Objective: To assess the relationship between the educational environment and academic performance of undergraduate medical students of Azad Jammu and Kashmir.
Method: The cross-sectional study was conducted from September 2018 to September 2019 at Poonch Medical College, Rawalakot, Azad Jammu and Kashmir, and comprised undergraduate medical students of either gender from first to fifth year of studies. Data was collected using the Dundee Ready Education Environment Measure questionnaire which was distributed electronically to the students. The percentage of scores achieved in the last professional examination was taken as the academic performance, and it was corelated with the questionnaire's subscale scores. Data was analysed using SPSS 23.
Results: Of the 500 students approached, 324(64.8%) returned the questionnaire fully completed; 92(28.4%) males and 232(71.6%) females. The largest group was from the third year of studies 108(33.3%). The mean questionnaire score was 96.31±18.47 and it was not significantly correlated with academic performance (p>0.05). The subdomain mean scores were also not significantly correlated with academic performance (p>0.05). Academic performance was significantly higher among females compared to males (p=0.002).
Conclusion: There was found a huge scope for improvement of the educational environment.
Keywords: DREEM, Learning, Undergraduate, Medical students. (JPMA 72: 243; 2022)
Training settings could be described as anything immediately or inadvertently affecting teaching.1 We severely need to assess our programme's power during the modern age of accountability and regression testing, and to select feasible areas for academic revision. Knowing about the educational environment will assist us in concentrating on what we need to maintain, build and enhance.2,3
A learning atmosphere is something that both the learners and the educators encounter and interpret.4 These views would be focussed on three key elements: physical setting, mental environment, and cognitive climate.5 A learning environment study aims at evaluating the attitudes of learners about their surroundings, and can direct the educators to introspect, design and integrate the greatest teaching approach for improving the academic climate.6 The latest desire to improve efficiency assessment processes in healthcare organisations has resulted in a revived involvement in the views of the academic setting by the learners.7 For instance, a beneficial teaching atmosphere, cosy teaching spaces, receptive clinical climate, and empowered, qualified and accessible educators, are thought to boost learner satisfaction, which, in turn, contributes to greater teaching commitment and enhanced efficiency.8
For dental practitioners and in the context of medical schooling, the current assessment of the academic setting has become a significant problem. While several steps have been recommended concerning the academic setting, the Dundee Ready Education Environment Measure (DREEM) continues to be the main discussion point.9 Training is the backbone of any instructional setting. Therefore, attempts to make this training more appealing and friendlier without undermining its value needs to be considered.10 Data obtained from these inquiries can be used to enforce and evaluate curriculum, instructional distribution, and physical landscape modifications. Although not relying on any particular academic theory, the professional medical schemes have released countless assessments of the instructional setting. In exchange for academics to provide their students with the greatest standard of teaching, creating a learning-friendly atmosphere is a precondition. This can be accomplished by defining environmental flaws.4 The understanding of the instructional setting by students is a helpful foundation for changing and enhancing their performance. The DREEM inventory has been created to index the medical and social schooling climate.11,12 In Europe, Africa, Asia, Australia and the United States, DREEM has been evaluated.13
To the best of our knowledge, no research has been conducted in Azad Jammu and Kashmir (AJ&K) to assess the instructional climate. Besides, a number of medical schools both in public and private sectors have started functioning in the region over the last 10 years, and that has required the evaluation of the instructional setting. The current study was planned to assess the relationship between the educational environment and academic performance of undergraduate medical students in AJ&K.
Subject and Methods
The cross-sectional study was conducted from September 2018 to September 2019 at Poonch Medical College, Rawalakot, AJ&K, and comprised undergraduate medical students of either gender from first to fifth year of studies who were assessed the DREEM questionnaire.14 After approval from the institutional ethics review board, the sample size was calculated using the formula n = Z2 P(1-P)/d215 with alpha value 0.05, while the prevalence rate was taken as 50% since the prevalence was not known. The study questionnaire along with informed consent form was electronically distributed to all the 500 medical students studying at the time. Incomplete questionnaire were excluded.
The 50-item DREEM questionnaire is scored on a five-point Likert scale, ranging from 0 = strong disagreement to 4 = strong agreement. The overall total ranges from 0 to 200. Of the 50 items, 9 are negatively stated. The questionnaires has five subscales: students' perception about learning (SPL), students' perception of teachers (SPT), students' academic self-perceptions (SAP), students' perception of atmosphere (SPA), and students' social self-perception. For the DREEM subscales, the maximum scores are 48, 44, 32, 48 and 28, respectively, and offer a chance to identify the system's faults and strengths.
The scores were interpreted as recommended.14
The returned DREEM questionnaires were checked for completeness and correctness. Data was analysed using SPSS 23 with 95% confidence interval (CI). Frequencies, percentages, mean, standard deviation and median values were used, as appropriate, to express the variables. Respondents' last professional examination scores were taken the academic performance, and, along with DREEM scores, were compared along demographic lines. DREEM score and academic performance were checked for normality by Shapiro Wilk and Kolmogorov Smirnov tests. Both tests revealed non-normal distribution with p<0.050. The mean and standard deviation values for each DREEM item and its Spearman correlation with academic performance was assessed. Subscale median values and their Spearman correlation with academic performance were also studied. Non-parametric correlation between the age of all respondents and academic performance and the DREEM score was also studied. The relationship between gender and academic performance and the DREEM score was assessed using the Mann-Whitney U test. The relationship involving academic year, academic performance and DREEM score was observed using Kruskal Wallis H test.
Of the 500 students approached, 324(64.8%) returned the questionnaire fully completed; 92(28.4%) males and 232(71.6%) females. The largest group was from the third year of studies 108(33.3%). The mean DREEM score was 96.31±18.47 (range: 36-145), which was interpreted as 'having many issues'. Only fifth-year medical students' DREEM score was categorised as 'more favourable than adverse' (Table-1).
Students' score in each DREEM category and subscale was noted and interpreted (Table-2). When each item of the DREEM questionnaire was correlated with the academic performance, a weak positive correlation was observed for SPL - item 2, SPT - item 11 and SPA - items 3 and 10 (p<0.05). Weak negative correlations were observed for SPL - item 11, SPT - item 10 and SSP item 2 (p<0.05) (Table-3).
Overall DREEM score subdomain mean scores were not significantly correlated with academic performance (p>0.05) (Table-4). Correlation of age with academic performance and DREEM score was not statistically significant (p>0.05). Female students had higher academic performance 65.64 ± 4.73 compared to males 63.78 ± 4.53 (p=0.002). The academic score was also significantly different in each academic year (p<0.001). However, the DREEM score was not significantly associated with gender (p=0.087) and academic year (p=0.109) (Table-5).
The findings suggested there is plenty of scope for improvement in terms of academic performance and DREEM scores. None of the students fell into the 'outstanding' category of DREEM scoring. A similar study involving Pakistani medical students revealed a mean DREEM score of 127 ±19.3, which was much higher than that noted in the current study.16 Regarding the DREEM subdomains, the current study did not find a good score compared to a previous study, which revealed higher scores in almost all domains.17 An Australian study also showed higher scores for clinical year undergraduate medical students.18 A Pakistani study showed DREEM subdomain scores19 that were very similar to the current study's findings.
The current study did not find any direct correlation between DREEM score and academic performance. When the DREEM scores were categorised as 'very bad', 'many issues', and 'more favourable than adverse', the mean academic scores were 64.38±1.19, 65.07±4.96 and 65.21±4.63 which were not significantly different (p>.05). In contrast, a previous Pakistani study revealed a strong positive correlation between DREEM scores and academic performance.20 However, a significant correlation between some specific DREEM items and academic performance was identified by the current study.
The current study raises critical questions. Why did females score better in academic performance? Why did fifth-year students have the highest DREEM score? Further studies are recommended to answer these questions and find out other significant factors responsible for better academic performance.
In terms of limitations, the current study was done at a single-centre and comprised only medical students. Nursing, dental, physiotherapy paramedics and postgraduate students could be included to attempt a clearer picture. Due to a lower response rate, the absolute precision of the study is >5%.
There was no significant relationship between overall DREEM scores and academic performance. However, some DREEM items correlated positively with the academic score which means there is some specific impact of the educational environment over academic performance. Although all respondents were in the same learning environment, females scored higher than males in terms of academic performance. Some other factors may have had a greater impact on academic performance other than the education environments in the study area.
Conflict of Interest: None.
Source of Funding: None.
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