Muhammad Imran ( Department of Surgery, King Abdulaziz University, Jeddah, KSA. )
Muhammad Shahid Shamim ( Medical Education Unit and Department of Surgery, King Abdulaziz University, Jeddah, KSA. )
Mukhtiar Baig ( Assessment Unit and Department of Biochemistry, King Abdulaziz University, Jeddah, KSA. )
Mohamed Farouq ( Clinical Affairs, Department of Pediatrics, King Abdulaziz University, Jeddah, KSA. )
Zohair Jamil Gazzaz ( Department of Medicine, Consultant Medicine (Diabetes), King Abdulaziz University, Jeddah, KSA. )
Osama Mohammed Al-Mutairi ( 6th Year Student, Rabigh Medical College, King Abdulaziz University, Jeddah, KSA. )
Objectives: To evaluate students\\\' perception about the educational environment at two medical colleges.
Methods: The cross-sectional study was conducted at King Abdulaziz University, Rabigh and Jeddah campuses, in Saudi Arabia, during the first semester of the year 2014 using Dundee Ready Education Environment Measure inventory. Data was collected from undergraduate medical students and analysed using SPSS 16.
Results: Of the 279 subjects in the study, 141(50.5%) belonged to the Rabigh campus, and 138(49.5%) to the Jeddah campus. Overall mean Dundee Ready Education Environment Measure inventory score was 124.90±20.66. The score for Jeddah was 131.38±21.37 and for Rabigh it was 118.56±17.85 (p=0.0001). The difference was also statistically significant in all domains of the inventory (p<0.05 each).
Conclusion: Students\\\' perception of their educational environment was positive in both campuses, it was more positive in Jeddah compared to Rabigh.
Keywords: Educational environment, DREEM inventory, Medical students. (JPMA 66: 316; 2016)
Rabigh and Jeddah are two cities located along the shores of Red Sea in Saudi Arabia. While Jeddah is the largest seaport on the Red Sea, an important commercial hub with population exceeding 5 million, Rabigh is an ancient town on the western coast with a much smaller population of under 200,000. The Faculty of Medicine, Rabigh, is one of the recently established faculties for undergraduate medical students in Saudi Arabia, with its second batch graduating this year. On the other hand, the well-established Faculty of Medicine at the University campus in Jeddah is providing medical education since four decades. Both medical institutes are affiliated with the highly prestigious King Abdulaziz University. Though separated by a distance of 160km, medical colleges in Rabigh and Jeddah employ paralleled educational philosophy with a modular integrated curriculum that is supposed to be implemented equally effectively in the two cities. In spite of common higher administration and curriculum, the two colleges have differences in number of students, human resources, logistic support, methods of implementing the curriculum and students\\\' demography. Hence, it is considered worthwhile to study the differences in their educational environment.
Educational environment is defined as "everything that happens within the institute", affecting students\\\' learning including class rooms, departments, faculty and university.1 It may also include factors such as geographical location, community and facilities provided to the students. Together, all factors determine the conduciveness of environment. A conducive environment is essential for learning in any institute\\\'s and its students\\\' success. Moreover, it is known to have impact on students\\\' satisfaction with the programme, aspirations and academic achievements, both during the programme and in future.1,2
Students\\\' perception regarding their institution is one method to evaluate the educational environment, which provides opportunity for the administration, faculty and staff to identify weaknesses and shortcomings of the educational process. The environment can then be improved, thus enhancing the education process for current and future students.3
Dundee Ready Education Environment Measure (DREEM) is a validated and appropriate tool that was created by Delphi panel of faculty members from international medical schools to evaluate the educational environment of medical colleges and other health professional institutions, especially for undergraduate medical schools.4 It has been used extensively to measure educational environment across the world.3 The DREEM inventory has been used to assess the educational environment of medical students at different medical schools of Saudi Arabia recently and in the previous years.5,6 Moreover, it is also emphasised that the DREEM is a valuable tool to observe transformation in educational environment over the passage of time.7 The DREEM inventory is found to be equally effective qualitatively even when it is compared with qualitative interviews.8
The current study was planned to evaluate through students\\\' perception, the educational environment of two medical colleges, at Rabigh and Jeddah, affiliated with the same university, implementing the same curriculum, but are different in other aspects related to location, faculty members and facilities.
Subjects and Methods
The cross-sectional study was conducted at Rabigh and Jeddah campuses of King Abdulaziz University, Saudi Arabia, during the first semester of 2014. After approval from the institutional ethics committee, cohorts of students from the faculty of Medicine at Rabigh and Jeddah campuses were asked to fill the DREEM questionnaire of which the English version was provided along with Arabic translation. It contained 50 questions, evaluating five domains of students\\\' perception about their learning, teachers, atmosphere, academics, and social self-perceptions (Appendix).
The response options for close-ended questions were 0-4, where in most cases 0 is for strongly disagree and 4 for strongly agree. However, items 4, 8, 9, 17, 25, 35, 39, 48 and 50 are scored in reverse direction; 0 for strongly agree, 1 for agree, 2 for uncertain, 3 for disagree and 4 for strongly disagree.3,4 The guidelines for the interpretation of scores on (i) individual items, (ii) subscales and (iii) overall DREEM were all followed.9,10
Convenience sampling method was used to enrol students from second year to sixth year in the study. The questionnaire was sent online with brief description of the study and filling of the questionnaire was taken as consent from the student. The questionnaire was sent to 300 students of both faculties. Identity of study participants was kept anonymous and data from the filled-up questionnaires was transferred to Excel file before analysis.
SPSS16 was used for data analysis. Shapiro-Wilk\\\'s test was used to check the normal distribution of the data and it was considered normally distributed when p>0.05. Means and standard deviations of DREEM total score, and the five subscales scores were calculated for normally distributed quantitative variables. Student\\\'s t test was applied to compare differences in mean score for total DREEM and for its five subscales between the two sets of students. P<0.05 was considered significant.
The questionnaire was sent out to students of different academic years, from 2nd to 6th year and including those of basic and clinical years (Figure).
Of the 300 questionnaires distributed, 279(93%) comprised the study sample, as 10(3.3%) students did not fill the questionnaire and 11(3.6%) filled it incorrectly.
Of these 279 students, 141(51%) were from the Rabigh campus with a mean age of 22.2±2.7 years, while 138(49%) were from the Jeddah campus with a mean age of 21.7±2.9 years. The Rabigh campus is an all-male facility, while participants from Jeddah included 71(51.4%) female and 67(48.5%) male students.
Students\\\' perception from both campuses was positive toward their educational environment both overall and in each domain, with 200(62%) saying their overall learning environment was in a positive direction, and they thought that their learning, the strategies implicated by their teachers for the learning process, their academic self-perception, their atmosphere and social self-perception were good (Table-1).
The students of Jeddah campus had more positive perception compared to the Rabigh campus overall and in all domains; the mean total DREEM score being 131.38±21.37 for Jeddah campus and 118.56±118.56 for Rabigh Campus (p<0.05) (Table-2).
The broader rationale for conducting this study was to see how we can improve the educational environment at our college. The results have shown that medical students at King Abdulaziz University have a positive perception toward their educational environment, and the total DREEM score is better (124.9/200) than a previous study conducted at the same university about a decade ago (102/200).11
Comparing our DREEM scores with institutions in other countries; 586 medical students from a medical college in Pakistan showed overall DREEM score of 114.4/200.12 In another study conducted at a university in Pakistan, the mean DREEM score was 117/200 and high achievers had more positive perception about their educational environment.9 It was 141/200 for students of a medical school from England,13, and 117/20014 from an Indian medical school (226 students). In Sri Lanka, the score was almost similar in two universities; 107.4/200 for the students of University of Colombo, Faculty of Medicine, and 107.2/200 for the students of Faculty of Medical Sciences, University of Sri Jayawardenapura.15 DREEM score from an Iranian medical school, though positive, was<100 (99.6).16 This shows that even when the overall scores are positive, they are variable due to factors such as region and curriculum, which were identified in the above examples from different countries.
An interesting aspect of our study was comparison of two campuses under one university. Although students\\\' perceptions were positive for both campuses, the scores from the larger campus situated in the metropolitan city of Jeddah were higher compared to the Rabigh campus. The findings give clues to the areas for improvement to bring the two campuses at par with each other. A similar study in the United Kingdom compared students\\\' perceptions from two campuses of Hull and York Medical Schools, using DREEM inventory. In most of the domains, the differences were not significant.17 However, in the UK study, faculty was the same for both campuses, and it included only first and second year students. In our study, the faculty members were altogether different, and we included students from second year to sixth year; which may carry a significant role in the difference in perceptions of students. On the contrary, a study from Australia showed statistically significant (p=0.03) better perception of students from smaller site (159.1/200) compared to the larger one (147.4/200). It emphasised on the importance of curriculum development and better infrastructure instead of campus size or other environmental factors.18
In a recently established medical college of Saudi Arabia, solely for females, overall mean DREEM score was 96.57/200.19 The study showed lesser overall score compared to Rabigh (96.57 versus 118.56). This can be due to the student-centred curriculum, which is not present at the female\\\'s college at present.
One of the limitations of our study was the sampling technique. We used convenience sampling that has a potential for missing some important points in evaluation.
Literature supports the use of DREEM inventory20,21 and we used the tool to evaluate our educational environment. In view of this evaluation, certain modifications in the curriculum, teaching strategies and logistic support have already been suggested to improve the educational environment for our students, with the hope that they will serve the community in a better way.
Students\\\' perception of their educational environment was positive at both Rabigh and Jeddah campuses of King Abdulaziz University, but perception of Jeddah students was more positive toward their environment.
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