1%) available students could be contacted in person who completed the questionnaire under direct supervision.

Data management and statistical analysis

The data were entered into a Microsoft Excel spreadsheet and analysis performed using the Statistical Package for the Social Sciences version 20.0 software (IBM, New York, USA). The internal consistency and reliability of this study was found to be 0.86 (Cronbach alpha). The results of the DREEM were considered at three levels: (i) individual items, (ii) subscales, and (iii) overall DREEM. The raw scores obtained for the items making up each of the five subscales were summed for each participant, and then the mean of this summed score was taken to give a subscale summary score and these were further summed up to give an overall DREEM score. Students who had a supplementary (extra) attempt in the university exam were labeled as underachiever and others as academic achievers for comparison purpose. Student’s t test and one-way analysis of variance (ANOVA) were used to compare the averages of five domains based on different characteristics.


  Results Top


Out of 117 students, 71 (60.7%) were males and 46 (39.3%) females; the native place of 77 (65.8%) students was Delhi and the rest (34.2%) were from states outside Delhi but within India; 79 (67.5%) students were staying in hostel; 94 (80.3%) students passed their 12th class from private/convent school whereas the rest (19.7%) were from government school and 22 (18.8%) students had a supplementary attempt in previous professional university exam. The self-assessment of current mental state of 6 (5.1%) students was sad while the remaining 111 (94.8%) were happy; and nearly 88 (75.2%) students opined that administration is student-supportive.

The overall mean DREEM inventory score (range: 0–200) among all the respondents was 130.34 (±15.76), which is suggestive of “more positive than negative.” Details are shown in [Table 2]. The mean score of DREEM subscales/domain is as follows: SPL was 31.48 (range: 0–48); SPA (31.62, range: 0–48); SPT was 29.0 (range: 0–44); SASP (18.33, range: 0–32); and SSSP (17.01, range: 0–28). Percentage-wise subdomain score among all medical students is shown in [Figure 1].
Table 2: Summary score in five subdomains of DREEM inventory tool

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Figure 1: DREEM score among all medical students out of 100 points

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The domain-wise score of DREEM inventory according to the background characteristics of students is shown in [Table 3]. Statistically (P < 0.05) higher DREEM score was found among senior medical students [score, 136.5 (4th year) vs. 131.9 (3rd year) vs. 123.6 (2nd year)]; those medical students who were globally satisfied (score, 131.2 vs. 119.3); satisfied getting admitted in current medical college (score, 133.0 vs. 115.7); and who opined that administration is student-supportive (score, 133.4 vs. 120.9). The gender, type of school, marks in 12th class, native place, current residence, supplementary (extra attempt) university exam, current mental state (sad/happy), and professional satisfaction had no statistical bearing on overall DREEM score.
Table 3: Mean scores (±SD) of five domains of DREEM as per background characteristics

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Item-wise DREEM inventory score according to underachiever and academic achiever students is given in [Table 4]. The three probable problem areas (score <2.0) which call for attention include: (i) the teaching overemphasizes factual learning (mean score: 1.58); (ii) the teachers are authoritarian (mean score: 1.75); and (iii) I am able to memorize all I need (mean score: 1.87).
Table 4: Average scores (mean ± SD) of 50 items of DREEM inventory among medical students (underachiever and academic achiever)

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  Discussion Top


A cross-sectional, descriptive study was undertaken to assess opinion and perception of medical students regarding education environment in a government medical college of Delhi, India using generic DREEM inventory tool. The overall mean score (range, 0–200) among medical students was 130.34 (±15.76) that is suggestive of overall positive results and education environment moving in right direction. The study gauges the experiential learning environment from the students’ perspective without any undue emphasis on infrastructure or allied logistics related issues. DREEM inventory tool provides an opportunity for the evaluation and feedback of education environment in a health institution from students’ perspective only; therefore, it has its own set of inherent limitations.

According to the studies conducted among medical students in India using DREEM inventory, the overall mean score in our study (130.3) was found to be higher than 101 (University College of Medical Sciences, Delhi), 115.2 (Udaipur, Rajasthan), 116.5 (Darbhanga, Bihar), 121.8 (Pune, Maharashtra), 122.4 (Belgaum, Karnataka), 123 (Mumbai, Maharashtra), 123 (Mangalore, Karnataka), 126.3 (Army College of Medical Sciences, Delhi) but slightly lower than 131.6 (Bhavnagar, Gujarat).[11],[12],[13],[14],[15],[16],[17],[18],[19] The near similarity of the findings could perhaps be because this institution as others have been able to maintain satisfactorily the minimum standards and the operational guidelines set by the regulatory body in the country, that is, MCI. In addition to this, the length (years) of running an institution could be another determinant leading to such results. A SWOT (strength, weakness, opportunity, and threat) analysis of a medical college in Kerala also reported similar observations.[20] As there is no information with regard to status of education environment in a medical college with adverse/unsatisfactory regulatory (MCI) inspection report that may throw surprising results for comparison.

Further, a small batch of 50 MBBS students leads to better and strong student–teacher interaction; doubt clearance/clarification; quick feedback and relaxed environment during tutorials with still smaller batches. However, some areas need strengthening and introspection, especially teaching style, concerning the item “teachers are authoritarian” and infrastructure-associated issues such as hostel accommodation. The sensitization of teachers is needed to act as role model, change agent, facilitator, in making the environment more congenial, and also in better managing the students in changing sociopolitical and information technology dynamics in India. Hostel accommodation and leisure time involvement of students are the other areas that need suitable betterment.

The domain under “student social self perception” (SSSP), which includes items such as support system for students, boredom of course, social life, feeling of loneliness, and tiredness, could garner “not bad” score (average score 17.1 out of a maximum of 28) among DREEM inventory. This domain reflects the inherent challenges of the course that call for attention, student support system, and individual counseling. The low scores are comparable to the majority of studies conducted in India such as 17.7 (Gujarat), 17.7 (Mumbai), 14.4 (UCMS, Delhi), and 14.1 (Udaipur). However, even under this domain, girls scored statistically (P < 0.05) higher and better than males (17.7 vs. 16.5); students with at least 90% marks in 12th class; students who were professionally satisfied; students who were satisfied getting admission in this college; and senior batches of students also scored high.

Overall, none of the DREEM inventory item had an average score more than 3.5, but the majority of scores in the present study were in the range of 2–3 points (range 0–4) indicating the aspects of the environment that could be improved or enhanced. Logically speaking, because this instrument measures the experiential learning, senior students had higher mean score than their juniors and the finding was found to be statistically significant. This is again similar to those reported in other studies.[11],[18],[21] In our study, out of all the listed background variables, “getting admission in present medical college” had a statistically significant bearing on all the subdomains of DREEM inventory tool.

The duration of MBBS course in medical college of India is four-and-half years followed by 1-year internship. The students are systematically and in structured way exposed to different subject streams (preclinical, paraclinical, and clinical) through processes prescribed under MCI with students to keep the record of daily activity/learning in a log book. Teaching, learning dynamics, and evaluation process form the core activity of student–teacher interaction in any institution. Motivated faculties are constantly engaged in building knowledge base, transforming attitude, and implementing innovative methods from a large bouquet of training methods, evaluation, and also have received the highest attention of medical researchers in Indian setting.[22],[23],[24]

The stimulating and involving education environment created in medical institutions by some of the esteem faculties makes learning active, interesting, and life-long. Inter-alia, need for cramming of the subjects becomes less critical. Inquisitive, novice, and innocent curious questions of the students can be best handled by understanding and mature faculty. Such practice needs to be nurtured with tender care. The development and growth potential of an individual is directly correlated with the depth of knowledge, positive attitude, and diverse skills s/he possesses and demonstrates whether at undergraduate or higher level of functioning.[25] Many institutions in India have introduced innovative training methods based on integrated teaching or problem/investigation report/field based learning, evidence-based medicine, and some of them are equipped with high-end research, clinical, simulation, and communication skill labs.

Medical education environment in the country is evolving for better, yet it needs a time-bound overhaul to overcome diverse uninspiring challenges and also to be in sync with newer competencies, digital technology, and changing time.[26],[27],[28],[29] Stakeholders, be it student, faculty, or administrator, are constantly engaged in discussion, debate, and meetings for overcoming the crises situation and suggest the way forward. Nontransparent interactions, favoritism, commercialization of medical education, and corruption have been the main stumbling blocks in its road to recovery. For the last couples of years, the thrust of medical education in country has been to increase the production of doctors and allied health staff, albeit increasing quantity is having a toll in terms of poor quality of doctor training including inadequate knowledge and skill transfer.[30],[31] The current number of medical colleges in India is 474 with annual MBBS seats of 60,000 plus while the number of postgraduate degree/diploma seats are nearly half. Considering the stiff challenge in securing a postgraduate seat in India, a significant number of undergraduate students are preparing for postgraduate entrance exam starting from 2nd year onwards. It may be attributed to early start and purposeful planning’ but also indicates a case scenario of intense peer pressure and rising stress.

In the backdrop of this journey, it was realized that teaching has shifted from black-board to power point with medical education largely being drifting toward western concept that carried little ethos, sentiments, and fragrance of vast rural and diverse democratic country such as India.[28],[32] There has been a predominance of “theoretical” knowledge transfer and subject cramming. However, it was noted during the last decade that there has been a compensatory increase in skill transfer, clinical case, and practical exposure of medical students through cutting down the time period of more “theoretical”-oriented preclinical subjects. Three months internship period has been reduced to 2 months in the department of community medicine again on the same premise. In times to come, we would witness more such pruning; however, there are reservations against this phenomenon.[33] With the rising materialistic aspirations, clinical–social case discussion and doctor–patient communication are witnessing a downward trend. Inter-alia, the proposed National Medical Commission that would replace current MCI may usher the next wave of change in medical education in India. Medical education is an encompassing term that considers various factors such as curriculum, learning and teaching methodologies, outcome and assessment, skill transfer, group dynamics, teacher–student relationship, self-development, and peer development. The students’ perception of their environment was shown to have a significant impact on their behavior and academic progress.[34] Students in present medical college get admitted through a highly competitive entrance exam and hence can be considered to be above average with self-drive and motivation for learning. However, the exact reasons for low scores for some of the subdomains of DREEM inventory could not be elucidated but the difference could be attributed to students’ personality, emotional factors, aspirations, challenging exposures in childhood, and socioeconomic-cultural upbringing, among others. In conclusion, overall students indicated progressive and positive developmental milieu in the present study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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