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BACKGROUND: The COVID-19 pandemic necessarily changed pre-medical students' educational environment into an online format-and students' subjective happiness (SH) is highly impacted by their educational environment. This study investigates changes in pre-medical students' perceptions of their educational environment and their SH before and after the pandemic, as well as explores the predictors related to their SH. METHODS: The Korean version of the Dundee Ready Educational Environment Measure (DREEM) questionnaire and single-item measures of SH and professional identity (PI) were used. The t-test was employed to analyze the differences of the SH, PI, and DREEM subscales scores before and after the onset of COVID-19. Cohen's d was used as effect size and correlations between SH and different subscales of DREEM were analyzed using Pearson's correlation. The multiple regression analysis was performed to reveal associations between predictors and SH. RESULTS: A total of 399 pre-medical students completed the survey both before and after the COVID-19 pandemic. The DREEM scores and all subscales scores significantly increased but each presents a different effect size. Students' Perceptions of Learning (SPL: Cohen's d = 0.97), Students' Perceptions of Teaching (SPT: Cohen's d = 1.13), and Students' Perceptions of Atmosphere (SPA: Cohen's d = 0.89) have large effect sizes. Students' Academic Self-Perceptions (SASP: Cohen's d = 0.66) have a medium effect size and Students' Social Self-Perceptions (SSSP: Cohen's d = 0.40) have a small effect size. In contrast, no significant change was noted in the SH and PI. Both PI and SSSP impacted SH before COVID-19, but after the pandemic, SH was impacted by SPL, SPA, and SSSP. CONCLUSIONS: Students' overall perception of their educational environment was more positive after the onset of COVID-19, but their social self-perceptions improved the least. Additionally, SSSP is the only predictor of SH both before and after the pandemic. The findings of this study suggest that educational institutions must pay attention to students' social relationships when trying to improve their educational environment. Furthermore, so as to increase students' SH, development of both educational environment and PI is essential.

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BACKGROUND: The learning environment is a vital part of the undergraduate curriculum which enable to delivery of quality education in the stipulated time. Therefore, this study aimed to evaluate the learning environment among BSc. Nursing undergraduates in Sri Lankan state universities. METHODS: A descriptive cross-sectional study was conducted among 161 final year BSc. Nursing undergraduates in six state universities. Socio-demographic characteristics were collected using a self-administered questionnaire. The Dundee Ready Educational Environment Measure (DREEM) questionnaire was used to evaluate the learning environment in Perception of learning (SPL), Perceptions of teaching (SPT), Academic self-perceptions (SASP), Perceptions of the atmosphere (SPA), and Social self-perceptions (SSP). Based on the SPL, SPT, SASP, SPA, and SSP domains, the overall score of learning environment was ranged from 0 to 200 and then the overall score was classified into four categories such as poor (0-50), many problems (51-100), more positive than negative (101-150) and excellent (151-200). One-way Analysis of Variance (ANOVA) and t-test were used to determine the difference in the subscales and the overall scale. RESULTS: The mean age of the students was 24.9 ± 0.9 years. The overall score of the learning environment was 127.1 ± 14.3. Student's Perception of learning showed the highest mean score of 31.1 ± 3.9 while the social self-perception showed the lowest score (mean 16.4 ± 3.1). A significant group effect was observed in SPL and SPT subdomains among state universities while no significant group effect was observed in other subdomains. Furthermore, participating in extracurricular activities, travelling time to the faculty, and gender were observed as associated factors for the learning environment among BSc. Nursing undergraduates in state universities. CONCLUSIONS: Although the overall learning environment of BSc. Nursing undergraduates in state universities in Sri Lanka was within more positive than negative category, none of the university reaches to the excellent category. Therefore, each university should have improved their subdomains of learning environment to reach excellent category through addressing the gaps of curricular and extracurricular activities in the future.

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OBJECTIVE: To measure medical students' perceptions of their educational environment and to determine the potential differences in those perceptions with regard to gender and the year of study. METHODS: The cross-sectional study was conducted at the College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia, in 2018-19, and comprised medical students enrolled at the college. Data was collected using the Dundee Ready Educational Environment Measure scale. Data was analysed using SPSS 22. RESULTS: Of the 262 students approached, 191(73%) responded. The total mean score was 122.49±21.50. Perception of educational environment was higher for male students and advanced-level students (p<0.05). CONCLUSIONS: The findings illustrated a healthy educational environment.

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BACKGROUND: Happiness, a subjective judgment about one's quality of life, is influenced by environmental factors and should be considered as an important goal of medical education, which should support each learner's development as a person as well as a professional. However, although several studies have reported on the correlation between Dundee Ready Educational Environment Measure (DREEM) scores and students' academic achievement, few have investigated the relationship between DREEM scores and students' subjective happiness. This study examined different perceptions of the educational environment between phases of the curriculum and determined which DREEM subscales affect the overall level of happiness. METHODS: We used the Korean version of the DREEM questionnaire and a single item measure of happiness on a scale of 0 to 10. First we analyzed student perceptions of the educational environment according to their demographic characteristics using independent sample t-tests and one-way analysis of variance. A multiple regression analysis was performed to reveal which subscales affect the overall level of happiness while controlling for grade point average (GPA) and other demographic characteristics. RESULTS: The subjects were 239 medical school students across all stages of the curriculum. The students' overall perception was more positive for the educational environment during Phase 3 (clerkship) than Phase 1 (pre-medical). Among the DREEM subscales, this difference was especially prominent in Students' Perception of Learning and Students' Academic Self-Perceptions. In contrast, no difference in the subjective perception of happiness was found between phases. The effect of GPA on happiness became insignificant under the control of other variables, but the influence of the Students' Social Self-Perceptions (SSSP) subscale remained significant. CONCLUSIONS: The students' overall perception of the educational environment was more positive during the clerkship period than in the pre-medical period. Based on our finding that the SSSP correlates significantly with subjective happiness, we suggest that institutions promote not only students' academic development but also their happiness by fostering an appropriate educational environment.

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OBJECTIVE: The purpose of this study was to investigate students' perception of the educational climate in a medical school in Dammam, Kingdom of Saudi Arabia (KSA). The difference in the perception of preclinical year students and clinical year students was also evaluated. MATERIALS AND METHODS: This cross-sectional study was conducted among 2nd to 6th year students at the medical college of Imam Abdulrahman Bin Faisal University. "Dundee Ready Educational Environment Measure" (DREEM) was used to evaluate the educational environment. RESULTS: Out of 518, 238 students participated in the study; participation rate of 45.9%. The average DREEM score was 112.38 with a SD of 22.4. Students' perception of atmosphere got the highest score (27.1 ± 6.7) of the five DREEM subscales. The 3rd year had the highest DREEM score compared to students of other levels, while the DREEM score of preclinical students was significantly higher than that of the clinical year students. CONCLUSION: Perception of medical students about the educational climate was more positive than negative. Although the DREEM score and its subdomains showed a positive educational environment, students still mentioned some problematic areas that need to be addressed. Findings of this study could encourage other medical colleges in the KSA to focus on weak areas and address the issues raised by students, especially clinical year students.

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BACKGROUND: Questionnaires and surveys are used throughout medical education. Nevertheless, measuring psychological attributes such as perceptions of a phenomenon among individuals may be difficult. The aim of this paper is to introduce the basic principles of Mokken scale analysis (MSA) as a method for the analysis of questionnaire data and to empirically apply MSA to a real-data example. METHODS: MSA provides a set of statistical tools for exploring the relationship between items and latent traits. MSA is a scaling method of item selection algorithms used to partition an array of items into scales. It employs various methods to probe the assumptions of two nonparametric item response theory models: the monotone homogeneity model and the double monotonicity model. The background and theoretical framework underlying MSA are outlined in the paper. MSA for polytomous items was applied to a real-life data example of 222 undergraduate students who had completed a 50-item self-administered inventory measuring the educational environment, the Dundee Ready Educational Measure (DREEM). RESULTS: A pragmatic and parsimonious approach to exploring questionnaires and surveys from an item response theory (IRT) perspective is outlined. The use of MSA to explore the psychometric properties of the Swedish version of the DREEM failed to yield strong support for the scalability and dimensional structure of the instrument. CONCLUSIONS: MSA, a class of simple nonparametric IRT models - for which estimates can be easily obtained and whose fit to data is relatively easily investigated - was introduced, presented, and tested. Our real-data example suggests that the psychometric properties of DREEM are not adequately supported. Thus, the empirical application depicted a potential and feasible approach whereby MSA could be used as a valuable method for exploring the behavior of scaled items in response to varying levels of a latent trait in medical education research.

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OBJECTIVES: The study aimed to examine the quality of the educational environment in the Faculty of Medicine, University of Tabuk, Saudi Arabia, and to compare between male and female students using the Dundee Ready Educational Environment Measure (DREEM). METHODS: We utilized a cross-sectional survey design.  Participants were 221 medical students (96 males and 125 females) from all classes (1st to 6th year). Each participant responded to a translated version of the DREEM questionnaire that measures five domains: students' perception of learning (SPL), students' perception of teachers (SPT), students' academic self-perception (SASP), students' perception of atmosphere (SPA), and students' social self-perception (SSSP). Numerical differences between male and female students were analyzed using the Student's t-test. RESULTS: The global average score of female students was significantly higher (105.0±22.9, 53% of maximum score) than male students (98.3±24.3, 49% of maximum score; t(219)= -2.119, p= 0.035). The major gender difference was found in the SPT domain, with a higher score in the females (60%) compared to the male (50%) cohort (t (219)= -5.519, p = 0.000). Differences in the other domains were statistically insignificant. Out of the 50 DREEM items, the items that need attention were 32 and 23 on the male and the female sides respectively. CONCLUSIONS: The perception of the educational environment by the female students is significantly better than male students. The study provides valuable information about many educational problems that need attention. DREEM-based surveys are highly recommended for periodic monitoring of the educational environment.

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BACKGROUND: Tertiary pediatric hospitals usually provide excellent clinical services, but such centers have a lot to do for educational perfection. OBJECTIVES: This study was performed to address under-graduate educational deficits and find feasible solutions. PATIENTS AND METHODS: This cross-sectional study was done in a target population of 77 sixth year undergraduate medical students (response rate = 78%) who spent their 3-month pediatric rotation in the Children's Medical Center, the Pediatrics Center of Excellence in Tehran, Iran. The Dundee ready educational environment measure (DREEM) instrument was used for assessing educational environment of this subspecialized pediatric hospital. RESULTS: Among 60 students who answered the questionnaires, 24 were male (40%). Participants' age ranged from 23 to 24 years. The mean total score was 95.8 (48%). Comparison of scores based on students' knowledge showed no significant difference. Problematic areas were learning, academic self-perception, and social self-perception. CONCLUSIONS: Having an accurate schedule to train general practitioner, using new teaching methods, and providing a non-stressful atmosphere were suggested solutions.

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OBJECTIVES: To examine the 'Expected' and 'Actual' educational environment experienced by a cohort of Bachelor of Dental Surgery (BDS) students at the University of Otago's Faculty of Dentistry using the Dundee Ready Educational Environment Measure (DREEM). METHODS: Cohort members were asked to complete five DREEM surveys over the four-year BDS programme. Student expectations at the beginning of their first year were assessed using a modified version of the DREEM questionnaire, while following (standard) DREEM questionnaires at the end of each professional year addressed students' 'Actual' perception of the educational environment. RESULTS: Sixty-six students (99%) completed at least one questionnaire. Overall, the BDS students' perceptions of their educational environment tended to be positive and students identified both perceived strengths and weaknesses in the BDS programme. However, more negative than positive shifts were reported between the 'Expected' and 'Actual' individual DREEM individual items, suggesting that BDS students initially expected more from their educational environment than they actually experienced. Individual DREEM outcomes undergoing negative and positive shifts differed over the years and varied in number. These may be explained, in part, by changes in the curriculum focus from year to year. CONCLUSION: The students' changing DREEM responses over time revealed anticipated and perceived strengths and weaknesses of the BDS curriculum, as well as shifts in students' perceptions in response to curricular changes. However, our findings highlight the potential usefulness for dental education of a measure for use that takes the unique aspects of the dental education environment into account.

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BACKGROUND: Students' perception of the environment within which they study has shown to have a significant impact on their behavior, academic progress and sense of well-being. This study was undertaken to evaluate the students' perception of their learning environment in an Indian medical school following traditional curricula and to study differences, if any, between the students according to the stages of medical education, i.e., the pre-clinical and clinical stages. METHODOLOGY: In the present study, the Dundee Ready Education Environment Measure (DREEM) inventory was administered to undergraduate medical students of first (n = 227), third (n = 175), fifth (n = 171) and seventh (n = 123) semesters. Scores obtained were expressed as mean ± Standard Deviation (SD) and analyzed using one-way ANOVA and Dunnett's test. P-value < 0.05 was considered as significant. RESULTS: The mean DREEM score for our medical school was 123/200.The first-year students were found to be more satisfied with learning environment (indicated by their higher DREEM score) compared to other semester students. Progressive decline in scores with each successive semester was observed. Evaluating the sub-domains of perception, the registrars in all semesters had a more positive perception of learning (Average mean score: 29.44), their perception of course organizers moved in the right direction (Average mean score: 26.86), their academic self-perception was more on the positive side (Average mean score: 20.14), they had a more positive perception of atmosphere (Average mean score: 29.07) and their social self-perception could be graded as not too bad (Average mean score: 17.02). CONCLUSION: The present study revealed that all the groups of students perceived their learning environment positively. However, a few problematic areas of learning environment were perceived such as: students were stressed more often; they felt that the course organizers were authoritarian and emphasized factual learning. Implementing more problem-based learning, student counseling and workshops on teaching-learning for educators might enable us to remedy and enrich our learning environment.

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BACKGROUND: Students' perceptions of their educational environment have been found to be related to their approaches to learning and learning outcomes. Educational environment is just beginning to be researched in nursing education with the vast majority of studies focusing on the clinical educational environment. Perception of educational environment has been shown to influence student implementation of a specific learning style and influences educational outcomes such as program completion and GPA. There is a need for sound research that explores the relationship, if any, between perceptions of environment and outcomes. OBJECTIVE: To explore the relationship between baccalaureate nursing student (BSN) perception of educational environment (SPEE) and objective learning outcomes. DESIGN: Retrospective correlational descriptive study. SETTING: Private School of Nursing in the Southwest. PARTICIPANTS: Convenience sample of 62 graduating baccalaureate students. METHODS: All graduating BSN students were invited to complete the Dundee Ready Education Environment Measure (DREEM) through the online survey application Qualtrics. A total of 62 students completed the DREEM survey. These results were compared with each student's GPA and HESI score. RESULTS: A total of 62 students completed the survey for an overall response rate of 57%. There was no correlation between total SPEE and nursing grade point average (NGPA) or HESI exit scores. CONCLUSIONS: Based on this study at this institution, it appears that students' performance was not influenced by SPEE. One of the major implications of this study is the possibility that an "acceptable" SPEE (one that is neither exceptional nor terrible) may not significantly influence student outcomes. Exploring this relationship has theoretical as well as practical implications as educators seek to determine the effectiveness of educational interventions. Student perception of learning environment is measured in various ways at the majority of institutions. It has been assumed that an educational environment that is ranked high by students result in increased learning. However, as the science of nursing education advances, educators need to determine if and how these perceptions relate to actual learning outcomes. As academicians, we need to be concerned with the relationship between learning outcomes and environment in order to create the most effective learning environment.

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PURPOSE: The objective of this study was to assess student perceptions of the environment in this medical college using the Dundee Ready Educational Environment Measure (DREEM). METHODS: Cross-sectional study; 348 medical student volunteers (68.1%) of all semesters participated (511 enrolled). DREEM has 50 items, each rated from 0-4 (Likert scale: 0, strongly disagree to 4, strongly agree), that measure five domains: students' perceptions of learning; perceptions of teachers; academic self-perception; perceptions of the atmosphere; and social self-perception. Mean item scores, domain scores, and global scores were computed. RESULTS: The three highest rated items were knowledgeable teachers, having good friends, and confidence about passing; the three most problematic items were a poor support system for stressed students, inability to memorize everything, and over-emphasis on factual learning. The percentage score for perception of learning (47.26± 14.85) was significantly lower than that for teachers (52.28± 9.91; P< 0.001); academic self-perception (52.14 ± 15.21; P < 0.001); perception of the atmosphere (51.21 ± 13.60; P = 0.001); and social self-perception (50.63± 13.90; P= 0.010). The global scores were lowest for eighth-semester students (89.8± 21.24) when compared to second (101.33± 21.05; P= 0.003), fourth (107.69± 18.96; P< 0.001), and sixth (100.07± 20.61; P= 0.020). CONCLUSION: Improvement is required across all domains of the educational environment at this institution. Students, particularly of the eighth semester, perceived the teaching negatively. The lowest scores were given to the support system, burdensome course content, and factual learning; thus, a hybrid curriculum that includes problem-based learning might provide students with stimulating learning; structured clinical teaching with specific curricular objectives, as well as mentoring of senior students by faculty and near-peers, might improve the learning environment for senior students.

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BACKGROUND: Students' perceptions of their academic learning environment have been found to be related to their approaches to learning and learning outcomes. Educational environment is just beginning to be researched in nursing education with the vast majority of studies focusing on the clinical educational environment. Accelerated Bachelor of Science in Nursing (ABSN) programs for students who have obtained a bachelor degree are a popular nursing pedagogue. These programs are instituted on the belief that degreed students have the ability to be successful in a demanding program, are older, are adult learners and tend to be more motivated than their traditional counterparts. There is a paucity of research exploring the differences in student perceptions of the educational environment between the traditional and accelerated programs. OBJECTIVE: Explore students' perceptions of the educational environment in the traditional and ABSN programs within an institution and determine any differences. DESIGN: Comparative descriptive study. SETTING: Private school of Nursing in the Southwest. PARTICIPANTS: Convenience sample of 24 ABSN and 38 traditional graduating senior students. METHODS: Invited students completed the Dundee Ready Education Environment Measure through the online survey application Qualtrics. An independent t-test was used to compare the scores. RESULTS: A total of 62 students completed the survey for an overall response rate of 57%. No statistical difference was found in students' perceptions of academic environment between the two groups on the total score. However, there was a statistically significant difference on the sub-domain pertaining to atmosphere and there were significant differences on 6 out of 50 individual items. CONCLUSIONS: The results of this study indicate that, taken in its entirety, there was no significant difference in student perception of educational environment between the traditional and accelerated cohorts at this institution as measured by the DREEM tool. However, there was a significant difference between the two cohorts within the student perception of Atmosphere sub-domain and on seven individual items. The DREEM tool was found to be a reliable instrument to determine students' perceptions of educational environment.

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PURPOSE: The objective of this study was to assess student perceptions of the environment in this medical college using the Dundee Ready Educational Environment Measure (DREEM). METHODS: Cross-sectional study; 348 medical student volunteers (68.1%) of all semesters participated (511 enrolled). DREEM has 50 items, each rated from 0-4 (Likert scale: 0, strongly disagree to 4, strongly agree), that measure five domains: students' perceptions of learning; perceptions of teachers; academic self-perception; perceptions of the atmosphere; and social self-perception. Mean item scores, domain scores, and global scores were computed. RESULTS: The three highest rated items were knowledgeable teachers, having good friends, and confidence about passing; the three most problematic items were a poor support system for stressed students, inability to memorize everything, and over-emphasis on factual learning. The percentage score for perception of learning (47.26+/-14.85) was significantly lower than that for teachers (52.28+/-9.91; P<0.001); academic self-perception (52.14+/-15.21; P<0.001); perception of the atmosphere (51.21+/-13.60; P=0.001); and social self-perception (50.63+/-13.90; P=0.010). The global scores were lowest for eighth-semester students (89.8+/-21.24) when compared to second (101.33+/-21.05; P=0.003), fourth (107.69+/-18.96; P<0.001), and sixth (100.07+/-20.61; P=0.020). CONCLUSION: Improvement is required across all domains of the educational environment at this institution. Students, particularly of the eighth semester, perceived the teaching negatively. The lowest scores were given to the support system, burdensome course content, and factual learning; thus, a hybrid curriculum that includes problem-based learning might provide students with stimulating learning; structured clinical teaching with specific curricular objectives, as well as mentoring of senior students by faculty and near-peers, might improve the learning environment for senior students.

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