Perceptions of medical students in different phases about educational environment: Qazvin University of Medical Sciences

Clinical education plays a major role in shaping the professional abilities of learners. In order to achieve the desired clinical education, it is necessary to perform continuous evaluation and monitoring. In this study, the views of medical students of Qazvin University of Medical Sciences (QUMS) regarding the educational atmosphere of the medical school in 2019-2020 were evaluated.
The present study is a descriptive epidemiological study and medical students of QUMS in 4 levels of basic sciences, physiopathology, stager, and intern participated in this survey. The instrument used was the DREEM questionnaire based on a five-point Likert scale that contains 50 questions with a total score of 200. The collected data were analyzed in SPSS 25 using T-test and ANOVA.
The total mean score of the educational space of 168 students surveyed was 96.02±22.68, which was in a semi-optimal condition. There was no significant difference in the score of general space and the score of subgroups governing educational environments by gender (P>0.05). But the mean score of physiopathology students' perceptions, of learning (p=0.001) teaching (p=0.002) educational atmosphere (p=0.005), and academic self-perceptions (p=0.015) were significantly higher from other levels of learners. The lowest score belongs to the internship level (student’s perceptions of learning, teaching, and social self-perceptions).
This study showed that the educational atmosphere at QUMS is in a partially favorable condition and interns have a more negative understanding of the learning environment and professors, hence needs further investigation.
 
Perceptions of medical students in different phases about educational environment: Qazvin University of Medical Sciences
The researchers showed that the educational atmosphere is one of the important components in students' learning (El Mahai Moeed-2013). The educational atmosphere is more related to how the curriculum is implemented, the teachers' attitude towards learning, the behavioral and organizational culture of the educational institution, and the student's view of the learning environment (Atapatu, Kumari et al. 2016). An appropriate educational environment creates opportunities for effective learning (Ikeda, Kubta et al. 2019). The DREEM model has been proposed to measure the educational atmosphere (Bakhshi Aliabad et al. 2019) is designed independently of cultural contexts and provides a comparison between different courses (Farough, Rahman et al. 2018). This study was conducted on the medical students of Qazvin University of Medical Sciences (QUMS) using the DREEM questionnaire. The results of this study can help teachers and managers enhance the learning experiences of medical students (Whittle, SR 2018).
This cross-sectional study was conducted on 168 medical students in QUMS in 2019-2020 after being approved by the Ethics Committee of QUMS (ethics code IR.QUMS.REC.1397.414). Sampling was based on the census. The DREEM questionnaire was used. Students at the end of the semester of internship, physiopathology, and basic sciences were questioned. This questionnaire contains demographic information and 50 questions in five areas of learning, teachers, students' academic self-perception, educational atmosphere, and student's social self-perception.
Questionnaire scoring is based on a five-item Likert scale. The items are scored as follows: (4) strongly agree, (3) agree, (2) unsure, (1) disagree and (0) strongly disagree. However, 9 items out of the total of 50 items are negative expressions and their scores were calculated in reverse. The overall score is classified into four categories: unfavorable (0 to 50), relatively favorable (51 to 100), favorable (101 to 150) and completely favorable (151 to 200). The statistical tests used include analysis of variance and t-test. Also, the standardized score of 100 was also calculated. The data were analyzed using SPSS v25. Ethical considerations such as completing the informed consent form, voluntary participation, explaining the research objectives, and ensuring the confidentiality of information were observed.
The mean DREEM score was calculated as 96.02±22.68, which is in a relatively favorable range. Based on the standardized score of the five areas, the highest score was related to their academic self-perception (54.56). The educational atmosphere with 49.64 and the learning environment with 36.95 has the lowest grade.
There was no difference between the mean DREEM score of the two genders in total and the 5 sub-areas of educational environments.
The mean scores of physiopathology students in the learning environment (p=0.001), teachers (p=0.002), and their academic self-perception (p=0.015) and educational atmosphere (p=0.005) were significantly higher than the students of other levels (table 3). From the students' point of view, the course of physiopathology is practical, and the course of basic sciences is impractical. Also, this desirable result is most likely due to the appropriate timing of this course. In QUMS, the course of physiopathology has been offered in an integrated form, but in the apprenticeship period, the theory classrooms are not coordinated with the schedule of the related clinical departments.
The lowest score belongs to the internship level (learning environment, teachers, and social self-perception). This result is similar to Peretti et al.'s study (Pai, Menzes et al. 2014). High work pressure, resident-oriented training in some clinical departments (Ikeda, Kubta et al. 2019), the inappropriate feedback especially in the morning report of some educational groups causes interns to feel that their personality is not respected. In fact, the clinical environment is not suitable for effective learning unless it is well-planned and organized (Demirren, Peleglu et al. 2008). Students' perception of clinical teachers can indicate that these teachers still do not use comprehensive methods. Internship students have the most negative impression of teachers. Active participation of students, accountability, effective supervision, and giving positive feedback are vital (Khorsandi and Khosravi 2002). The lowest score in the subcategory of students' understanding of social self-perception was related to internship level due to stresses related to bedside activities and worries about the future of employment. It seems that there is no good support system for stressed learners.
One of the limitations of this study was regarding physiopathology students. The collection of information for this group coincided with COVID-19 restrictions, and as a result, the questionnaire was completed online. Also, due to the cross-sectional nature of the study, generalization of the results should be done with caution.
The result of the study showed that the educational atmosphere is partially favorable. Among possible changes that may be useful are periodic surveys of students and accurate evaluation of their results, holding workshops on medical ethics and how to provide correct educational feedback to students for teachers, careful monitoring of teachers students' feedback, and creating support systems for students. Also, hidden curriculum effects may be important in explaining the relatively low DREEM scores of internship students. It is necessary to continuously monitor the learning environment. It is also recommended to use student-centered learning-teaching methods, more interaction between students and teachers, and psychological support for students in order to reduce their anxiety and stress and improve their social self-perception.