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MAMCJMS_51_17R5

MAMC Journal of Medical Sciences

Original Article

Medical Students’ Opinion and Perception of the Education


Environment in a Medical College of Delhi, India
Sandeep Sachdeva, Nidhi Dwivedi
Department of Community Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India

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

INTRODUCTION In this context, a study was undertaken to evaluate the quality


of education environment in a medical college as perceived
Optimal education climate is an important determinant for
by medical students using globally accepted Dundee Ready
effective learning to occur.[1,2] Evidences exist which indicate
Educational Environment Measure (DREEM) inventory tool.
that the educational environment experienced by students has
This study would provide an opportunity for the sensitization
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 Address for correspondence: Dr. Sandeep Sachdeva, Department of
teaching environment are now recognized as valid indicators Community Medicine, North DMC Medical College and Hindu Rao Hospital,
of the appropriateness of curricula and educational settings.[5] New Delhi 110007, India.
E-mail: sachdevadr@yahoo.in

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DOI: How to cite this article: Sachdeva S, Dwivedi N. Medical Students’


10.4103/mamcjms.mamcjms_51_17 Opinion and Perception of the Education Environment in a Medical
College of Delhi, India. MAMC J Med Sci 2017;XX:XX.

© 2017 MAMC Journal of Medical Sciences | Published by Wolters Kluwer - Medknow 1


Sachdeva and Dwivedi: Medical education

of stakeholders for a timely and apt feedback for corrective participants enables the identification of specific strengths
intervention and resource mobilization. and weakness within the educational environment.
In addition, the sociodemographic details of students such
MATERIALS AND METHODS as gender, native place, type of school, percentage of
The Dundee Ready Educational Environment Measure marks obtained in 12th class, supplementary attempt in
instrument previous university examination, and current residence
(hostel/day scholar) were also taken. The subjective (self)
The DREEM, a universal, culturally nonspecific, generic, assessment of satisfaction (yes/no) with regard to medical
reliable, and diagnostic inventory tool was used to assess profession, admission in current college, and global (overall)
students’ perceptions about the educational environment. satisfaction was also documented.
DREEM has been widely used to gather information about
the quality of education environment in many institutions
across the globe.[6-9]
Background information
The current government medical college under the aegis of
DREEM is a 50-item inventory questionnaire, consisting of North Delhi Municipal Corporation started in the year 2013
five subscales: following approval from Medical Council of India (MCI),
(1) Students’ perceptions of learning (SPL) − 12 items; and it is affiliated to Guru Gobind Singh Inderprastha
maximum score is 48; University and admits 50 students per batch through
(2) Students’ perceptions of atmosphere (SPA) − 12 items; a competitive entrance examination. The 1000-bedded
maximum score is 48; multispecialty hospital associated to this college was
(3) Students’ perceptions of teachers (SPT) − 11 items; established way back in the year 1958 that has evolved
maximum score is 44; and expanded over the years.
(4) Students’ academic self-perceptions (SASP) − 8 items;
maximum score is 32; Data collection
(5) Students’ social self-perceptions (SSSP) − 7 items;
MBBS students of three batches (2nd, 3rd, and 4th year) were
maximum score is 28.
considered in the present cross-sectional study. Students were
Each item is rated on a five-point Likert scale with score briefed about the study objectives, voluntary nature
ranging from 0 to 4 where 0 = strongly disagree, 1 = disagree, of participation, and confidentiality of data collection.
2 = unsure, 3 = agree, and 4 = strongly agree. There are nine However, none of them declined to participate. Out of the
negative items (items 4, 8, 9, 17, 25, 35, 39, 48, and 50), for 150 permitted (50 per batch) seats, only 139 were filled. Thus,
which correction is made by reversing the scores; thus after a total of 117 (84.1%) available students could be contacted in
correction, higher scores indicate disagreement with that person who completed the questionnaire under direct
item. Items with a mean score of ≥3.5 are true positive supervision.
points; those with a mean of 2 are problem areas; scores
in-between these two limits indicate the aspects of the Data management and statistical analysis
environment that could be enhanced. The maximal global The data were entered into a Microsoft Excel spreadsheet and
score for the ques­tionnaire is 200, and the global score is analysis performed using the Statistical Package for the
interpreted as follows: 0–50 = very poor; 51–100 = many Social Sciences version 20.0 software (IBM, New York,
problems; 101–150 = more positive than negative; and USA). The internal consistency and reliability of this study
151–200 = excellent.[10] The guide to interpreting DREEM was found to be 0.86 (Cronbach alpha). The results of the
score is given in Table 1. The examination of the individual DREEM were considered at three levels: (i) individual items,
items by looking at the mean score obtained across all (ii) subscales, and (iii) overall DREEM. The raw scores

Table 1: The guide to interpreting DREEM score


Score Total DREEM score Score Perception of teachers Score Perception of atmosphere
0–50 Very poor 0–11 Very poor 0–12 Very poor
51–100 Plenty of problems 12–22 In need of some retraining 13–24 In need of some retraining
101–150 More positive than negative 23–33 Moving in right direction 25–36 Moving in right direction
151–200 Excellent 34–44 Model teachers 37–48 Model teachers

Score Perception of learning Score Academic self-perception Score Social self-perception


0–12 Very poor 0–8 Feeling of total failure 0–7 Miserable
13–24 Teaching viewed negatively 9–16 Many negative aspects 8–14 Not a nice place
25–36 More positive than negative 17–24 Feeling more on positive side 15–21 Not too bad
37–48 Teaching highly thought of 25–32 Confident 22–28 Very good socially

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Sachdeva and Dwivedi: Medical education

obtained for the items making up each of the five subscales college (score, 133.0 vs. 115.7); and who opined that
were summed for each participant, and then the mean of this administration is student-supportive (score, 133.4 vs.
summed score was taken to give a subscale summary score 120.9). The gender, type of school, marks in 12th class,
and these were further summed up to give an overall DREEM native place, current residence, supplementary (extra
score. Students who ever had a supplementary (extra) attempt attempt) university exam, current mental state (sad/happy),
in the university exam were labeled as underachiever and and professional satisfaction had no statistical bearing on
others as academic achievers for comparison purpose. overall DREEM score.
Student’s t test and one-way analysis of variance
Item-wise DREEM inventory score according to
(ANOVA) are used to compare the averages of five
underachiever and academic achiever students is given in
domains based on different characteristics.
Table 4. The three probable problem areas (score <2.0) which
call for attention include: (i) the teaching overemphasizes
RESULTS factual learning (mean score: 1.58); (ii) the teachers are
Out of 117 students, 71 (60.7%) were male and 46 (39.3%) authoritarian (mean score: 1.75); and (iii) I am able to
female; the native place of 77 (65.8%) students was Delhi and memorize all I need (mean score: 1.87).
the rest (34.2%) were from states outside Delhi but within
India; 79 (67.5%) students were staying in hostel; 94 (80.3%) DISCUSSION
students passed their 12th class from private/convent school
A cross-sectional, descriptive study was undertaken to assess
whereas the rest (19.7%) were from government school and
opinion and perception of medical students regarding
22 (18.8%) students had a supplementary attempt in previous
education environment in a government medical college of
professional university exam. The self-assessment of current
Delhi, India using generic DREEM inventory tool. The
mental state of 6 (5.1%) students was sad while the remaining
overall mean score (range, 0–200) among medical students
111 (94.8%) were happy; and nearly 88 (75.2%) students
was 130.34 (±15.76) that is suggestive of overall positive
opined that administration is student-supportive.
results and education environment moving in right direction.
The overall mean DREEM inventory score (range: 0–200) The study gauges the experiential learning environment from
among all the respondents was 130.34 (±15.76), which is the students’ perspective without any undue emphasis on
suggestive of “more positive than negative.” Details are infrastructure or allied logistics related issues. DREEM
shown in Table 2. The mean score of DREEM subscales/ inventory tool provides an opportunity for the evaluation
domain is as follows: SPL was 31.48 (range: 0–48); SPA and feedback of education environment in a health institution
(31.62, range: 0–48); SPT was 29.0 (range: 0–44); SASP from students’ perspective only; therefore, it has its own set of
(18.33, range: 0–32); and SSSP (17.01, range: 0–28). inherent limitations.
Percentage-wise subdomain score among all medical
According to the studies conducted among medical students
students is shown in Figure 1.
in India using DREEM inventory, the overall mean score in
The domain-wise score of DREEM inventory according to our study (130.3) was found to be higher than 101 (University
the background characteristics of students is shown in College of Medical Sciences, Delhi), 115.2 (Udaipur,
Table 3. Statistically (P < 0.05) higher DREEM score was Rajasthan), 116.5 (Darbhanga, Bihar), 121.8 (Pune,
found among senior medical students [score, 136.5 (4th year) Maharashtra), 122.4 (Belgaum, Karnataka), 123 (Mumbai,
vs. 131.9 (3rd year) vs. 123.6 (2nd year)]; those medical Maharashtra), 123 (Mangalore, Karnataka), 126.3 (Army
students who were globally satisfied (score, 131.2 vs. College of Medical Sciences, Delhi) but slightly lower
119.3); satisfied getting admitted in current medical than 131.6 (Bhavnagar, Gujarat).[11-19] The near similarity

Table 2: Summary score in five subdomains of DREEM inventory tool


SN Five subdomains of DREEM inventory Mean score (SD) among all Avg. score among all MBBS Inference
including range of score the MBBS students students out of 100 points
A Students’ perception of learning − SPL 31.48 (±4.65) 65.4% More positive than
(0–48) negative
B Students’ perception of atmosphere − SPA 31.62 (±5.4) 65.8% Moving in right
(0–48) direction
B Students’ perception of teachers − SPT 29.02 (±3.95) 65.9% Moving in right
(0–44) direction
D Students’ academic self-perception − SASP 21.22 (±3.24) 66.2% Feeling more on
(0 − 32) positive side
E Students’ social self-perception − SSSP 17.01 (±3.4) 60.7% Not too bad
(0–28)
Over-all DREEM score (0–200) 130.3 (±15.76) 65.0% More positive than
negative

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Sachdeva and Dwivedi: Medical education

of the findings could perhaps be because this institution as opportunity, and threat) analysis of a medical college
others have been able to maintain satisfactorily the minimum in Kerala also reported similar observations.[20] As there is
standards and the operational guidelines set by the regulatory no information with regard to status of education environment
body in the country, that is, MCI. In addition to this, the length in a medical college with adverse/unsatisfactory regulatory
(years) of running an institution could be another determinant (MCI) inspection report that may throw surprising results for
leading to such results. A SWOT (strength, weakness, comparison.
Further, a small batch of 50 MBBS students leads to better
Percentage score of DREEM tool amongst all medical students
and strong student–teacher interaction; doubt clearance/
clarification; quick feedback and relaxed environment
SPL 65.4% during tutorials with still smaller batches. However,
SPA 65.8%
some areas need strengthening and introspection,
especially teaching style, concerning the item “teachers
SPT 65.9%
are authoritarian” and infrastructure-associated issues
SASP 66.2% such as hostel accommodation. The sensitization of
teachers is needed to act as role model, change agent,
SSSP 60.7%
facilitator, in making the environment more congenial, and
Total DREEM score 65% also in better managing the students in changing
sociopolitical and information technology dynamics
Figure 1: DREEM score among all medical students out of 100 points in India. Hostel accommodation and leisure time

Table 3: Mean scores (±SD) of five domains of DREEM as per background characteristics
Variable SPL SPT SASP SPA SSSP Total
Gender Male 31.46 (5.1) 29.07 (4.4) 21.20 (3.5) 31.45 (6.3) 16.51* (3.6) 129.69 (17.9)
Female 31.50 (4.0) 28.93 (3.2) 21.26 (2.9) 31.87 (3.6) 17.78* (2.9) 131.35 (11.8)
School Government 31.48 (3.6) 28.74 (3.8) 22.30 (2.3) 32.26 (4.3) 17.30 (3.2) 132.09 (11.9)
Private 31.48 (4.9) 26.67 (3.6) 20.96 (3.4) 31.46 (5.7) 16.94 (3.5) 129.91 (16.6)
Native place Delhi 31.70 (4.7) 29.13 (3.9) 21.47 (3.2) 31.83 (5.4) 17.10 (3.3) 131.23 (16.1)
Other 31.05 (4.5) 28.80 (4.1) 20.75 (3.3) 31.2 (5.5) 16.83 (3.5) 128.63 (15.1)
Residence Hostel 30.82* (4.7) 28.94 (3.9) 20.87 (3.3) 31.33 (5.3) 16.81 (3.7) 128.77 (15.7)
Day scholar 32.84* (4.2) 29.18d (4.2) 21.95 (2.9) 32.21 (5.4) 17.42 (2.6) 133.61 (15.5)
12th class marks <90% 30.88 (4.68) 28.96 (3.88) 20.78 (3.41) 31.73 (5.35) 16.42* 128.76 (15.8)
(3.43)
≥90% 32.28 (4.5) 29.01 (4.09) 21.82 (2.93) 31.46 (5.56) 17.80* 132.46 (15.7)
(3.23)
Satisfaction (profession) Satisfied 31.57 (4.7) 29.02 (3.9) 21.35 (3.07) 31.77 (5.3) 17.17* 130.89 (15.8)
(3.34)
Not 29.83 (3.31) 28.83 (4.83) 18.83 (5.3) 28.67 (6.59) 14.0*(3.4) 120.17 (12.5)
satisfied
Satisfaction (college) Satisfied 32.09* (4.1) 29.37* (3.9) 21.71* (2.9) 32.41* (4.8) 17.41* (3.3) 133* (13.6)
Not 28.11* (5.8) 27.05* (3.8) 18.56* (3.6) 27.22* (6.4) 14.78* (3.3) 115.72* (18.9)
satisfied
Satisfaction (global) Satisfied 31.64 (4.6) 28.88 (3.9) 21.44* (3.1) 32.04* (5.0) 17.24* (3.3) 131.26* (15.2)
Not 29.44 (5.1) 30.55 (3.6) 18.67* (3.7) 26.44* (7.4) 14.22* (4.1) 119.33*
satisfied (19.35)
Current mental status Sad 32 (1.67) 30.66 (2.50) 20.17 (5.04) 29.33 (3.98) 14.83 (3.31) 127 (9.71)
Happy 31.45 (4.75) 28.93 (4) 21.28 (3.14) 31.74 (5.46) 17.12 (3.38) 130.52 (16.03)
Administration is student- Agree 32.43* 29.59* 21.84* 32.31* 17.27 (3.50) 133.44*
supportive (4.14) (3.58) (3.01) (5.27) (14.92)
Disagree 28.59* 27.28* 19.34* 29.52* 16.21 (2.99) 120.93*
(4.95) (4.56) (2.99) (5.35) (14.71)
MBBS batch 4th year 32.48* 28.75 (4.05) 23.03* 34.0* (3.85) 18.30* 136.58*
(4.33) (2.63) (2.73) (12.80)
3rd year 32.63* 29.44 (4.14) 21.46* 31.09* 17.27* 131.91*
(4.35) (2.94) (5.89) (3.31) (15.47)
2nd year 29.46* 28.78 (3.73) 19.51* 30.24* 15.68* 123.68*
(4.61) (3.17) (5.44) (3.58) (16.07)
SPL = Students’ perception of learning, SPT = Students’ perception of teachers, SASP = Students’ academic self-perception, SPA = Students’ perception of
atmosphere, SSSP = Students’ social self-perception. *P < 0.05.

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Sachdeva and Dwivedi: Medical education

Table 4: Average scores (mean ± SD) of 50 items of DREEM inventory among medical students (underachiever and
academic achiever)
Questions Overall U-A (mean ± SD) Achievers (mean ± SD) P
(mean ± SD)
(A) Students’ perception of learning (SPL)
1–I am encouraged to participate during teaching sessions 2.79 (0.76) 2.80 ± 0.77 2.77 ± 0.75 0.88
7 − The teaching is often stimulating 2.63 (0.79) 2.63 ± 0.76 2.64 ± 0.95 0.98
13 − The teaching is student-centered 2.71 (0.79) 2.74 ± 0.76 2.59 ± 0.91 0.43
16 − The teaching helps to develop my competence 2.79 (0.90) 2.78 ± 0.86 2.86 ± 1.04 0.69
20 − The teaching is well focused 2.95 (0.64) 2.95 ± 0.57 2.95 ± 0.90 0.96
22 − The teaching helps to develop my confidence 2.66 (0.67) 2.68 ± 0.69 2.55 ± 0.60 0.38
24 − The teaching time is put to good use 2.80 (0.76) 2.87 ± 0.72 2.50 ± 0.86 0.03
25 − The teaching over emphasizes factual learning 1.58 (0.87) 1.57 ± 0.92 1.64 ± 0.66 0.74
38 − I am clear about the learning objectives of the course 2.88 (0.60) 2.91 ± 0.60 2.77 ± 0.61 0.36
44 − The teaching encourages me to be an active learner 2.69 (0.77) 2.72 ± 0.71 2.59 ± 1.00 0.49
47 − Long term learning is emphasized over short term learning 2.67 (0.93) 2.67 ± 0.92 2.64 ± 1.00 0.87
48 − The teaching is too teacher centered 2.32 (0.92) 2.39 ± 0.91 2.0 ± 0.87 0.07
(B) Students’ perception of teachers (SPT)
2 − The teachers are knowledgeable 3.32 (0.63) 3.36 ± 0.56 3.18 ± 0.85 0.24
6 − The medical consultation is patient centered 2.60 (0.86) 2.53 ± 0.87 2.91 ± 0.75 0.06
8 − The teachers ridicule the student 2.38 (0.94) 2.45 ± 0.92 2.05 ± 0.99 0.07
9 − The teachers are authoritarian 1.75 (0.97) 1.80 ± 0.95 1.55 ± 1.05 0.27
18 − The teachers have good communication skills 3.01 (0.70) 3.02 ± 0.70 2.95 ± 0.72 0.69
29 − The teachers are good at providing feedback to students 2.81 (0.77) 2.80 ± 0.79 2.86 ± 0.64 0.72
32 − The teachers provide constructive criticism here 2.58 (0.82) 2.54 ± 0.84 2.77 ± 0.75 0.22
37 − The teachers give clear examples 2.84 (0.64) 2.83 ± 0.63 2.86 ± 0.71 0.83
39 − The teachers get angry in teaching sessions 2.36 (0.86) 2.36 ± 0.86 2.36 ± 0.85 0.98
40 − The teachers are well prepared for their class 3.14 (0.74) 3.18 ± 0.70 2.95 ± 0.90 0.20
50 − The students irritate the teachers 2.23 (1.0) 2.15 ± 0.95 2.59 ± 1.18 0.06
(C) Students’ academic self-perception (SASP)
5 − Learning strategies which worked for me before continue to work 2.39 (0.95) 2.41 ± 0.91 2.32 ± 1.13 0.68
for me now
10 − I am confident about my passing this year 3.22 (0.77) 3.17 ± 0.81 3.45 ± 0.51 0.11
21 − I feel I am being well prepared for my profession 2.79 (0.71) 2.83 ± 0.68 2.64 ± 0.85 0.25
26 − Last year’s work has been a good preparation for this year’s 2.61 (0.81) 2.68 ±0.76 2.27 ± 0.94 0.03
work
27 − I am able to memorize all I need 1.87 (0.92) 1.88 ± 0.91 1.82 ± 1.00 0.76
31 − I have learnt a lot about empathy in my profession 2.91 (0.74) 2.91 ± 0.73 2.95 ± 0.79 0.78
41 − My problem solving skills are being well developed here 2.53 (0.84) 2.54 ± 0.80 2.50 ± 1.01 0.85
45 − Much of what I have to learn seems relevant to a career in 2.89 (0.82) 2.92 ± 0.83 2.77 ± 0.75 0.46
healthcare
(D) Students’ perception of atmosphere (SPA)
11 − The atmosphere is relaxed during ward teaching 2.72 (0.91) 2.75 ± 0.93 2.59 ± 0.80 0.47
12 − This course is well time-tabled 2.82 (0.90) 2.81 ± 0.89 2.86 ± 0.94 0.80
17 − Cheating is a problem on this college 2.38 (1.12) 2.38 ± 1.18 2.41 ± 0.85 0.89
23 − The atmosphere is relaxed during lectures 2.70 (0.84) 2.71 ± 0.85 2.68 ± 0.84 0.91
30 − There are opportunities for me to develop interpersonal skills 2.54 (1.08) 2.55 ± 1.05 2.50 ± 1.23 0.85
33 − I feel comfortable in teaching sessions socially 2.89 (0.67) 2.94 ± 0.62 2.68 ± 0.84 0.11
34 − The atmosphere is relaxed during tutorials/seminars 2.69 (0.93) 2.71 ± 0.92 2.64 ± 1.00 0.76
35 − I find the experience disappointing 2.7 (0.85) 2.80 ± 0.79 2.27 ± 0.99 0.03
36 − I am able to concentrate well 2.45 (0.84) 2.45 ± 0.85 2.45 ± 0.80 0.99
42 − The enjoyment outweighs the stress of study course 2.18 (1.10) 2.22 ± 1.04 2.00 ± 1.31 0.39
43 − The atmosphere motivates me as a learner 2.59 (0.86) 2.69 ± 0.75 2.14 ± 1.17 0.04
49 − I am able to ask questions when I want to 2.95 (0.76) 3.06 ± 0.68 2.45 ± 0.91 0.07
(E) Students’ social self-perception (SSSP)
3 − There is a good support system for students who get stressed 2.10 (1.11) 2.11 ± 1.10 2.09 ± 1.19 0.96
4 − I am too tired to enjoy the course 2.32 (1.11) 2.39 ± 1.09 2.05 ± 1.17 0.19
(Continued )

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Sachdeva and Dwivedi: Medical education

Table 4 (Continued)
Questions Overall U-A (mean ± SD) Achievers (mean ± SD) P
(mean ± SD)
14 − I am rarely bored on this course 2.12 (1.08) 2.11 ± 1.07 2.18 ± 1.18 0.77
15 − I have good friends in this college 3.07 (0.90) 3.09 ± 0.90 2.95 ± 0.90 0.51
19 − My social life is good 2.97 (0.78) 2.97 ± 0.79 3.0 ± 0.76 0.87
28 − I seldom feel lonely 2.10 (1.09) 2.07 ± 1.07 2.23 ± 1.15 0.55
46 − My accommodation is pleasant 2.32 (1.25) 2.28 ± 1.27 2.45 ± 1.18 0.57
U-A = underachiever.

involvement of students are the other areas that need The stimulating and involving education environment created
suitable betterment. in medical institutions by some of the esteem faculties makes
learning active, interesting, and life-long. Inter-alia, need for
The domain under “student social self perception” (SSSP),
cramming of the subjects becomes less critical. Inquisitive,
which includes items such as support system for students,
novice, and innocent curious questions of the students can be
boredom of course, social life, feeling of loneliness, and
best handled by understanding and matured faculties. Such
tiredness, could garner “not bad” score (average score 17.1
practice needs to be nurtured with tender care. The
out of a maximum of 28) among DREEM inventory. This
development and growth potential of an individual is
domain reflects the inherent challenges of the course that call
directly correlated with the depth of knowledge, positive
for attention, student support system, and individual
attitude, and diverse skills s/he possesses and demonstrates
counseling. The low scores are comparable to the majority
whether at undergraduate or higher level of functioning.[25]
of studies conducted in India such as 17.7 (Gujarat), 17.7
Many institutions in India have introduced innovative
(Mumbai), 14.4 (UCMS, Delhi), and 14.1 (Udaipur).
training methods based on integrated teaching or problem/
However, even under this domain, girls scored statistically
investigation report/field based learning, evidence-based
(P < 0.05) higher and better than males (17.7 vs. 16.5);
medicine, and some of them are equipped with high-end
students with at least 90% marks in 12th class; students who
research, clinical, simulation, and communication skill labs.
were professionally satisfied; students who were satisfied
getting admission in this college; and senior batches of Medical education environment in the country is evolving for
students also scored high. better, yet it needs a time-bound overhaul to overcome
Overall, none of the DREEM inventory item had an diverse uninspiring challenges and also to be in sync with
average score more than 3.5, but the majority of scores newer competencies, digital technology, and changing
in the present study were in the range of 2–3 points (range time.[26-29] Stakeholders, be it student, faculty, or admini-
0–4) indicating the aspects of the environment that could be strator, are constantly engaged in discussion, debate, and
improved or enhanced. Logically speaking, because this meetings for overcoming the crises situation and suggest
instrument measures the experiential learning, senior way forward. Nontransparent interactions, favoritism,
students had higher mean score than their juniors and commercialization of medical education, and corruption
the finding was found to be statistically significant. This have been the main stumbling blocks in its road to
is again similar to those reported in other studies.[11,18,21] In recovery. For the last couples of years, the thrust of
our study, out of all the listed background variables, medical education in country has been to increase the
“getting admission in present medical college” had a production of doctors and allied health staff, albeit
statistically significant bearing on all the subdomains of increasing quantity is having a toll in terms of poor quality
DREEM inventory tool. of doctor training including inadequate knowledge and skill
transfer.[30,31] The current number of medical colleges in
The duration of MBBS course in medical college of India is India stood at 474 with annual MBBS seats of 60,000 plus
four-and-half years followed by 1-year internship. The while the number of postgraduate degree/diploma seats are
students are systematically and in structured way exposed nearly half. Considering the stiff challenge in securing
to different subject streams (preclinical, paraclinical, and a postgraduate seat in India, a significant number of
clinical) through processes prescribed under MCI with undergraduate students are preparing for postgraduate
students to keep the record of daily activity/learning in a entrance exam starting from 2nd year onwards. It can be
log book. Teaching, learning dynamics, and evaluation though attributed to early start and purposeful planning but
process form the core activity of student–teacher also indicating a case scenario of intense peer pressure and
interaction in any institution. Motivated faculties rising stress.
are constantly engaged in building knowledge base,
transforming attitude, and implementing innovating In the backdrop of this journey, it was realized that teaching
methods from a large bouquet of training methods, shifted from black-board to power point with medical
evaluation, and also have received the highest attention of education largely being drifting toward western concept
medical researchers in Indian setting.[22-24] that carried little ethos, sentiments, and fragrance of vast

6 MAMC Journal of Medical Sciences ¦ Volume XX ¦ Issue XX ¦ Month 2017


Sachdeva and Dwivedi: Medical education

rural and diverse democratic country such as India.[28,32] 7. Mayya SS, Roff S. Students’ perceptions of educational environment:
There has been a predominance of “theoretical” knowledge A comparison of academic achievers and under-achievers at Kasturba
Medical College, India. Educ Health 2004;17:280-91.
transfer and subject cramming. However, it was noted during 8. Roff S, McAleer S, Harden R, Al-Qahtani M, Ahmed A, Deza H, et al.
the last decade that there has been a compensatory increase in Development and validation of the Dundee Ready Education
skill transfer, clinical case, and practical exposure of medical Environment Measure (DREEM). Med Teach 1997;19:295.
students through cutting down the time period of more 9. Miles S, Swift L, Leinster SJ. The Dundee Ready Education
“theoretical”-oriented preclinical subjects. Three months Environment Measure (DREEM): A review of its adoption and use.
Med Teach 2012;34:9. e62034. doi: 10.3109/0142159X. 2012.668625.
internship period has been reduced to 2 months in the 10. Genn JM. AMEE Medical Education Guide No. 23 (Part 1):
department of community medicine again on the same Cur­riculum, environment, climate, quality and change in medical
premise. In times to come, we would witness more such education –A unifying perspective. Med Teach 2001;23:337-44.
pruning; however, there are reservations against this 11. Kohli V, Dhaliwal U. Medical students’ perception of the educational
phenomenon.[33] With the rising materialistic aspirations, environment in a medical college in India: A cross-sectional study
using the Dundee Ready Education Environment questionnaire. J Educ
clinical–social case discussion and doctor–patient comm- Eval Health Prof 2013;10:5. doi: 10.3352/jeehp.2013.10.5
unication are witnessing a downward trend. Inter-alia, the 12. Sharma S, Kaur M. Perception of educational ambiance among
proposed National Medical Commission that would replace undergraduate medical students at Geetanjali Medical College,
current MCI may usher the next wave of change in medical Udaipur, Rajasthan, India. Int J Res Med Sci 2016;4:5411-6.
education in India.Medical education is an encompassing 13. Rana RK, Kumar S, Kumar A, Roy V, Roy C. Analyzing the dreams
coming true for young undergraduates of DMCH, Laherisarai,
term that considers various factors such as curriculum, Darbhanga using DREEM score. Int J Recent Trends Sci Tech
learning and teaching methodologies, outcome and 2013;6:60-3.
assessment, skill transfer, group dynamics, teacher–student 14. Methre ST, Methre TS, Borade NG. Perception of educational environment
relationship, self-development, and peer development. The among undergraduate medical students. JMSCR 2015;3:60-6.
students’ perception of their environment was shown to 15. Sunkad MA, Javali S, Shivapur Y, Wantamutte A. Health sciences
students’ perception of the educational environment of KLE
have a significant impact on their behavior and academic University, India as measured with the Dundee Ready Educational
progress.[34] Students in present medical college get admitted Environment Measure (DREEM). J Educ Eval Health Prof 2015;12:37.
through a highly competitive entrance exam and hence can be doi: 10.3352/jeehp.2013.10.5
considered to be above average with self-drive and 16. Patil AA, Chaudhari VL. Students’ perception of the educational
motivation for learning. However, the exact reasons for environment in medical college: a study based on DREEM
questionnaire. Korean J Med Educ 2016;28:281-8.
low scores for some of the subdomains of DREEM 17. Pai PG, Menezes V, Srikanth P, Subramanian AM, Shenoy JP. Medical
inventory could not be elucidated but the difference could students’ perception of their educational environment. J Clin Diag Res
be attributed to students’ personality, emotional factors, 2014;8:103-7.
aspirations, challenging exposures in childhood, and 18. Tripathy S, Dudani S. Students’ perception of the learning environment
socioeconomic-cultural upbringing, among others. In in a new medical college by means of the DREEM inventory. Int J Res
Med Sci 2013;1:385-91.
conclusion, overall students indicated progressive and 19. Parmar D, Shah C, Parmar R. Students’ perception of educational
positive developmental milieu in the present study. environment in an Indian medical school using DREEM inventory.
Ann Comm Health 2015;3:4-12.
Financial support and sponsorship 20. Sathidevi VK, Sivadas MG. SWOT analysis of medical and training in
government medical college, Kerala. Int J Sci Res Publ 2013;3:1-5.
Nil. 21. Gade S, Chari S. Students perception of undergraduate educational
environment in multiple medical institutes across central India using
Conflicts of interest DREEM inventory. NJIRM 2013;4:125-31.
22. Sachdeva S. Training methods. J Postgrad Med Educ Train Res
There are no conflicts of interest. 2008;3:4-8.
23. Sachdeva S, Malik JS, Sachdeva R, Sachdev TR. HIV/AIDS
knowledge among first year MBBS, nursing, pharmacy students of
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