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https://doi.org/10.36570/jduhs.2020.3.992 JDUHS ORIGINAL ARTICLE Comparison of the Educational Environment at a Medical College under Two Different Curricula Ayesha Younas,1 Robina Mushtaq,2 Rafia Minhas,3 Moatter Jahan4 1-2: Department of Medical Education1/Department of Community Medicine2,Wah Medical College, Wah Cantt Punjab, Pakistan. 3: Department of Dental Education, Avicenna Medical College Lahore, Punjab, Pakistan. 4: Fatima Jinnah Dental Hospital & College Karachi, Pakistan. Correspondence to: Dr. Ayesha Younas, Email: [email protected], ORCiD: 0000-0003-1508-1395 ABSTRACT Objective: To compare the perceptions of students regarding the educational environment at a medical college which underwent a curricular change using the Dundee Ready Education Environment Measure (DREEM) at two different points in time. Methods: A comparative cross-sectional study was conducted at Wah Medical College, Punjab, Pakistan. The DREEM instrument was distributed in 2015 to students in all five years of the MBBS program and in 2019 to students in years 1-3 of the MBBS program.The DREEM questionnaire comprised of five categories which included learning, teaching, academic self-perception, atmosphere, and social self-perception. Results: A total 692, participated in the study [400 (57.8%) students in 2015 and 292 (42.2%) in 2019]. The total median DREEM score in 2015 was 122 (134-111) whereas in 2019, the overall median DREEM score slightly increased up to 126 (142-103) (p-value 0.850). The comparison of the two different curricula with categories of DREEM inventory score showed that a significant association of two curricula was observed with students' perception about learning (p-value <0.001), positive perception about course organizers (p-value <0.001), atmosphere (p- value <0.001), and academic self-perception (p-value 0.031). Conclusion: Curricular shift had not made a significant impact on the overall educational environment and the institute was able to maintain a healthy learning environment. Keywords: Educational environment, student perceptions, Undergraduate medical education, curriculum shift, hidden curriculum. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creative commons. org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 4 INTRODUCTION educational environment they experience. It contribu- tes to their overall wellbeing, satisfaction with their The educational environment refers to the contexts, education and future aspirations of the students. The the cultures and the physical environments that are educational environment is a dynamic entity and is 1-2 unique to an educational institute. Being used as a continuously evolving. It is a measurable element that synonym with learning environment and educational has the potential to improve the quality of education climate, it is a broad concept. Educational or Learning itself. It is recommended that routine assessment of the environments are constructed in particular ways, with educational environment should be a policy of an choices made at institutional and classroom levels institution's educational practice. Diversity in medical about pedagogic measures, assessment and evaluation student's demographics have further strengthened measures, relations between teacher and learner, this need. The improvements that are being made in relations between types of learners, the physical medical curricula also call for a periodic reassessment of infrastructure arrangements and the overall the educational environment. DREEM inventory is a atmosphere of the institute. It comprises of all things validated, widely used tool to assess the learning that surrounds the educational organization and is environment especially in medical field.5 characterized by its policies, its reward and Wah Medical College is a private sector medical college consequence equation, and the pressure students face in Punjab Pakistan. For almost 15 years, the college as a result of their educational experience in the remained affiliated with one of the largest public sector 3 institute. Student learning is greatly affected by the universities of the country. Students, at the college J Dow Univ Health Sci 2020, Vol. 14 (3): 119-125 119 Younas et al. Comparison of the Educational Environment at a Medical College have performed exceptionally well, with various scale of 1 to 5. Higher scores for each category are academic achievements to their name and over 1467 demonstrative of the perfect educational environment students have graduated. However, a recent paradigm with a total conceivable score of 200. However, 9 of the shift took place in 2017 when the college changed its 50 items (number 4, 8, 9, 17, 25, 35, 39, 48 and 50) are affiliation and became registered under a new negatively phrased statements and are scored university. Thus, currently we, at WMC are in a unique reversely. McAleer and Roff 7-8 have described a time in our history as we have students in our earlier practical guide for interpreting the overall and subscale years of medical school (year 1 to 3) under an integrated scores, and the number of items in each subscale. This curriculum with a different curricular style and those in guide (Table 1) has also been used for interpretation of their last two years (4 and 5) under an older university scores in this study. with a traditional style of teaching and assessment. This Data analysis was performed using statistical packages study aims to gauge the educational environment at the for social sciences (SPSS) software 21.0. Median and college in this time of our history and identify the inter-quartile ranges were reported for quantitative differences if any (identified by the students). Thus, variable scores after checking normality by Shapiro- trying to determine whether a new university with its Wilk test. Frequencies and percentages were different curriculum, newer teaching & changed computed for categories of five subscales of DREEM assessment strategies, created a difference in our inventory, gender, year of study and number of educational environment. students studying in two different curricula (2015, 2019). Inferential statistics were explored using Chi- METHODS square test. Moreover, Mann-Whitney U test was The study is a comparative cross-sectional study applied to compare the median difference of five conducted at Wah Medical College, Wah Cantonment, subscales of DREEM inventory with two different years Punjab, Pakistan. Ethical approval from the institutional of data. p-values ≤ 0.05 taken as significant. review board of Wah Medical College was obtained prior conduction of the study (WMC/ERC/IRB/005). The RESULTS MBBS program at the college runs over five years. In 2015, the educational environment at the college was A total of 692 students participated in the study. Four assessed using the DREEM questionnaire.6 Data was hundred (57.8%) students in 2015 and 292 (42.2%) collected from students in all five years of the MBBS students in 2019. There were 338 (48.8%) males and 354 program. The college underwent a change in university (51.2%) females. affiliation in 2017 resulting in a change in curriculum The total median DREEM score in 2015 was 122 (134-111) implementation and assessment. Keeping this in mind, whereas in 2019, the overall median DREEM score in 2019, the educational environment was again slightly increased up to 126 (142-103) with a p-value of evaluated and students from year 1 to year 3 who were 0.850 which indicated that the learning environment at studying the new university curriculum were included. the college almost remained the same and no Students from year 4 and 5 were excluded as they were significant difference was observed between 2015 and not affiliated with the new university. All willing 2019 cohorts of MBBS students (Table 2). students who signed the consent form were included in The median difference of five sub scales of DREEM the study. inventory showed statistically significant difference The DREEM inventory questionnaire was used to assess regarding students' perception of course organizers (p- the perception of students regarding the educational value <0.001) and students' perception of atmosphere environment under two different educational curricula. (p-value <0.001) with respect to two different curricula. DREEM is a 50-items, self-administered, closed-ended In particular, there was a higher median score for questionnaire based on students' recognitions of five students' perception of course organizers in 2019 as main aspects related to their educational environment. compared to the students of 2015, i.e. 27 (31-24) and 25 These include learning, teaching, academic self- (28-22) respectively. According to effect size the perception, atmosphere, and social self-perception. difference is higher in students' perception of The 50 items questionnaire includes 12 questions for atmosphere and students' perception of course students' perception about learning, 11 questions about organizers as compare to others (0.388, 0.326). faculty/course organizers, 8 about academic self- However, the median score of students' perceptions perception, 12 about atmosphere, and 7 about social about atmosphere was higher among students' of 2015 self-perception. Students mark answers on a Likert batch as compared to students' of 2019 batch, i.e. 120 J Dow Univ Health Sci 2020, Vol. 14 (3): 119-125 Younas et al. Comparison of