Sean McAleer

WHAT IS EDUCATIONAL CLIMATE

When students enter a new learning institution, they become aware of the curriculum they will follow through various explicit means such as the course syllabi, the classes they attend, the examinations they prepare for. The teachers, of course, should be well aware of the curriculum they are expected to teach through the course documentation and through faculty meetings and discussions. In some cases the curriculum is developed by the institution itself; in others it is mandated by external authorities, or even is taught as part of a national curriculum. In addition to the documented curriculum, students and teachers both become aware of the ‘educational environment’ or ‘climate’ of the institution. Is the teaching and learning environment very competitive? Is it authoritarian? Is the atmosphere in classes and field placements relaxed or is it in various ways stressful, perhaps even intimidating? These are all key questions in determining the nature of the learning experience. What some researchers refer to as the ‘press’ in the academic and social environment of the institution can vary from course to course within the curriculum, even from class to class. These expectations can be perceived as either formal or informal components of the educational experience—and they can vary from individual to individual. They can be motivating—or demotivating. Individual students may respond differently to these subtle elements in their learning experience. If we can identify the elements operating in the educational environment or climate of a given institution or course, and evaluate how they are perceived by students and teachers, we have the basis for modifying them to enhance the learning experience in relation to our teaching goals. Several research groups over the years have attempted to identify and quantify the presence and impact of rather intangible aspects of a learning environment: the climate, or atmosphere, or ethos, tone or ambience, the culture or personality of the institution. Just as there is a ‘sick building syndrome’ there could be a ‘sick learning environment’. Jack Genn surveys these and many other important aspects in his paper in this issue. Perhaps one reason why the study of learning environments in health professions such as medicine has been of increasing interest in recent years is the growing diversity of the student population. We can no longer assume that we are teaching young people just out of secondary education. The move to mature entry in several countries may mean that we have to teach differently. Kick et al. (2000) have begun to study the perceived learning environment needs of mature students at the University of Colorado Health Sciences Center. There may also be gender differences in preferred learning environments that will become increasingly apparent now that many institutions have a more equitable gender balance in their student populations. Carol Gilligan and Susan Pollak (1988) commented more than a decade ago that “The increasing number of women entering the medical profession prompts a rethinking of medical education. Like the canaries taken into mines to reveal the presence of unseen dangers, women medical students in their heightened sensitivity to detachment and isolation often reveal the places in medical training and practice where human connection has become dangerously thin”. Perhaps the study of learning environments can help us to begin to explore those places. And although we have seen many studies of the learning needs of socially disadvantaged minorities who seek access to medical schools and other health professions institutions, we have not yet really looked at their needs from the educational environment once they succeed in getting admitted. Another variable that is apparent from the work that has been done recently, e.g. Pololi and Price’s (2000) development of an instrument to measure the learning environment as perceived by undergraduates in an American medical school and similar work done by the present writers with the help of postgraduate research students (Roff et al., 1997) is the level or stage that the learner is at in the curriculum. Firstand second-year students have different perceptions of the desirable learning environment than do those in the clinical years. Undergraduate students’ perceived needs are different from those who are newly graduated and in their first year of practice. Even within the first 2 or 3 years of postgraduate training, we begin to see that the mature learner wants progressively different types of teaching and learning—and environments. Data that we have begun to collect from Scottish postgraduates suggest that the new practitioner wants progressive degrees of autonomy in his or her learning environment, but at the same time wants to be able to reach out to more competent and experienced supervisors when he/she needs to. We have also looked at the question of whether it is possible to develop a universal ‘culture free’ inventory to measure the quality of the educational environment for the health professions. Our Dundee Ready Education Environment Measure (DREEM) (Roff et al., 1997) is being used in a dozen countries in medical schools, nursing colleges

Teaching the consultant teachers: identifying the core content.

To determine the key themes for teaching hospital consultants how to teach.

Comparing the educational environment (as measured by DREEM) at two different stages of curriculum reform

Background: The medical programme at Lund University, Sweden, has undergone curricular reform over several stages, which is still ongoing. Students have been somewhat negative in their evaluations of the education during this time. Aim: To find out how the students perceived the educational climate using the Dundee Ready Education Environment Measure (DREEM), and to compare the findings taken at two given points in time. Method: The DREEM instrument was distributed in semesters 2, 6 and 10 in 2003 and 2005, to a total of 503 students. Results: The students rated their climate as positive. The total DREEM score (145) was somewhat higher than other published results and in the same range as for other reformed curricula. There was hardly any difference between the genders in their perceptions of the climate. Certain items were rated low and became subject of development between the measurements. These items concerned a perceived lack of a support system for stressed students and a lack of feedback and constructive criticism from teachers. Some improvement was detected in 2005. Conclusion: The educational climate was high in a reformed curriculum and could be maintained high during on-going curricular reform. Educational development resulted in better results on some items.

Cultural similarities and differences in medical professionalism: a multi-region study

Medical Education 2012: 46: 257–266

The implementation and evaluation of a mandatory multi-professional obstetric skills training program

Objective. To implement and evaluate a simulation‐based training program. Design. Descriptive. Study period: June 2003–June 2006. Setting. Obstetric Department, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Population. Two training sessions were provided for all health professionals including doctors, midwives, auxiliary nurses, and 147 out 156 participants (94%) took part in the first training session and 192 out possible 201 (96%) took part in the second session. Methods. An intervention study of the impact of simulation‐based training in management of postpartum bleeding, shoulder dystocia, basic neonatal resuscitation, and severe preeclampsia. Main outcome measures. Before, just after and 9–15 months following the training, data were collected on the confidence and stress levels relating to the carrying out of certain procedures. In addition, a written objective test on basic neonatal resuscitation was administered. Data on any changes in work‐routines experienced by the participants were obtained by open‐ended questions. Registry data from the Danish Medical Birth Registry and from the hospital administration were included in the analysis. Results. Ninety‐two percent of all respondents had a positive attitude toward the training program. They considered management of shoulder dystocia, preeclampsia, and neonatal resuscitation less stresful and less unpleasant to perform after training. Confidence scores for all the trained skills improved significantly. A significant association was found between confidence in neonatal resuscitation and numbers of correct answers in the objective test. More than 90% found the training to have had a positive influence on their work. The need for organizational changes in the department became evident and necessary changes were implemented. Sick leave amongst midwives diminished significantly during the study period. Conclusions. A comprehensive evaluation of a mandatory simulation‐based program, implemented in a obstetric department, demonstrated a positive impact at individual and organizational levels.

The long case and its modifications: a literature review.

Context  This review provides a summary of the published literature on the suitability of the long case and its modifications for high‐stakes assessment.

Students' perception of the learning environment in a distributed medical programme

Abstract Background : The learning environment of a medical school has a significant impact on students’ achievements and learning outcomes. The importance of equitable learning environments across programme sites is implicit in distributed undergraduate medical programmes being developed and implemented. Purpose : To study the learning environment and its equity across two classes and three geographically separate sites of a distributed medical programme at the University of British Columbia Medical School that commenced in 2004. Method : The validated Dundee Ready Educational Environment Survey was sent to all students in their 2nd and 3rd year (classes graduating in 2009 and 2008) of the programme. The domains of the learning environment surveyed were: students’ perceptions of learning, students’ perceptions of teachers, students’ academic self-perceptions, students’ perceptions of the atmosphere, and students’ social self-perceptions. Mean scores, frequency distribution of responses, and inter- and intrasite differences were calculated. Results : The perception of the global learning environment at all sites was more positive than negative. It was characterised by a strongly positive perception of teachers. The work load and emphasis on factual learning were perceived negatively. Intersite differences within domains of the learning environment were more evident in the pioneer class (2008) of the programme. Intersite differences consistent across classes were largely related to on-site support for students. Conclusions : Shared strengths and weaknesses in the learning environment at UBC sites were evident in areas that were managed by the parent institution, such as the attributes of shared faculty and curriculum. A greater divergence in the perception of the learning environment was found in domains dependent on local arrangements and social factors that are less amenable to central regulation. This study underlines the need for ongoing comparative evaluation of the learning environment at the distributed sites and interaction between leaders of these sites.

Preliminary benchmarking of appropriate sanctions for lapses in undergraduate professionalism in the health professions

Objective: To investigate the extent of consensus between faculty and students in order to benchmark appropriate sanctions for first-time offences with no mitigating factors in the area of Academic Probity by quota sampling in one cohort of medical, nursing and dental students in a Scottish university. Methods: This study reports administration of a web-based preliminary inventory derived from the international research literature to a target population of health professions staff and students. This study was conducted at Scottish University College of Medicine, Dentistry, Nursing and Midwifery. Subjects: 57 faculty and 689 students in the College in first quarter of 2009 participated in this study. Results: 50% of medical students, 26% of dental students, 22% of nursing students and 27% of midwifery students responded; 22% of faculty responded. Administration of a preliminary 41-item inventory to 57 faculty and 689 students from a Scottish College of Medicine, Dentistry, Nursing and Midwifery has allowed us to preliminarily rank the sanctions that are broadly agreed between the two cohorts as well as to identify a small cluster of behaviours which are viewed less severely by students than by faculty. Conclusions: These data will give guidance to undergraduate Fitness to Practice committees but also guidance to curriculum planners about the areas in which students may need more teaching. The results informed the reduction of the inventory and its refinement in to a 30-item e-learning tool that is being field tested for generalisability within and beyond the UK. The researchers have also been invited to adapt the proposed teaching and learning tools beyond the health professions.

Medical student rankings of proposed sanction for unprofessional behaviours relating to academic integrity: results from a Scottish medical school:

The General Medical Council emphasizes the cultivation of professional behaviours among medical students from early undergraduate years. Learning professional behaviours, however, is a progression and is constituted of several developmental stages. Behaving with academic integrity may be the first stage. In an educational setting, academic integrity is represented by a collection of diverse behaviours. Although there is consensus within the medical community that the absence of (or lapses in) academic integrity is unacceptable, the level of sanctions recommended for medical students is controversial. In the main, these punitive decisions over students are taken by teachers and clinicians. What sanctions would students suggest for a colleague who is academically unprofessional? This study reports the sanctions recommended by 375/700 (54%) of the students of one Scottish medical school in relation to lapses in academic integrity.

Student selected components: do students learn what teachers think they teach?

Background: It is well recognized that what teachers teach and what students learn may not be the same. This applies to all parts of the undergraduate medical curriculum, but may be especially relevant to student selected components, which vary substantially in their educational content. This has not been studied previously. Aims: To compare perceptions of students and supervisors in relation to learning outcomes addressed by student selected components, and thus to examine differences between what is taught and what is learned. Methods: Supervisors (n = 69) were asked to indicate which of twelve learning outcomes they felt were components of teaching and assessment. Upon completion of each SSC, students were required to complete the same outcomes template as part of their feedback (n = 644). Perceptions were compared in two ways: (1) a colour-coded ‘traffic-light’ system was used to record agreement/disagreement between students and supervisors of individual SSCs; (2) differences in perception of outcomes across the entire SSC programme were compared using the χ2 statistic. Results: (1) The ‘traffic-light’ system readily identified individual SSCs where significant disagreement existed and which were subject to further scrutiny. (2) More students than supervisors thought that outcome 2 (competent to perform practical procedures) was a component of teaching and assessment (41.8% v 27.5%, χ2 = 5.24, p = 0.02), whereas more supervisors than students thought that outcome 6 (competent in communication skills) (97.1% v 82.1%, χ2 = 6.91, p = 0.009) and outcome 7 (competent to retrieve and handle information) (100% v 93.7%, χ2 = 4.8, p = 0.02) were. Conclusions: Significant disagreement exists about the outcomes addressed by SSCs, suggesting that students do not always learn what teachers think they teach. The use of two complementary approaches allows global and individual comparisons to be drawn and thus provides a powerful tool to address this important issue.