Student Perception of Educational Environment at a

Private Medical School of Pakistan

HEAD OF DEPARTMENT
PROF. DR. RABIA ARSHAD USMANI

MBBS, DMCH, DGO, FCPS

Supervised By:
Dr. Maria Naeem

DEPARTMENT OF COMMUNITY MEDICINE

INDEPENDENT MEDICAL COLLEGE FAISALABAD
Session:
2019-2024
SUBMITTED BY:
Tajammal Ali
College Roll # 94

4TH YEAR MBBS

1
2
 SUPERVISED BY:
DR. Maria Naeem
BATCH C2

SR NO NAME Roll No University Roll No

1. Nisha Farooq 77
2. Qurat Ul Ayan Ijaz 78
3. Rabbania Razeen 79
4. Rabeel Ibrar 80
5. Rabia Ayub 81
6. Rana Muti Ur Rehman 82
7. Roha Areej 83
8. Saira Muzammil 84
9. Sana Shameem 87
10. Shanzay Ayesha 88
11. Shifa Qadeer 90
12. Smama Safdar 91
13. Syed Ali Zaman 92
14. Tajammal Ali 94

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 Table of Contents
ACKNOWLEDGMENTS..............................................................................................................6
Abstract..................................................................................................................................7
Chapter 1.................................................................................................................................9
Introduction............................................................................................................................9
1.1 Background of the Study;...................................................................................................10
1.2 Importance of understanding student perceptions;.....................................................11
1.3 Factors Affecting Student Perception of Educational Environment in Independent
University Hospital..................................................................................................................12
1.4 Importance of the Study:...................................................................................................14
1.5 Synopsis of the Learning Environment at Medical colleges:..............................................15
1.6 Research Objectives:..........................................................................................................16
1.7 Research Questions:......................................................................................................16
Chapter 2...............................................................................................................................18
Literature Review..................................................................................................................18
2.1 Previous studies on student perceptions in medical education....................................18
2.2 Factors Affecting Student Perception of Educational Environment at Medical Colleges...24
2.3 Relationship of the Educational Environment between Learning Outcomes and Student
Well-being................................................................................................................................27
2.4 Efforts and Methods to Enhance Students' Perceptions of the Educational Environment at
Medical Institutions................................................................................................................. 31
Chapter 3...............................................................................................................................34
METHODOLGY.......................................................................................................................34
3.1 Research Type:...................................................................................................................34
3.2 Research Design:................................................................................................................34
3.3 Study population:...............................................................................................................34
3.4 Inclusion criteria:............................................................................................................... 34
3.5 Exclusion criteria:...............................................................................................................34
3.6 Sample size:....................................................................................................................... 34

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 3.7 Sampling techniques:.........................................................................................................35
3.8 Data collection methods and tool:.....................................................................................35
3.9 Data analysis methods/ statistical analysis:.......................................................................35
3.10 Descriptive Analysis:........................................................................................................ 35
3.11 Study duration................................................................................................................. 35
3.12 Resources:........................................................................................................................35
3.13 Limitations:...................................................................................................................... 35
3.14 Ethical Considerations:.....................................................................................................35
CHAPTER 4.............................................................................................................................37
RESULTS AND DISCUSSION....................................................................................................37
4.1 Socio-Demographic Data................................................................................................... 37
4.2 Activities Related Questions.............................................................................................. 47
4.3 Discussion.......................................................................................................................... 53
Chapter 5...............................................................................................................................56
CONCLUSION.........................................................................................................................56
References.............................................................................................................................57

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 ACKNOWLEDGMENTS
First and foremost, I want to give Allah, the Almighty, all the praise and gratitude in the world
for the blessings He showered on me throughout my research work. May the Peace and
Blessings of the Highest be upon our Beloved and Last Prophet, Hazrat Muhammad (SAWW),
Who has been Sent as a Mercy for all World.

I want to thank my renowned Patron, Dr. Rabia Arshad Usmani, for all the advice, help, and
education he gave me during my studies. I would like to express my gratitude to the Faculty of
Community Department at Independent University Hospital for giving me the means to pursue
graduate studies in the Community Medicine department. My supervisor, Dr. Maria, has been a
mentor and adviser I could not have asked for more.

For everyone, the rewarding and treasured interactions we've shared as friends, lab mates,
employees, and members of our research team have profound significance. These shared
memories have enhanced our work path while also forging deep friendships and a sense of
solidarity among us. It is crucial for me to offer my sincere appreciation to each and every one
of you for your invaluable psychological and emotional support as I look back on my research
journey. Your support has been crucial in guiding me through the highs and lows of my
academic endeavor because research can be a challenging activity due to its rigorous
expectations and difficulties.

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 Abstract
Background
This study was primarily centered on a comprehensive examination of the perceptions held by
two distinct groups of students: those in their first year and those in the clinical phase of their
education at Independent University Hospital (IUH). The central objective was to scrutinize and
draw comparisons between these two groups concerning their views on the learning
environment within the institution. Furthermore, an additional layer of analysis was integrated
into the research design, focusing on gender-based differences in the students' perceptions of
the learning environment. This element of the study aimed to discern whether gender played a
role in shaping how students perceived their educational surroundings at IUH. The overarching
purpose of this research endeavor was to provide a deeper understanding of the critical role
that the learning environment plays within the context of a medical school.

Objective
This study is undertaken with the primary aim of conducting a thorough evaluation of the
educational environment (EE) experienced by both medical students and interns, employing the
Dundee Ready Education Environment Measure (DREEM) as the principal assessment tool.
Firstly, it seeks to discern and illuminate the strengths inherent in the current educational
environment. Through a systematic examination, the study endeavors to identify and
emphasize the positive attributes that contribute significantly to the learning experiences of
medical students and interns. Secondly, this research aims to identify and elucidate the
problems and challenges that exist within the educational environment. By closely examining
the educational landscape, it seeks to pinpoint any factors, elements, or issues that may pose
obstacles or hinder the learning process for students and interns

Methods
Medical interns and students were included in this cross-sectional study. The DREEM
questionnaire was used to assess the EE's five domains. These areas cover how students view
themselves as learners, teachers, environment, and societal self-perceptions. The input was
given by respondents on a 5-point Likert scale.

Results
The mean global DREEM score amounted to 124 out of 200. Key findings indicated
predominantly positive perceptions among students, particularly in the domains of academic
self-perception (22.76/32), atmosphere (27.52/48), and learning (31.23/48). Social self-
perception (17.53/28) was reasonably favorable, while perceptions of teachers (25.54/44)

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demonstrated positive movement. Notably, fifth-semester students exhibited a more positive
perception of the EE compared to their peers in other semesters.

Conclusion
The overall good view of the EE among all participating students is highlighted by this study, in
my opinion. Knowledgeable instructors, solid peer connections, and students' confidence in
passing exams are all positive qualities. The study did, however, point out some issues that
require attention, such as worries about authoritarian teaching styles, an overemphasis on
memorization, excessively teacher-centered teaching methods, instances of teacher frustration,
and the need for a support system to help anxious students.

Keywords:
Teachers, Learning, Atmosphere, Academic, Social self-perception

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Chapter 1

Introduction
Everything that occurs in the classroom, departments, faculty, and institution on a physical and
psychological level constitutes the educational environment. Any institute's ability to succeed or
fail depends critically on its educational environment. [1] Students experience a change in
environment the moment they walk through the doors of the medical institute. While a bad
atmosphere might hamper their success, a good one promotes success, enjoyment, and
involvement in learning.

In our country, the old model is still used for the MBBS undergraduate program. It often
focuses on the instructor, is discipline-based, information-gathering, and hospital-based, and
lacks any alternatives or optional courses. The majority of the curriculum is made up of lecture,
tutorial, practical, and ward teaching classes with a few problem-based sessions sprinkled in.
Replicate the subject matter in the final exam as the learning task.

Apart from other university-related factors, students' expectations have a significant

impact on how they perceive the educational environment. These factors include the varied
cultural backgrounds of the students, the educational resources that are accessible to them, the
caliber of the faculty, the curriculum, and the students themselves. Understanding the
educational environment and implementing appropriate modifications and remedies when
necessary are key components of effective management of teaching and learning. The
relationship between the learning environment and students' achievement and satisfaction is
well-documented. [2]

The purpose of this study is to assess how medical students perceive their learning
environment and to look for gender and college-related disparities. Examining the DREEM
questionnaire's internal consistency among Pakistani medical students was a secondary goal.
This research aids in locating issue areas that require correction. Additionally, it enables
institutions to compare their results and accomplishments with those of their competitors, which
may be instructive for teaching.

A modular curriculum that integrates the basic and clinical sciences in two spirals
vertically and horizontally is being developed by the university. Studying students' perceptions
of the educational environment is important since curricula are changing, and various institutions
have diverse student demographics.

Since the learning environment has a significant impact on students' progress,

contentment, and accomplishments, it is crucial to get student feedback on their experiences

9
there. [3] Therefore, the goal of this study was to evaluate students' opinions of the Independent
University Hospital learning environment and see how it connects to their academic
performance. The literature demonstrates a link between the educational environment and the
beneficial results of students' accomplishment, contentment, and success, making this
relationship between education and student achievement a fruitful subject for research. [4]

1.1 Background of the Study;

The term "educational environment" (EE) refers to a broad category of environments,
situations, and cultural settings in which students engage in learning activities. Medical
educators, worldwide, are working to understand the elements of EE and how they interact in
order to change EEs for increased productivity. [5]

The study of medicine often takes several years of undergraduate and graduate studies
and is hard and demanding. It combines classroom instruction with clinical rotations and hands-
on training. Due to the rigorous curriculum, long hours, high levels of stress, and the moral
obligations related to patient care, the student experience in medical institutions is distinctive.

The Independent University Hospital considers the educational environment (EE) to be a

key indicator for the evaluation and improvement of medical education programs because it
influences students' knowledge, motivation to learn, personal safety, and well-being. [6] The
recommended EE tools, such as the CUES (College and University Environment Scales), CLES
(Classroom Environment Scales), and CUCEI (College and University Environment Inventory),
have been used for decades to assess learning environments. Because of disparities in objectives
and operating systems, they haven't been used to medical education. But the DREEM scale was
created, and it has been widely applied in a variety of academic formal contexts for medical
education ever since. [7]

This research was carried out in the Pakistan University, Independent University
Hospital. It is a recognized community-oriented/community-based school that emphasizes
problem-based learning and strives to achieve synergy within the fundamental sciences as well
as between the fundamental and clinical sciences. Three educational phases make up the faculty's
five-year, ten-semester MBBS program. It is now widely acknowledged as a crucial metric for
the advancement of medical education in Pakistan and the surrounding area.

In much research, a variety of criteria were evaluated in connection to the educational

environment, including students' academic standing, accomplishments, gender, quality of life,
resilience, and positive attitudes toward courses. The link between medical students' perceptions
of the educational environment and the function of peer mentorship, however, has not yet been
studied. Furthermore, practically speaking, involvement in peer mentorship programs appears to
have a significant impact on the impression and happiness of students. [8]

It is essential to employ a comprehensive, accurate, and valid technique while assessing

the learning environment in a health professions institute. The Dundee Ready Education
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Environment Measure (DREEM), [9] which was created by an international Delphi panel in
Dundee, Scotland, is probably the one that is now utilized the most. It has been translated into a
number of languages, including Arabic, and is an international, approved instrument that offers
medical faculties diagnostic support for assessing the general state of affairs in the learning
atmosphere of their institution.

With this context, we set out to investigate two study questions: (A) Do students who
have peer mentors and those who don't see EE differently? & (b) Are there differences in these
two groups' EE subscales or items? The purpose of this study is to examine how mentees and
non-mentees view the educational environment (EE) and to learn how students view it.

1.2 Importance of understanding student perceptions;

It is important to comprehend how students feel about medical schools for a number of
reasons, including the potential influence it may have on the standard of medical instruction and,
ultimately, patient care. The following are some major justifications for why medical colleges
should be concerned about students' perceptions:

1. Quality Improvement;

Learning results at universities were more strongly predicted by students'

assessments of their present learning environment than by their past academic performance. [10].
Student feedback offers insightful information about the medical education program's strengths
and weaknesses, which is helpful for quality improvement. As a result of this input, curriculum,
instructional strategies, and resource improvements may be made where there are gaps.

2. Improvements to the learning environment

Medical colleges may improve the supporting and favorable learning environment
by comprehending student perspectives. A more favorable educational experience can result
from addressing problems including poor communication, poor faculty-student relationships, and
workload.

3. Subject Matter Relevance:

The applicability of the curriculum to actual medical practice is frequently seen

from the perspective of the students. Their suggestions can assist medical institutions in
modifying and modernizing the curriculum so that it adequately educates students for the future
of medicine and satisfies current healthcare demands. We offer a conceptual model based on an
empirical study of the Blackboard for analyzing user happiness, behavioral intention, and the
efficiency of e-learning. The conceptual model also demonstrates how contextual factors will
influence perceived satisfaction, perceived usefulness, and the efficacy of online learning. [11]

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 4. Teaching and Learning:

The exploratory study focuses on teachers' perspectives, which, according to our

research, are depictions of how they view their own professional identities. From this vantage
point, we believe that teachers' conceptions of their professional identities correspond to the
information they have of their identities on a personal level. [12] Students' feedback can be
utilized to pinpoint areas where professors might need further help or training. This may result in
instructors continuing their professional development, which would improve their mentorship
and instruction.

5. Difference and Inclusion:

Whites, Blacks, Hispanics, and Asian students from different institutions were
represented in the groups. The households of the students were middle class. When compared to
other students, gifted children had considerably better verbal efficacy, mathematical efficacy,
and strategy utilization. [13] In medical colleges, difficulties with inclusion, equity, and diversity
can be brought to light through student perspectives. By addressing these issues, we can build a
more welcoming and equitable learning environment and make sure that every student has an
equal chance to achieve.

The ability to create a productive learning environment, enhance the standard of medical
education, and eventually improve the quality of patient care depends on a knowledge of student
perspectives at medical institutions. It is a crucial part of continuous efforts to improve and
ensure the quality of medical education.

1.3 Factors Affecting Student Perception of Educational Environment in

Independent University Hospital
One of the most popular e-learning applications is Moodle. [14] Students of
diverse backgrounds pursue their academic goals in the educational environment; thus, it must
offer the right circumstances to have an impact on those ambitions. According to diverse
findings from prior study, the researcher focused on the internal and external education
environment variables as the primary components. While external variables are those that are
outside the institution yet may have an impact on students if improperly managed, internal
factors are those within the institution that directly affect students. [15]

1. Internal Factors:
The internal factors are significant elements of the organization that have a
propensity to affect students' academic achievement. These are:

 Academic Competence and Accessibility:

According to Considine & G.Zappalà, instructors' professionalism and
friendly demeanor are crucial in the process of influencing students' academic

12
 achievement. Since teachers are a source of information, students should be able
to approach them with any concerns or challenges they may be having in order to
get the right advice and answers
 Educational Resources:
a. The classroom:
Authorities are concerned about the physical conditions in the classroom,
including the amount of seating, lighting, temperature, ventilation, and other
amenities.
b. Library Facilities:
Students' usage of the library affects their academic performance, particularly
for those students who come from underprivileged, marginalized, and
socioeconomically disadvantaged backgrounds and who extensively rely on
library resources for their education. Consequently, a library with enough
equipment will enhance their education.
c. Laboratory Facilities:
Kids retain visual information better than auditory information. In other
words, it means that knowledge acquired via laboratory work is maintained in
people's thoughts for a very long period.
 Effective Teaching:
Teaching is the process of transferring pertinent information, developing
anticipated new confidence, and altering students' attitudes and behaviors. A
successful teacher is adept in using a variety of approaches and techniques that
are suitable for diverse student types in every educational setting. This has an
impact on the students' academic achievement. [16]
 Assessment:
Four variables are involved in the continuous assessment process: the
instructor, the student, the evaluator, and the circumstance, [17]. This assertion is
consistent with Pedder and James (2012), who contend that contact between
teachers and students is a crucial component of both instruction and evaluation.
Lecturers are unable to accurately and appropriately evaluate students' work
because of a poor comprehension of the evaluation requirements. [18]
2. External Factors:
If these external elements are ignored, they will negatively impact students'
academic achievement since they have a strong association with the educational
environment. They are:
 Motivation:
According to research, motivation helps students set clear goals, get appropriate
guidance, and work toward those goals. The learner is influenced because it
makes them want to work more since the more motivated someone is, the more
they will learn. Low academic accomplishment, a lack of passion, interest, and

13
 dedication to the learning process are all consequences of a lack of motivation, in
2010, M.J.
 Environment at Home:
A person's home has an effect on them since parents are a child's first socializers.
As a result, location and the type of home have a bigger impact on the student.
According to the reviewed studies, the effect of a student's family environment on
their academic achievement is generally understood. [19]
 The parent's role:
The parents are wise to assume responsibility for offering assistance since they
are fast in identifying their children's strengths and weaknesses. [20]. The
socioeconomic status of a parent, including their professional background, salary,
and line of work, is also related to their child's intellectual development.
Regarding evaluation and treatment efficacy, the consequences of absenteeism
from school as a multifaceted issue are highlighted. [21]

1.4 Importance of the Study:

Understanding the complexities of the educational system is extremely valuable for
parents, students, and educational authorities alike. Such knowledge may have a variety of
positive effects, from better decision-making to improved educational institutions.

A comprehensive grasp of the educational environment is a crucial tool for educational

authorities. It gives them the ability to undertake a thorough analysis of their institutions,
identifying both their advantages and their areas for development. This reflection is essential
for improving educational tactics, instructional techniques, and resource allocation, which will
ultimately result in greater standards of education.

Parents, who play a significant role in their children's academic journeys, stand to benefit
significantly from this knowledge. When choosing the best college or educational institution for
their children, they may make well-informed decisions since they are well-informed about the
educational environment. This makes sure that their children's academic and personal
requirements are successfully satisfied, laying the groundwork for a successful educational
experience.

The benefits provided to students themselves are as important. Students who have a thorough
awareness of the educational environment should feel confident that their academic endeavors
are taking place in a setting that is supportive of their personal progress. It gives students the
confidence that their investment in school will probably result in a safe and reliable
professional path once they graduate, establishing a feeling of purpose and stability in their
academic journey.

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In summary, the goal of this study project is to perform a thorough analysis of the numerous
factors that influence the educational environment from both internal and external viewpoints.
This thorough investigation aims to identify the elements that go towards a student's academic
achievement. We want to create a technical and data-driven basis for enhancing the
educational environment so that improved results for students, parents, and educational
institutions as a whole may be promoted by carefully examining these elements.

1.5 Synopsis of the Learning Environment at Medical colleges:

A vital part of expanding medical knowledge and preparing the following generation of
healthcare workers is the dynamic and diversified educational environment found at medical
research schools. An overview of the main components of the learning environment at medical
institutions for research is given below:

 Curriculum: Medical schools generally provide students with a well-organized

curriculum that combines didactic (classroom-based) and practical (clinical)
elements. There are several ways that research is incorporated into the
curriculum, including elective research opportunities, research-focused tracks or
programs, and research techniques courses. Early on in their education, students
are exposed to the ethics of research and the principles of evidence-based
medicine. The social work curriculum has not adequately addressed the subject
of redundancy. The Curriculum Policy Statement tackles vertical redundancy
across educational levels and program years as well as horizontal redundancy
between curriculum areas. [22]
 Research possibilities: Students in undergraduate, graduate, and postgraduate
studies at medical institutions have access to a variety of research possibilities.
Students can participate in epidemiology studies, fundamental scientific
research, translational research, and clinical research. Students can explore their
interests and hone their research abilities thanks to these chances.
 Collaboration and networking: Medical research frequently involves
collaboration with other research institutions, healthcare facilities, and industrial
partners. Opportunities for those interactions are frequently constrained in
environments for remote learning because of geographic distances. Modern
communication technology advancements have given us a number of tools to
reduce issues caused by such geographic distances, such that distance learners
now have a number of ways, both synchronous and asynchronous, to
communicate with their instructors and classmates.[23]
 Research Culture: Medical institutions are passionate advocates for a strong
research culture that strongly emphasizes the fundamental ideas of inquiry,
critical thinking, and evidence-based practice. A spirit of innovation and

15
 exploration flourishes within this dynamic culture, engaging and motivating
faculty members as well as students to actively engage in research initiatives as
an essential component of their academic careers. The quest for knowledge is
not only encouraged but also interwoven in the very fabric of these medical
institutions, which is at the core of their dedication to fostering such an
atmosphere. This dedication is best exemplified by the persistent
encouragement of inquiry, which enables people to inquire about, investigate,
and look for answers to some of the most urgent problems in the healthcare
industry.

1.6 Research Objectives:

1. The purpose of this study was to assess students' impressions of the educational
environment in the College of Medicine at Independent University Hospital during the
preclinical stage and to suggest corrective measures.
2. To learn more about how students feel about their teachers and staff at medical
institution, Independent University Hospital.
3. This research project's main objective is to evaluate and get a thorough grasp of how
study guides are viewed in terms of their usefulness and worth by undergraduate medical
students. The primary goal of this analysis is to elucidate the complex issues surrounding
the usefulness and import of study aids in the setting of medical education.

1.7 Research Questions:

The study utilized the DREEM (Dundee Ready Education Environment Measure)
questionnaire as a tool to gauge students' perceptions of the educational environment (EE). The
DREEM questionnaire consists of 50 items, each related to different aspects of the EE, with a
maximum achievable score of 200. It encompasses five distinct domains:

1. Students' Perceptions of Learning (SPL): This domain comprises 12 items and has a
maximum score of 48.
2. Students' Perceptions of Teachers (SPT): With 11 items, this domain has a maximum
score of 44.
3. Students' Academic Self-Perceptions (SASP): This domain consists of 8 items and
carries a maximum score of 32.
4. Students' Perceptions of Atmosphere (SPA): Comprising 12 items, this domain has a
maximum score of 48.
5. Students' Social Self-Perceptions (SSSP): This domain involves 7 items and has a
maximum score of 28.

Prior to participating in the study, students were provided with an explanation of its
purpose and were introduced to the DREEM questionnaire. A consent form was administered for
their agreement to participate. Students were instructed to carefully read each statement in the

16
questionnaire and express their agreement or disagreement using a 5-point Likert-type scale,
ranging from "strongly agree" (4) to "strongly disagree" (0). Incomplete questionnaires were
excluded from the study.

To ensure consistency in scoring, nine negative items (4, 8, 9, 17, 25, 35, 39, 48, and 50)
were reverse scored, where "strongly agree" was assigned a score of 0 and "strongly disagree"
received a score of 4.

 Overall scores falling between 0 and 50 were categorized as "very poor."

 Scores in the range of 51 to 100 indicated "plenty of problems."
 Scores between 101 and 150 were considered "more positive than negative."
 Scores ranging from 151 to 200 were deemed "excellent."

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Chapter 2

Literature Review
2.1 Previous studies on student perceptions in medical education
A study of students' perceptions of the educational environment of medical institutions
in Bangladesh was conducted by Nurun Nahar and her colleagues. The undergraduate MBBS
curriculum in our nation is still conventional, teacher-centered, and hospital-based. With a few
problem-based sessions, it mostly consists of lectures, tutorials, practical, and ward
instructions. The main goal is to replicate the material in final exams. A new curriculum with a
focus on educational innovation was adopted in 2002. However, putting it into practice proved
difficult for both students and teachers. Sadly, there hasn't been much research on how
students see the learning environment. Regular review and feedback are required to make
adjustments, fix errors, and sustain progress in order to manage changes efficiently. 1903
medical students from 15 medical schools in Bangladesh who were specifically chosen to
participate in this cross-sectional survey were in their third, fourth, and fifth year of MBBS. The
Dundee Ready Education Environment Measure (DREEM) inventory was used to assess several
aspects of the learning environment. Positive (110/200) was the overall mean score. A
favorable academic self-perception (19.5/32) and positive impressions of learning (28/48) and
teachers (24/44) were shared by students. However, they noticed a number of difficulties with
the environment that needed to be fixed (24/48), and social self-perceptions weren't good
(14/28). Male and female pupils perceived things differently. In order to increase the learning
environment, corrective efforts should concentrate on enhancing the ambiance and social self-
perceptions. The curriculum designers and college administrators may use these findings as a
roadmap to further enhance the learning environment. [24]

Students' perceptions of the educational environment in medical colleges: research

based on the DREEM questionnaire in the National Institute of Health was conducted by Korean
Journal of Medical Education. This cross-sectional study used the Dundee Ready Education
Environment Measure (DREEM) questionnaire to evaluate the educational environment (EE) for
medical students and interns. The goal of the study was to pinpoint the EE's advantages,
disadvantages, and potential improvement areas. Learning, instructors, academic self-
perceptions, environment, and social self-perceptions are the five dimensions evaluated by the
DREEM questionnaire. Responses were gathered using a 5-point Likert-type scale, and
significance was established at p 0.05 for the statistical tests that were used to evaluate the
data. In conclusion, the study discovered that, on average, students had a favorable opinion of

18
their educational environment (EE), as evidenced by their mean global DREEM score of
123/200. They had favorable opinions of their academic self-perception (21.24/32), the
environment (29.21/48), and learning (28.99/48), in particular. While teacher impression
(26.71/44) showed modest improvement, social self-perception (17.48/28) was largely
favorable. Students in the fifth semester, in particular, had the best opinions of the EE. This
study's findings suggest that all students had a generally favorable opinion of the EE.
Knowledgeable instructors, encouraging social connections, and exam-passing assurance were
strengths. Authoritarian teaching methods, an overemphasis on factual learning, teacher-
centered teaching strategies, teacher dissatisfaction, and the need for improved support
networks for anxious students were all identified as areas that needed improvement. [25]

Lisette Dunham et al., 2010 contributed to the paper Medical Student Perceptions of the
Learning Environment in Medical School Change as Students Transition to Clinical Training
when she was enrolled in undergraduate medical school. The physical, social, and psychological
setting in which pupils learn is referred to as the learning environment. A bad learning
environment can lead to burnout, tiredness, and cynicism in students whereas a pleasant one
fosters well-being for learners, sympathy, ethics, and successful learning. The way in which
students see the learning environment at medical school may change over time and may
depend on their training year, gender, or ethanoic background. In research conducted in 2010
and 2011, 4,262 medical students from 23 medical schools in the United States and Canada
completed the Medical School Learning Environment Survey (MSLES). Each year, students
participated in the survey, and the results showed that as students advanced through medical
school, their opinions of the learning environment deteriorated. The move to the clinical
learning environment in the third year is when there was the greatest deterioration. However,
in the fourth year following Match Day, there was some recovery. Over three times as much as
the reduction between the first and second years, the MSLES score decline during the
adjustment to the clinical setting was significant (-0.26 points beyond annual change). The areas
where declines were most noticeable were those that dealt with informal student connections
and work-life balance. Finding time for extracurricular activities and peer support both showed
noticeable losses in the third year. Based on gender and race/ethnicity, perceptions vary. The
study's findings, in light of the difficulties students have adjusting to the clinical learning
environment, point to the need for interventions and enhancements to medical education. [26]

Teamur Aghamolaei et al., 2010 conducted research on medical students' impressions of

the educational environment at an Iranian Medical Sciences University. This study was meant to
assess how medical students at Iran's Hormozgan University of Medical Sciences felt about their
learning environment. 182 full and analyzable responses—or an 86.6% response rate—were
received from the 210 medical students who participated in the cross-sectional research study.
A DREEM questionnaire with 50 Likert scale-based items and scores ranging from 0 to 200 was

19
used to gather the data. Five areas were covered by the questionnaire: students' views of
learning, instructors' perspectives, their own perceptions in academic settings, their
perceptions of the environment, and their own perceptions in social settings. The SPSS16
program was used to analyze the data. In terms of demographics, the participants' mean age
was 21.7 years, with 61.5% female students and 38.5% male students. The findings showed that
students' views of learning (21.2/48), perceptions of instructors (24.2/44), academic self-
perceptions (15.8/32), perceptions of atmosphere (23.8/48), social self-perceptions (14.5/28),
and the overall DREEM score (99.6/200) had mean scores that fell into each of these categories.
In the student population's educational environment subscales, gender did not demonstrate
any discernible disparities. Regarding views of learning, academic self-perceptions, atmosphere,
and perceptions of the overall educational environment, significant differences between
students enrolled in fundamental sciences and pathophysiology courses compared to those in
clinical courses occurred (p 0.05). Comparatively to their peers studying fundamental science
and pathophysiology, students in clinical courses tended to rank these features more favorably.
This study's findings showed that respondents' overall evaluations of the educational
environment were classed as ordinary. It implies that each of the five areas of the educational
environment has to be improved. Educational institutions looking to improve the learning
opportunities for their medical students may find this material useful. [27]

Students' perceptions of the educational environment in Korean medical schools: results

from a national survey, was the focus of Kwai Hwa Park's research. The purpose of this study
was to evaluate how South Korean medical students perceived the learning environment there.
9,096 students out of 12,035 took part, representing a 75.6% response rate. 40 Korean medical
schools participated in the study, which finished the 2013 academic year. Applied the Dundee
Ready Education Environment Measure (DREEM), a five-domain assessment. Descriptive
statistics, independent t-tests, and one-way analysis of variance were used to analyze the data.
The average DREEM score across all schools was 113.97 out of 200, with values that ranged
from 100.24 to 134.32. Based on school systems, scores, races, and levels of academic
accomplishment, significant differences in DREEM ratings were discovered. In comparison to
undergraduates, graduate students showed higher DREEM scores across all domains. The
lowest scorers were second-year students (mean, 111.80). With the exception of two areas (SPL
and SPT), views of male students were usually more favorable. Overall, students' opinions of
their learning environment in Korean medical schools are favorable. Suggested that curriculum
designers and school officials conduct constant review and improvement. At conclusion, this
study sheds light on students' impressions of the learning environment at South Korean medical
schools, showing both strong points and areas that might use improvement. [28]

Preethi G Pai and his colleagues investigated how medical students felt about their
learning environment. This study focused on the distinctions between preliminary and clinical

20
aspects of education in order to evaluate students' impressions of their educational
atmosphere at an Indian medical school. It was measured using the Dundee Ready Education
Environment Measure (DREEM) inventory. Undergraduate medical students from the first (n =
227), third (n = 175), fifth (n = 171), and seventh (n = 123) semesters participated. Dunnett's
test and one-way ANOVA were used to evaluate the data; the significance level was set at p
0.05. The medical school's average DREEM rating was 123/200. In comparison to previous
semesters, first-year students reported being more satisfied with their learning environment,
with ratings gradually dropping. Registrars had higher favorable opinions of learning, course
planners, academic self-perception, environment, and social self-perception across all
semesters. Overall, pupils had favorable perceptions of their learning environment. Higher
levels of stress and views of dictatorial teaching with a focus on factual learning were some
areas of concern, though. To improve the learning environment, suggested treatments included
establishing problem-based learning, offering student counseling, and providing educators with
teaching-learning seminars. [29]

Mayya and Shreemathi S, At Kasturba Medical College in India, conducted research on

students' perceptions of the educational environment and compared academic achievers and
underachievers. This study sought to address the issue of keeping medical students in nations
with little resources, such as India. With an emphasis on gender disparities, it tried to identify
pupils at risk of academic failure and comprehend the elements of the educational environment
that set them apart from successful students. The goals were to: (1) analyze gender-based
differences in views; (2) compare the perceptions of academic achievers and underachievers,
identifying opportunities for development. Using the Dundee Ready Educational Environment
Measure (DREEM), the study polled 508 medical students enrolled in their clinical years at
Kasturba Medical College in India. The overall educational atmosphere was assessed as ordinary
according to the findings. In comparison to underachievers, academic achievers had more
favorable opinions of professors, the academic environment, and their own social impressions.
Additionally, the overall ratings of female students in the intellectually vulnerable category
were lower than those of male students. In short, the study showed that opinions of weak and
great performers within the same institution varied significantly. Positive views are associated
with higher learning outcomes and attitudes, therefore, recognizing and dealing with these
perceptions is essential for improving the educational environment. The DREEM can be a useful
monitoring tool for prompt interventions to address academic difficulties. [30]

Reem Abraham, K Ramnarayan, P Vinod, and Sharmila Torke, At Melaka Manipal

Medical College (MMMC), studied how students perceived the learning environment at an
Indian medical college. This study compared how first-year and clinical-phase students at
Melaka Manipal Medical College, Manipal Campus, felt about the classroom setting and looked
into any potential gender discrepancies. The Dundee Ready Education Environment Measure

21
(DREEM) assessment was used to evaluate the effectiveness of the learning environment.
Nonparametric tests were used to compare the exam results of the 118 first year and 108
clinical-phase medical students in undergraduate programs who participated in the study.
Results showed that first-year students were more satisfied with the educational environment
at MMMC than clinical-phase students, as evidenced by their higher DREEM ratings. It's
interesting that there wasn't any noticeable gender-based perceptual variations among
students. Both groups had excellent overall impressions of the learning environment. The
report did, however, also point out particular areas that need improvement, which prompted
corrective efforts inside the medical school. [31]

Medical students' impressions of their educational environment: anticipated VS actual

perceptions was research undertaken by Susan Miles and Sam J Leinster. This study used the
Dundee Ready Education Environment Measure (DREEM) to compare first Year medical
students' predicted impressions of their educational environment at the start of the year with
their actual experiences at the end of the first year. 130 first year students at University of East
Anglia Medical School participated in the study. They conducted the DREEM two times: once
during their orientation week at the start of the first year, thinking about the educational
environment they anticipated (Expected DREEM), and once more at the end of first Year,
thinking about the real educational environment they encountered (Actual DREEM). 87
students in total (66.92% of the cohort) finished both DREEM tests. In several areas of
education, instruction, academic self-perception, and social self-perception, key findings
showed that students' predicted perceptions were more favorable than their actual
perceptions. Between predicted and actual impressions of the educational environment's
climate, no discernible difference was found. The report also pinpointed particular instances
where the expectations of the students were not realized. The study's findings showed that first
year doctors had unmet expectations regarding the learning environment when they started
their programs. Even without taking into account student expectations, the analysis identified
areas of conflict that may serve as a roadmap for adjustments. [32]

Syed Ilyas Shehnaz and Jayadevan Sreedharan, in a medical college in the United Arab
Emirates that was through a curricular change, conducted research on students' impressions of
the educational environment. The purpose of this study was to examine students' opinions of
the learning environment at Gulf Medical College in the United Arab Emirates before and after
a significant curriculum shift from a discipline-focused to an integrated curriculum based on
organs. With the Dundee Ready Education Environment Measure (DREEM), information was
gathered from 2nd-year learners in the discipline-based program (Group 1) and the integrated
curriculum (Group 2) the following year. As a result, Group 2 had a considerably higher overall
DREEM score (135/200) than did Group 1 (116/200), according to the findings. Both groups said
there was a good educational atmosphere, although Group 2 seemed happier. They did,

22
however, also observe an overemphasis on actual learning and worries about plagiarism. The
school's overall DREEM rating was 120/200. The study's findings imply that as compared to the
discipline-based curriculum, students regarded the integrated curriculum based on organ
systems as offering a superior learning environment. However, several aspects still need
improvement, such as the curriculum load and evaluation methods. [33]

Wasana Hongkan, Rajin Arora, Roungtiva Muenpa, and Parinya Chamnan investigated
how medical students in Thailand perceived their educational environment. There are several
evaluation instruments available to measure how students see their learning settings, and prior
research generally points to a positive learning environment as the norm. The perception of the
learning environment has also been connected to a number of variables, including the gender
of the students, their academic performance, and features of medical schools, among others.
It's noteworthy that, with a considerable dearth of data at the national level, the bulk of earlier
research has mostly concentrated on examining student attitudes within specific or a small
number of medical schools. The inability to evaluate learning environments among various
medical schools and educational institutions due to the lack of such comprehensive data has
made it difficult to adopt benchmarking tactics for development. Furthermore, there is a dearth
of data on how clinical-year students in Thai medical schools perceive their learning
environment. Our knowledge of whether these impressions are impacted by certain traits of
the students themselves and the educational institutions is also lacking. This research thus
highlights the need to explore and assess, using the Dundee Ready Education Environment
Measure (DREEM), the perceptions of the educational environment among clinical-year
students in Thailand and to identify the variables linked to variances in DREEM scores. Such
research projects are essential for acquiring a thorough grasp of the instructional environment
at medical schools and pinpointing possible improvement areas. 2,467 clinical-year medical
students from Thailand's 34 teaching hospitals took part in this study by answering questions
on a Thai translation of the DREEM survey. We gathered information on the GPAX, teaching
hospital size, gender, and year of study of the students. Using t-tests and one-way ANOVA, the
mean total DREEM scores and subscale scores were obtained, then they were compared
between various groups. With a mean total DREEM score of 131.1 (SD=17.4), the results
showed that students' impressions of the educational environment were generally favorable.
All DREEM subscales showed the same degree of positive. Although this difference was
significantly different (F (2,2422) =3.21, p=0.04), students at medium in size teaching hospitals
indicated slightly reduced mean total DREEM scores (129.9, SD=18.1) than those in small
teaching hospitals (131.9, SD=17.5) and big teaching hospitals (131.6, SD=16.4). Additionally,
several DREEM subscales were related to male and female students and years of study.
Although there were differences in attitudes among various sizes of teaching hospitals, clinical-
year medical students in Thailand generally indicated happiness with their academic learning
environment. The study emphasizes the significance of periodically assessing the learning
23
environment in medical schools to track changes brought on by certain educational strategies.
[34]

2.2 Factors Affecting Student Perception of Educational Environment at

Medical Colleges
In an Indian dentistry school, Prof. Betsy Sara Thomas, Reem Rachel Abraham, Mohan
Alexander, and K. Ramnarayan investigated students' impressions of the teaching environment.
With 268 dental schools as of the most current census, a major rise from just a few years ago,
the landscape of dental education in India has undergone significant changes recently.
Paradoxically, even several reputable dentistry schools have struggled to fill seats due to issues
attracting students. The Manipal College of Dental Sciences, founded in 1965, is one of these
institutes and boasts the distinction of being India's first dental school to be self-supporting. It
claims a 100-student yearly intake for its undergraduate program, attracting applicants from all
around India and 32 other nations. Notably, the institution has been certified for ISO 9001-2000
and has received a 5-star rating from the National Assessment and Accreditation Committee.
Even though the school has continually worked to uphold top-notch standards and has adopted
best practices from throughout the world, a major gap has existed because students'
impressions of the academic and general educational environment inside the institution are
lacking. The institution decided to conduct research to learn more about students' perspectives
in order to fill this gap. The study had two main goals: (1) to learn more about how students see
the educational environment; and (2) to compare these results with those of other dentistry
and medical schools. The Dundee Ready Education Environment Measure (DREEM) was used in
the study to gather information on the setting of the institution. 63 students from the first-year
class and the graduating class, respectively, were each given this test. The findings brought to
light a worry that both groups had in common: that the institution's social climate was not very
friendly. Notably, perceptions of the professors' authoritarian inclinations were reported by
both groups. In the end, the study highlighted the necessity of enhancing the institutional
climate generally, particularly in terms of establishing a friendlier social environment. The
results also emphasized how crucial it is to change instructor attitudes and methods in order to
improve students' overall learning experiences. [35]

Using DREEM, Alia H. Zawawi and Margaret Elzubeir compared graduating students'
evaluations of the learning environments at medical schools that used various instructional
approaches. Some medical schools have switched to mix problem-based learning (PBL) courses
in response to the changing medical education landscape in Saudi Arabia, where worries about
traditional teaching methods have grown. Other medical schools have stuck with traditional
discipline-based curricula. This study focused on examining the educational environments of
two medical institutions in Riyadh, Saudi Arabia, in order to gather important insights into
students' opinions of these two distinctive learning environments, which can guide curriculum

24
creation and advancement. The Dundee Ready Education Environment Measure (DREEM)
inventory was used to perform this evaluation via the eyes of graduating medical students. The
findings of this study showed that students' opinions of the medical school using an
interdisciplinary PBL program and the medical school using a traditional curriculum differed
significantly. Particularly, the conventional school's total DREEM score was significantly lower (p
0.001) than the hybrid-PBL schools. Additionally, students who participated in the hybrid-PBL
curriculum had noticeably better opinions in particular DREEM sub-domains, such as learning,
academic self-perception, and environment (p 0.001). These results are consistent with other
studies on DREEM scores in area traditional medical schools and abroad PBL-focused
institutions. In conclusion, the DREEM inventory's use as a diagnostic tool has demonstrated its
value in delivering important insights into learning contexts distinguished by a variety of
instructional methodologies. This knowledge can act as a catalyst for important changes and
advancements in institutions that teach health professions. The implications of these findings
for developing curricula and improving learning environments in such institutions are also
examined. [36]

Yasar Ahmed, Mohamed H. Taha, Salma Al-Neel, and Abdelrahim M. Gaffar investigated
how students in Sudan perceived their study year and performance in connection to the
learning environment. The learning environment has a significant impact on what, how, and
why students learn, which helps to shape their educational experiences. Their excitement and
the success of their learning outcomes are also affected by it. Numerous studies have looked at
the connection between the learning environment and students' accomplishments,
contentment, and success in general, and they have constantly shown a substantial link. Studies
have repeatedly demonstrated that pupils who have a favorable impression of their learning
environment are more likely to succeed academically than those who have a negative
perception. Numerous research exploring students' opinions of their educational environments
resulted from this. Evidence in the literature emphasizes the link between students' academic
achievement and their impressions of the learning environment in the context of health
professions education. 638 students from the second, sixth, and tenth semesters of the Gezira
University Faculty of Medicine in Sudan were the subject of this study, which was a descriptive
cross-sectional examination. Study year and academic achievement were major predictor
factors in the study, which used the Dundee Ready Education Environment Measure (DREEM)
that was translated into Arabic. Descriptive statistics, one-way analysis of variance, and post
hoc Tukey-Kramer multiple comparisons tests were all included in the data analysis. The study's
total DREEM score was 122/200 (SD=16.6), which shows that students had a favorable opinion
of their learning environment. Additionally, the total mean score changed throughout the
course of the several research years: The mean score for semester 2 students was 109.94/200
(SD: 21.2), for semester 6 it was 122.9/200 (SD: 20.29), and for semester 10 it was 116.53/200
(SD: 20.12). These discrepancies indicated that students at various phases of their academic
25
careers had diverse assessments of the learning environment (F (2,2422) = 3.21, p=0.04).
Additionally, there were noticeable disparities in academic performance total ratings. The
average DREEM score for high achievers was 126 (SD: 24.4), whereas the average for poor
achievers was 102 (SD: 26.25) (F (2,2453) = 3.53, p=0.029). As a result of this study, it was
discovered that high achievers had more positive opinions of the learning environment than did
poor achievers. Additionally, there were notable variations in the opinions of the students
according to their academic year. It is crucial to look more into these variations in academic
achievement, maybe concentrating on certain disciplines. To fully analyze the advantages and
disadvantages related to each academic level, a complete, extensive investigation is required.
[37]

Medical Students' Perception of the Educational Environment at College of Medicine

was the focus of Syed Sameer Aga's research with his colleagues. The Dundee Ready Education
Environment Measure (DREEM) checklist has been extensively used to evaluate educational
settings, notably in the healthcare industry, and it provides helpful insights into the strengths
and limitations of programs. The purpose of this study was to learn more about how medical
students at the College of Medicine (COM) in Makkah perceived the educational environment
(EE). The research, which was done as a longitudinal investigation during May and August 2020,
made use of a pre-made DREEM English questionnaire with five subdomains. There were 220
participating medical students, with a mean age of 21.97 (SD = 1.28) overall. 64.5% of the
responders were men and 35.5% were women. The majority (49.5%) were in their fourth year
of medical school, and the majority (65.4%) were in phase II (basic sciences) of the college.
Overall, EE had a DREEM score of 129.64 (SD = 31.81; 64.82%). All five DREEM subdomains had
scores over 60%; the academic self-image of students (SASP) received the greatest score
(66.31%) and the perception of learning by students (SPL) received the lowest score (62.83%).
SASP2 had the greatest mean score of 3.13 (SD = 0.96) out of all the items, while SPA8 had the
lowest mean score of 1.99 (SD = 1.38) among them. The study showed that students' opinions
of the EE in the medical program were generally favorable when compared to the body of
current literature. It did, however, also point out several areas that needed improvement,
especially in the area of students' perceptions of teaching (SPT). This research is in line with the
larger body of knowledge on educational settings and offers insightful suggestions for improving
the curriculum. [38]

Abdulaziz Abdulrahman Aldayel et al., 2019 dealt with problem-based learning: Al-Imam
Mohammad Ibn Saud Islamic University medical students' perceptions of their learning
environment. A student-centered teaching strategy called problem-based learning (PBL) allows
students to choose their learning objectives by posing problems to them. The purpose of this
study, which was carried out at the Islamic University of Al-Imam Mohammad Ibn Saud in Saudi
Arabia, was to gauge undergraduate medical students' opinions on PBL sessions and compare

26
these opinions according to gender as well as grade point average (GPA). During the 2017–2018
academic year, information collected from second, third, and fourth-year male and female
students were gathered for the study. The findings showed that the majority of learners had a
favorable opinion of PBL. With variances between various GPA groups, they thought that PBL
sessions increased their grasp of fundamental sciences and strengthened synergy among basic
and clinical sciences. However, a sizable number of students said that PBL sessions needed
greater planning from the teaching staff. Additionally, it was widely agreed that students
needed additional preparation before participating in PBL. Finally, just a small percentage of
students felt that PBL was superior to traditional lectures for learning. In order to improve
students' clinical reasoning abilities and foster a more conducive learning environment, the
study concluded that it is critical to provide good PBL tutor training and to guarantee that
students receive a thorough introduction to the methodology. [39]

2.3 Relationship of the Educational Environment between Learning

Outcomes and Student Well-being
Benjamin Kutsyuruba et al., 2015 worked on the connections between student success,
school safety, and school atmosphere. Academic success is significantly influenced by the
culture of the school, student safety, and wellbeing. It's crucial to understand, though, that
depending on each individual student's subjective experiences and unique personal traits, they
may each have a distinct perception of the school atmosphere. This literature review reviews
existing studies in this field to acquire a clearer knowledge of the connection between school
atmosphere, safety, student well-being, and academic success. Using a systematic review
methodology, we investigate the following crucial elements: The following topics will be
covered: (a) the idea of school climate as a social construct and how it relates to school safety;
(b) the elements that go into making a safe school environment; (c) the traits of particular
student groups that may make them feel unsafe; and (d) The effects of a toxic school climate
marked by problems like bullying and violence on academic performance, completion of
secondary school, and general well-being. An overview of the status of the research on school
atmosphere and safety is given in this review. It talks about how these findings could affect
school policies and procedures that are intended to improve school atmosphere, safety, and
student performance. We also make suggestions for more studies in this area. [40]

VR Ruus et al., 2007 dealt with STUDENTS' WELL-BEING, COPING, Educational Success,
and School Climate. This article presents the results of a thorough student survey that was
carried out in 2004 at Tallinn University as a component of a wider endeavor titled "School as a
Developmental Environment and Students' Coping." 3,838 kids from grades 7, 9, and 12
participated in the poll, making up a varied sample from 65 different schools around Estonia.
This project's main objective was to address the serious problems of school dropouts and grade
repeats, with the intention of significantly reducing these difficulties. The study's main premise

27
was that altering the social atmosphere of a school might have a significant impact on whether
or not pupils acquire healthy coping mechanisms. Additionally, it was suggested that these
coping mechanisms may have a major influence on kids' academic success. The discovery of
various important conclusions is the main finding of this long study project. First and foremost,
it was found that a number of factors connected to the school atmosphere, with a focus on the
school's guiding principles and how pupils viewed instructors' attitudes, had a significant
impact. These factors were discovered to have an impact on a variety of aspects of kids' lives,
including their positive view on life, general psychological and physical health, and ultimately,
their achievement in school. [41]

LT Wasson et al., 2016 executed on the research endeavor Relationship between

Learning Environment Improvements and Medical Student Well-Being. The influence of the
learning environment on students' mental health is a crucial component of medical education.
Compared to their contemporaries who attended college, prospective US medical students
often have lower rates of depression and burnout and report higher mental and emotional
well-being; however, this trend tends to reverse throughout their undergraduate medical
education (UME) years. Alarming statistics show that more medical students than other
graduate students or the general population exhibit signs of burnout (52%), and that 14% of
them experience moderate to severe depression. Additionally, research shows that up to 11%
of medical students have suicide ideation. This systematic review's goal was to find
undergraduate medical education practices that work effectively and are linked to improving
students' emotional wellbeing. The main outcome was the students' self-reported well-being as
measured by surveys, semi-structured interviews, or other quantitative approaches. Various
learning environment treatments were investigated, notably those used in US academic
medical schools. Data for this review came from medical digital databases, including Ovid
MEDLINE, EMBASE, the Cochrane Library, and ERIC. These databases' contents ranged from
their creation to October 2016 and included data from all time periods. 28 publications that
matched the eligibility requirements and had at least 8224 participants included in the review.
These articles included a variety of research methodologies and teaching strategies meant to
improve students' emotional health. Pass/fail grading schemes, mental health programs, mind-
body skill programs, curriculum structure changes, multicomponent set up changes, wellness
initiatives, and advising/mentoring programs were some of the interventions that were
investigated. It's important to remember that, despite these results, the overall quality of the
evidence was assessed to be inadequate, highlighting the urgent need for rigorous research in
medical education to better understand and enhance the emotional wellbeing of medical
students. [42]

Kathleen A. Klik et al., 2023 worked on the project School environment, school
belonging, and student results; a longitudinal assessment of student well-being. Schools are

28
increasingly being recognized for their role in fostering children's and youth's wellbeing. In this
context, the social environment of the school has received a lot of focus, with a particular
emphasis on school climate and school connection, both of which are essential for student
development. It has been proposed that school social identification may be the fundamental
mechanism through which school environment affects individual student well-being, drawing
on the social identity method and related studies (Applied Psychology, 28, 2009, 171).
However, earlier studies on social identity and wellbeing have primarily used cross-sectional
methodology, which has limited our ability to comprehend these topics fully. The goal of the
current study is to better understand the complex connections between school atmosphere,
school identification, and both good and bad well-being results. It makes use of a longitudinal
dataset made up of three waves of data collection from Australian children in grades 7 through
10 (N = 6537 at wave 3), while also taking into account a number of control factors. This study
investigates the proposed links experimentally by use of multilevel modeling (MLM). In line with
our expectations, the results show that school identification, but not anxiety, significantly
mediates the relationship between school atmosphere and well-being variables including
positive affect and sadness. This study has important theoretical and practical ramifications that
shed light on the crucial role that young people's social environments at school play in
supporting successful transitions to adulthood. [43]

Marie-Christine Opdenakker et al., 2010 researched on effects of schools, teaching staff

and classes on achievement and well-being in secondary education: similarities and differences
between school outcomes. The impacts of schools, teaching personnel, and classroom settings
on academic success and general well-being of first-grade secondary education students in
Belgium are thoroughly examined in this paper. The study offers a thorough examination of
these determining factors by using a multilevel analytic technique. Our research has revealed
some important findings, one of which highlights the fact that schools and classrooms have a
much greater relative impact on academic accomplishment than on students' well-being. The
study shows that academic success and well-being are directly and indirectly influenced by
schools and classes. However, only a small number of class-pupil interactions contribute to the
interactive effects, which are predominantly seen in connection to the students' well-being
outcomes. These results highlight a fundamental contrast between academic success and well-
being as two separates but connected goals in the setting of the classroom and school.
Furthermore, the study shows that while the influence of some school features depends on the
particular result criterion being looked at, other school characteristics have an impact
independent of the result variable under examination. This thorough and detailed analysis is a
worthwhile project that provides deep insights into the subtle interactions among student well-
being, academic success, and classroom dynamics. This study's central focus is on the complex
dynamics that play out in the classroom setting. It aims to identify the intricate relationships—
both overt and covert—that affect how pupils learn. It hopes to accomplish this by giving a
29
comprehensive knowledge of how these classroom dynamics affect students' academic
progress and personal wellbeing. Additionally, the study aims to provide light on the strong link
between classroom dynamics and academic accomplishment. [44]

Janne Pietarinen's et al., 2014 research focused on how students' emotional and
cognitive involvement affected their well-being and academic success. This study's main goal is
to further our understanding of the complex relationship between students' emotional and
cognitive engagement, a relationship that is mediated by the students' perceived feeling of
well-being in the educational environment. A key premise was that students reported
emotional involvement, which was influenced by interactions with their peers and instructors,
together with their general school wellbeing, contributed to their perceived cognitive
engagement. Additionally, it was proposed that this cognitive activity subsequently affects their
general academic performance. The study collected information from 170 students from three
different case study schools in order to thoroughly explore this concept. To examine the
postulated linkages, structural equation modeling (SEM) was used as the analytical framework.
The results of the study shed light on a complex web of linkages that exists within the
educational setting. It became clear that the dynamic interaction between students and the
learning environment had a significant impact on students' cognitive engagement. Additionally,
the everyday instructional strategies used by schools were crucial in forming this level of
cognitive involvement. Importantly, the study showed that the complicated link between
emotional and cognitive engagement was mediated by students' experiences of well-being
within the educational system. Additionally, it was determined that this well-being element had
a considerable impact on students' general academic success. These findings have significant
ramifications for future investigations into the complex dynamics of participation in the many
social contexts provided by educational institutions. The study underlines the necessity of
changing the educational focus from isolated aspects or the environment to a more holistic
viewpoint, highlighting the dynamic interactions between students and their learning
environment. This viewpoint reframes the conversation on educational approaches by
emphasizing the value of creating an atmosphere that encourages both emotional and
cognitive engagement while placing an emphasis on students' well-being as a key factor in the
pursuit of academic achievement. [45]

JONATHAN COHEN et al., 2006 influenced Social, Emotional, Ethical, and Academic
Education: Fostering an Environment for Learning, Democracy Participation, and Well-Being. In
his fascinating piece, Jonathan Cohen makes a strong case for a paradigm change in the goals of
education, arguing in favor of giving equal weight to the development of social, emotional, and
ethical skills in addition to academic learning. Cohen emphasizes the critical role played by
social-emotional skills, knowledge, and dispositions in laying the groundwork for active
citizenship within a democracy and enhancing overall quality of life through a comprehensive

30
examination of the current landscape of research in the domains of social-emotional education,
personality development, and school-based mental health in the United States. In this work,
Cohen digs into current best practices and policy efforts, looking at how they relate to
developing strong home-school connections, creating safe and loving school settings, and
improving pedagogical methods that are based on social-emotional and ethical concerns. He
emphasizes the urgent necessity for the creation and application of scientifically reliable
assessment tools for assessing social-emotional and ethical learning as a key component of his
presentation. Cohen also supports the formation of collaborations between academics and
practitioners to conduct action research projects and create practical evaluation techniques.
Cohen draws attention to a troubling inconsistency by highlighting the discrepancy between the
prevalent curriculum and pedagogical techniques in PreK–12 institutions and the evidence-
based social-emotional learning recommendations that are being increasingly implemented at
the state level. He emphasizes that integrating social, emotional, ethical, and intellectual
education is more than just a goal; it is a basic human right, and he claims that every student
has a right to an all-encompassing approach. Cohen makes a strong case that ignoring this
necessary change will result in a serious social wrong that cannot be disregarded. [46]

2.4 Efforts and Methods to Enhance Students' Perceptions of the

Educational Environment at Medical Institutions
Shaikha Alzaabi et al., 2021 conducted research on how to enhance medical students'
perceptions and values of peer learning in the development and evaluation of their clinical skills
at the undergraduate level. His study explores the complex area of peer learning in the context
of medical students' acquisition of clinical skills. Peer learning has received praise for its
efficiency in improving learning outcomes, lessening the educational load on the faculty, and
developing the teaching abilities of aspiring medical professionals. However, peer assessment's
potential as a tool for evaluation and the extent to which it may operate independently of
faculty direction are still largely unexplored areas in the field of medical education. The main
goal of the study is to investigate how medical students feel about peer learning as an
evaluation tool, based on the ideas of self-regulated learning. Additionally, it aims to determine
the degree to which peer and professor evaluations of clinical skill performance are
comparable. 36 3rd year medical students participated in peer learning for clinical skills
education during a three-month period in order to achieve these goals. The study technique
uses a convergent mixed methods approach and gathers information from three different
sources: performance evaluations, reflective observational analysis, and student views of peer
learning. A 5-point Likert-type scale is used to assess student perspectives, representing 28
participants, in order to determine the actual value of peer learning. Additionally, students
evaluate their classmates' clinical skill performance using a predetermined checklist, and the
results are then compared to the results of the faculty evaluations. Videos of a few peer

31
learning sessions are used to get reflective observational observations. Through collaborative
display analysis, the results from these several sources are combined. The study reveals
convincing findings, with 25 of the 28 students who participated in the survey acknowledging
the importance of peer learning in the development of clinical abilities. Notably, the average
score obtained from peer evaluation outperforms that of professor evaluation. In terms of
student performance, there is a statistically significant difference between those that received
supervised instruction and those that participated in PEER learning. The study also sheds light
on how students frequently neglect to pay attention to the quality of their technique in favor of
focusing primarily on skill acquisition. Many students also struggle to understand the clinical
significance of possible results from physical tests. In conclusion, the study emphasizes the
empowerment that peer learning, built on the principles of self-regulated learning, bestows
upon students, cultivating a greater feeling of responsibility in their academic path. In spite of
this, it highlights the shortcomings of peer evaluation as a stand-alone method for assessing
clinical skill performance in the absence of faculty direction. In order to maximize the benefits
of peer learning, the research recommends that faculty-supervised sessions come first. [47]

Abdulrasheed A. Nasir's et al., 2014 research was to enhance medical students'

perceptions of objective structured clinical examination. Medical professionals have long
looked for efficient summative and formative evaluation techniques for students. A widely
accepted method for objectively and systematically evaluating clinical competency is the
Objective Structured Clinical Examination (OSCE). Despite being widely used in medical colleges
throughout the world, it hasn't been extensively used in Nigerian medical schools. In this study,
final-year medical students who took the final MBBS surgery exams in June 2011 participated in
a cross-sectional survey. For the purpose of gathering information, a structured 19-item
questionnaire with questions addressing demographics and evaluating different facets of OSCE
stations, such as classes quality, management, learning possibilities, genuineness, honesty, and
equivalent usefulness with various evaluation formats, was given to participants. Five-point
Likert scale responses were recorded. SPSS version 15 was used for data analysis. 187 final-year
medical students who engaged in the survey took part in the study, which was conducted at the
University of Ilorin's College of Health Sciences. An 80.7% response rate was achieved with 151
of the 187 eligible students completing the survey. Important results include At OSCE stations,
written instructions were simple to grasp for 40.4% of the pupils. 70.2% of students said that
the time allotted for each station was enough. 58.9% of students thought that the OSCE fairly
assessed their knowledge and abilities. 56.3% said OSCE improved their ability to communicate.
53% of participants in the OSCE felt uneasy. Inter-evaluator variability at staffed stations was a
concern for 48.3% of respondents. 35.1% said OSCE was the second-fairest exam design. 37.1%
advocated using OSCE more frequently than other evaluation formats. The poll findings show
that students at the Department of Surgery at the University of Ilorin, College of Health
Sciences, have favorable opinions on OSCE's reliability, objectivity, thoroughness, and general
32
organization. The study emphasizes how crucial it is to incorporate OSCE early in the surgical
curriculum. A thorough and in-depth assessment of the Objective Structured Clinical
Examination (OSCE) technique may be fostered with the use of the data and comments
gathered from various sources. This thorough examination seeks to improve and maximize the
OSCE's performance as an essential instrument for evaluating and assessing medical students.
In this comprehensive project, the knowledge gained from many inputs, such as participant,
examiner, and stakeholder feedback, is crucial. It allows for a complete review of the OSCE's
strengths, flaws, and areas in need of improvement and makes it easier to examine the OSCE
from a variety of angles. [48]

33
Chapter 3

METHODOLGY
This chapter describes the approach taken to look at student perception of medical students in
Faisalabad's Independent University Hospital. It addresses the research methodology, population,
sampling method, sample size, study environment, design, and data equipment and methods for
gathering data, data analysis, and ethical considerations obstacles, constraints, and data
management and distribution issues.

3.1 Research Type:

The current study utilizes a non-experimental survey research approach to examine the
prevalence and factors contributing to student perception among the medical students.

3.2 Research Design:

In the ongoing research, we have adopted a non-experimental survey research methodology as
our primary approach. Our objective is to thoroughly investigate two key aspects: the
prevalence of specific student perception and the multitude of factors that play a pivotal role in
shaping these preferences within the cohort of medical students.

3.3 Study population:

The study population consists of medical students at Independent University Hospital. The
sample size targeted for this research is 448 individuals.

3.4 Inclusion criteria:

All the medical students (1st year- 5th year) are taking part in this survey by filling out a
questionnaire.

3.5 Exclusion criteria:

1. Individuals outside the hospital students were excluded.
2. Participants under 18 years of age were excluded.
3. Individuals who declined participation in the study were also excluded.

3.6 Sample size:

The sample size for this study comprises n= 448 medical students from Independent University
Hospital. The sample size determination for the research objectives was guided by the single
population proportion formula.

34
3.7 Sampling techniques:
Sampling techniques for filling out questionnaires from medical students involve selecting a
representative sample of medical students to ensure that the survey results accurately reflect the
broader population of medical students.

3.8 Data collection methods and tool:

Data collection for this research was facilitated through survey forms designed to assess career
preference among medical students at Independent University Hospital, Faisalabad. These
questionnaires are designed to check career preference and its contributing factors effectively,
encompassing a range of questions aimed at understanding the participants' concept of career
preference.

3.9 Data analysis methods/ statistical analysis:

The collected data will be analyzed by statistical analysis, which will be conducted to explore the
relationships between variables related to student perception among the university students.

3.10 Descriptive Analysis:

Descriptive analysis will provide an overview of various key variables associated with student
perception of education environment at Independent University Hospital. This analysis aims to
present the distribution, frequency, and central tendencies of these variables, shedding light on
the student perception of educational environment at different medical colleges.

3.11 Study duration

Present research will be carried out for the period of 3 months

3.12 Resources:
In the context of the current research project, the methodology employed does not necessitate
the utilization of laboratory instruments or equipment. Instead, the primary materials and tools
to facilitate this study are survey forms. These survey forms serve as the foundational material
through which data collection and investigation will be conducted. Rather than relying on
laboratory-based instrumentation, our research approach centers on the distribution and
administration of carefully designed survey forms. These survey forms have been specifically
crafted to elicit essential information, opinions, or responses from the study's participants.

3.13 Limitations:
Since the data will be collected by questionnaire respondents may not provide accurate
information due to a non-serious attitude.

3.14 Ethical Considerations:

Ethical considerations are paramount in any research endeavor, as they ensure that studies are
conducted in a responsible and morally sound manner, safeguarding the rights and well-being

35
of participants and upholding the integrity of the research process. Here are some key ethical
considerations for research:

 Informed Consent: Researchers must obtain informed consent from all participants
involved in the study. Participants should be fully aware of the study's purpose,
procedures, potential risks, benefits, and their right to withdraw at any time without
repercussions.
 Privacy and confidentiality: Researchers need to take precautions to safeguard
participant privacy and confidentiality. This entails removing participant identities from
any publications and anonymizing data as well as protecting sensitive information.
 Beneficence: Researchers must work to minimize risks to participants while maximizing
benefits. They ought to think about the study's possible dangers and take precautions to
reduce them. The advantages of the trial should outweigh any possible risks.
 Respect for Autonomy: Participants' autonomy, or their freedom to decide whether or
not to participate without compulsion or manipulation, should be respected by
researchers.
 Justice: Ensure that participants are selected fairly and that the burdens and benefits of
research are distributed equitably. Avoid exploiting vulnerable populations.
 Honesty and Integrity: Researchers should conduct their work with honesty and
integrity, including accurate and transparent reporting of methods, results, and conflicts
of interest.
 Research Approval: Seek ethical approval from relevant institutional review boards
(IRBs) or ethics committees before commencing the study, especially when human
subjects are involved.
 Inclusion and Diversity: Strive for diversity and inclusivity in participant selection to
avoid biases in research outcomes and to ensure that the benefits of research are
distributed broadly.

36
CHAPTER 4

RESULTS AND DISCUSSION

This chapter is dedicated to the analysis and interpretation of the data collected in the study
titled "Student Perception of the Educational Environment at Private Medical Colleges in
Pakistan." The data were organized and compiled within an MS Office Excel spreadsheet. To
gain insights from the data, various statistical measures, including means and standard
deviations, were computed. Both the total scores and domain-specific scores for all semester
students were meticulously calculated. The analytical aspect of the study was facilitated using
the statistical software package SPSS, specifically version 25.0. This software was employed to
conduct the necessary data analyses and generate meaningful findings from the dataset.

PART 1

4.1 Socio-Demographic Data

Table 4.1.1 Gender Distribution

Gender Number Percentage %

Male 202 45%
Female 246 55%
Total 448 100 %
Table 4.1.1 provides an overview of the gender distribution among the participants in our
research study. Out of the total sample size of 448 individuals, 202 are identified as males,
representing approximately 45 percent of the total population. Conversely, there are 246
females, accounting for approximately 55 percent of the total study population.

60%
50%
40%
30%
20%
10%
0%
Male Female

37
 Figure 4.1.1 Gender Distribution

Table 4.1.2 Marital Status

Status Number Percentage%

Married 22 5%

Unmarried 426 95%

Total 448 100%

Table 4.1.2 offers a comprehensive breakdown of the marital status distribution among the
participants included in our research study. The dataset consists of a total of 448 individuals,
each with their unique marital status. Among these participants, 22 individuals are categorized
as married, constituting a relatively smaller portion, approximately 5 percent, of the total study
population. This indicates that a limited number of participants in our research have chosen the
path of marriage. In contrast, the vast majority of the participants, specifically 426 individuals,
are classified as unmarried. This group accounts for the majority, approximately 95 percent, of
the total study population.

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Married Unmarried

Fig 4.1.2 Marital Status

38
Table 4.1.3 Distribution of students across different academic classes within our Research

Class Number of Students Percentage%

1st Year 51 11%

2nd Year 99 22%

3rd Year 92 21%

4th Year 106 24%

Final Year 100 22%

Total 448 100%

Table 4.1.3 presents an overview of the distribution of students across different academic
classes within our research study, which includes a total of 448 participants. Specifically, there
are 51 students from the 1st year, 99 from the 2nd year, 92 from the 3rd year, 106 from the 4th
year, and 100 from the final year.

120

100

80

60

40

20

0
1st year 2nd year 3rd year 4th year Final Year

Figure 4.1.3 Distribution of students across different academic classes within our Research

39
Table 4.1.4 Parent`s Education

Education Number Percentage %

Illiterate 16 2%
Primary 13 1%
Middle 32 4%
Matric 60 7%
Intermediate 119 13%
Graduation 365 41%
Post-Graduation 146 16%
Professional Education 145 16%
Total 896 100%
Table 4.1.4 shows both Mother`s and Father`s education collectively. Among the 448 students
included in our study, we observe a range of educational backgrounds among their parents.
Approximately 2 percent of the students have parents who are illiterate, while 1 percent has
parents with primary education. Around 4% have parents with a middle-level education.
Furthermore, 7 percent have parents educated up to matric level, 13 percent have parents with
intermediate education, and a substantial 41 percent have parents who are graduates.
Moreover, 16 percent have parents with postgraduate qualifications, and an additional 16
percent have parents who are professionally educated.

45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
at
e
ar
y
dl
e ric iat
e on on on
ter ir m id at ed ati ati cati
Illi M M u u u
P rm ad ra
d
Ed
In
te Gr G al
st n
Po ssio
e
of
Pr

Figure 4.1.4 Parent`s Education

40
Table 4.1.5 Parent`s Occupation

Occupation Number Percentage%

Unemployment 269 30%

Employed 299 33%

Businessman and 269 30%

Businesswoman
Service Provider 59 7%

Total 896 100%

Table 4.1.5 offers an insight into the occupational status of the parents of the students who
participated in our research study. Among the surveyed students, a significant 30 percent have
unemployed parents, while 33 percent have parents who are employed. An equal percentage,
totaling 30 percent, comprises parents engaged in various business ventures as businessmen
and businesswomen. Additionally, 7 percent of the students have parents working as service
providers.

35%

30%

25%

20%

15%

10%

5%

0%
Unemployed Employed Businessman Service Provide

Figure 4.1.5 Parent`s Occupation

41
Table 4.1.6 Monthly Household Income in Rupee

Income Number of Families Percentage%

30-50 Thousand 27 6%
50-100 Thousand 97 22%
Above 100 thousand 324 72%
Total 448 100%
Table 4.1.6 offers a comprehensive overview of the monthly household income, measured in
Rupees, for the students who participated in our research study. Among the surveyed
population, 6 percent of families reported a monthly income between 30,000 to 50,000 Rupees.
Furthermore, a significant 22 percent of families fell within the income bracket of 50,000 to
100,000 Rupees. Notably, the majority, comprising 72 percent of families, reported a monthly
income exceeding 100,000 Rupees.

80%

70%

60%

50%

40%

30%

20%

10%

0%
30-50 Thousand 50-100 Thousand Above 100 Thousand

Figure 4.1.6 Monthly Household Income in Rupee

42
Table 4.1.7 Schooling

Schooling Number Percentage%

Private 335 75%

Public 113 25%

Total 448 100%

Table 4.1.7 presents an overview of the schooling background of the students who participated
in our research study. Among the surveyed students, 25 percent attend public schools, while
the majority, constituting 75 percent, enrolled in private schools.

80%

70%

60%

50%

40%

30%

20%

10%

0%
Private Public

Figure 4.1.7 Schooling

43
Table 4.1.8 History of Travel Abroad

Travel Abroad Number Percentage%

Yes 183 41%

No 265 59%

Total 448 100%

Table 4.1.8 describes the students who ever travel abroad. About 41 percent of students
travelled abroad and 59 percent of students had never travelled too abroad.

70%

60%

50%

40%

30%

20%

10%

0%
Travel Abroad Never Travel ABROAD

Figure 4.1.8 History of Travel Abroad

44
Table 4.1.9 Address

Address Number Percentage%

Urban 383 85%

Rural 65 15%

Total 448 100%

Table 4.1.9 describes the address of students who had participated in the research. Out of 448
students about 383 students are from urban areas and 65 are from rural areas.

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%
Urban Rural

Figure 4.1.9 Address

45
Table 4.1.10 Any Siblings Study Abroad

Siblings Study Abroad Number Percentage%

Yes 130 29%

No 318 71%

Total 448 100%

Table 4.1.10 provides information regarding the educational pursuits of the siblings of the
students who participated in our research. Among the 448 students, approximately 130 of their
siblings are studying abroad, while the remaining 318 siblings are not pursuing education
abroad.

80%

70%

60%

50%

40%

30%

20%

10%

0%
Siblings Study Abroad Siblings do not Study Abroad

Part 2

46
4.2 Activities Related Questions
Table 4.2.1 Student`s Perception of Learning (SPL)

Class Total Students Mean of SPL Score Out of

48
st
1 Year 51 30.66
nd
2 Year 99 29.88
rd
3 Year 92 30.5
th
4 Year 106 33.77
Final Year 100 31.36
Table 4.2.1 presents the mean SPL (Students' Perceptions of Learning) scores, which have a
maximum possible score of 48. The table illustrates that among the different academic years,
the mean SPL scores vary. Specifically, the mean SPL score for 1st Year students is 30.6667, for
2nd Year students it is 29.8889, for 3rd Year students it is 30.5, for 4th Year students it is
33.773, and for final year students, the mean SPL score is 31.36. These scores provide insights
into how students' perceptions of their learning experiences differ across different academic
years within the study.

35

34

33

32

31
Mean SPL Score

30

29

28

27
1st Year 2nd Year 3rd Year 4th Year Final Year

Figure 4.2.1 Mean Student Perception of Learning Score Out of 48

Table 4.2.2 Student`s Perception of Teachers (SPT)

47
Class Total Students Mean of SPT Score out of 44

1st Year 51 25.03

2nd Year 99 23.72

3rd Year 92 25.26

4th Year 106 28.62

Final Year 100 25.08

Table 4.2.2 presents the mean SPT (Students' Perceptions of Teachers) scores, which have a
maximum possible score of 44. The table illustrates that among the different academic years,
the mean SPT scores vary. Specifically, the mean SPT score for 1st Year students is 25.03, for
2nd Year students it is 23.72, for 3rd Year students it is 25.26, for 4th Year students it is 28.62,
and for final year students, the mean SPL score is 25.08. These scores provide insights into how
students' perceptions of teacher experiences differ across different academic years within the
study.

35

30

25

20

Mean SPT Score

15

10

0
1st Year 2nd Year 3rd Year 4th Year Final Year

Figure 4.2.2 Mean Student Perception of Teachers Score Out of 44

Table 4.2.3 Student`s Academic Self-Perception (SASP)

48
Class Total Students Mean of SASP Score out of
32
1st Year 51 21.90
2nd Year 99 22.42

3rd Year 92 22.35

4th Year 106 24.05

Final Year 100 23.12

Table 4.2.3 presents the mean SASP (Students' Academic Self-Perception) scores, which have a
maximum possible score of 32. The table illustrates that among the different academic years,
the mean SASP scores vary. Specifically, the mean SASP score for 1st Year students is 21.90, for
2nd Year students it is 22.42, for 3rd Year students it is 22.35, for 4th Year students it is 24.05,
and for final year students, the mean SASP score is 23.12. These scores provide insights into
how students' Academic Self-Perception experiences differ across different academic years
within the study.

24.5

24

23.5

23

22.5
Mean SASP Score

22

21.5

21

20.5
1st Year 2nd Year 3rd Year 4th Year Final Year

Figure 4.2.3 Mean Student Academic Self-Perception Score Out of 32

Table 4.2.4 Student`s Perception of Atmosphere (SPA)

49
Class Total Students Mean of SPA Score out of 48

1st Year 51 26.88

2nd Year 99 25.93

3rd Year 92 26.26

4th Year 106 31.15

Final Year 100 27.38

Table 4.2.4 presents the mean SPA (Students' Perceptions of Atmosphere) scores, which have a
maximum possible score of 48. The table illustrates that among the different academic years,
the mean SPA scores vary. Specifically, the mean SPA score for 1st Year students is 26.88, for
2nd Year students it is 25.93, for 3rd Year students it is 26.26, for 4th Year students it is 31.15,
and for final year students, the mean SPL score is 27.38. These scores provide insights into how
students' perceptions of Atmosphere experiences differ across different academic years within
the study.

35

30

25

20

Mean SPA Score

15

10

0
1st Year 2nd Year 3rd Year 4th Year Final Year

Figure 4.2.4 Mean Student Perception of Atmosphere Score Out of 48

Table 4.2.5 Student`s Social Self-Perception (SSSP)

50
Class Total Students Mean of SSSP Score out of
28
1st Year 51 16.68
2nd Year 99 17.03

3rd Year 92 18.35

4th Year 106 18.32

Final Year 100 17.3

Table 4.2.5 presents the mean SSSP (Students' Social Self-Perception) scores, which have a
maximum possible score of 28. The table illustrates that among the different academic years,
the mean SSSP scores vary. Specifically, the mean SSSP score for 1st Year students is 16.68, for
2nd Year students it is 17.03, for 3rd Year students it is 18.35, for 4th Year students it is 18.32,
and for final year students, the mean SSSP score is 17.3. These scores provide insights into how
students' Social Self-Perception experiences differ across different academic years within the
study.

18.5

18

17.5

17
Mean SSSP Score

16.5

16

15.5
1st Year 2nd Year 3rd Year 4th Year Final Year

Figure 4.2.5 Mean Student Social Self-Perception Score Out of 28

Table 4.2.6 Mean Overall DREEM Score

Class Total Students Mean Overall DREEM Score

51
 out of 200
1st Year 51 121.17
2nd Year 99 119.01

3rd Year 92 122.73

4th Year 106 135.92

Final Year 100 124.24

Table 4.2.6 presents the mean overall DREEM scores, which have a maximum possible score of
200. The table illustrates that among the different academic years, the mean DREEM scores
vary. Specifically, the mean DREEM score for 1st Year students is 121.17, for 2nd Year students
it is 119.01, for 3rd Year students it is 122.73, for 4th Year students it is 135.92, and for final
year students, the mean overall DREEM score is 124.24. These scores provide insights into how
DREEM scores differ across different academic years within the study.

140

135

130

125
Mean of Overall DREEM Score

120

115

110
1st Year 2nd Year 3rd Year 4th Year Final Year

Figure 4.2.6 Mean of overall DREEM Score Out of 200

4.3 Discussion
To determine how our students felt about their educational environment (EE), we used the
DREEM (Dundee Ready Education Environment Measure) assessment in our study. Preclinical
52
(first and second years), Para-clinical (third and fourth years), and clinical (final year) are the
three separate stages that make up our institute's five-year curriculum. The clinical year is
followed by a one-year house-job.

One of the significant takeaways from this research was the prevailing positive perception
among our student body. This positivity encompasses various dimensions, including their
confidence in their academic capabilities, recognition of the practical relevance of their learning
to real-world healthcare needs, and a notable emphasis on the development of empathy—a
crucial trait for future healthcare professionals. These aspects affirm the efficacy of certain
facets of our educational environment and underscore the dedication and efforts of our
institution in these areas.

The average DREEM score we received from our students was 124 out of 200, which shows that
they primarily see the EE favorably. This result is consistent with findings from other worldwide
studies that found DREEM scores between 101 and 139. We purposefully included preclinical,
Para-clinical, and clinical branch students instead of House-job students in order to increase the
validity of our analysis. Given that a large portion of the DREEM questions relate to clinical
interactions between doctors and patients, this method produced more pertinent and
understandable findings.

In our five-year program, we observed that students in the fifth year had considerably higher
global DREEM scores and domain scores than students in the previous years. This conclusion is
in line with the outcomes of a number of another research. Students in their fifth semester who
participated in Para-clinical coursework and clinical placements showed higher enthusiasm
about their upcoming clinical knowledge and as a result had a more favorable opinion of the EE.
However, in-depth conversations with advanced semester students revealed difficulties, such as
the extensive clinical curriculum, the requirement for substantial clinical exposure, the stress
associated with exams, and the need to bridge theoretical knowledge and clinical applications.
All of these factors contribute to a less favorable perception of the EE.

In the area of academic self-perception, our pupils had the highest mean ratings, indicating a
favorable view. Students' confidence in their capacity to succeed in their examinations was very
strong. Numerous formative tests and an exam style that is appealing to students may be
significant factors to this confidence.

Students' social self-perceptions were generally positive, and fifth-year students performed
much better in this area, especially on questions about having a strong support network and
feeling less worn out. These favorable opinions were greatly influenced by our mentoring
program, which allowed students to communicate informally with mentors who offered advice
and assisted with stressful circumstances.

53
Students had a favorable impression of the institutional setting, believing it to be calm, cozy,
and conducive to focus. However, clinical branch students raised certain issues including the
lack of availability of particular cases, the doctors' restricted teaching time, and a patient-
centered approach, which resulted in lower marks for some categories.

Students' opinions of professors have improved in certain areas, notably among fifth-year
students, including knowledge, the capacity for giving feedback and constructive criticism, the
clarity of examples, and the level of preparation for classes. Student complaints about
professors being dictatorial and even losing their cool in class, however, persisted. It
emphasizes the need for faculty development to keep up with changing needs and a transition
from conventional to cutting-edge teaching strategies, where teachers take on a facilitative role
rather than just passing along information.

Students usually reported excellent learning experiences, feeling clear about their learning
goals, being encouraged to engage in lessons, and being confident in the growth of their
competence. However, they suggested a focus on factual learning that was overemphasized
and a method that was more teacher-centered, which is consistent with the results of previous
research.

The use of a fixed-response questionnaire, which could not fully represent our institution's EE,
is one of the study's weaknesses. A more thorough assessment may have been possible with
qualitative interviews. Some students also thought the questionnaire was too long and included
too many questions. However, only 14 individuals submitted their surveys in full. We
acknowledge that the DREEM tool may not entirely cover all facets of medical education in its
current form, and that a locally customized version more appropriate to our situation may be
desired. This survey provides a preliminary evaluation of students' views of EE at our school and
will provide as baseline information for ongoing monitoring of curricular changes.

Moving forward, we are committed to utilizing the insights gleaned from this study as a
foundation for constructive change. Our institution recognizes the need for a pedagogical shift
towards more student-centric approaches, fostering a nurturing and inclusive learning
environment. We aim to cultivate an atmosphere where critical thinking, problem-solving skills,
and collaborative learning are paramount. In essence, this research underscores both the
strengths and areas in need of development within our educational environment. It reinforces
our dedication to continuous improvement and the provision of an enriching and effective
educational experience for our students. As we embark on the journey of refining our
educational practices, the lessons learned from this study will guide us toward a more robust
and holistic educational framework in the future. However, this study has also unveiled areas
that warrant focused attention and potential enhancement. Issues such as authoritarian
teaching styles, an overemphasis on rote memorization of facts, a predominantly teacher-

54
centered approach, and sporadic challenges in teacher-student interactions have come to light.
These findings serve as valuable indicators of areas that require improvement and restructuring
within our educational framework. Compared to their colleagues enrolled in the fundamental
sciences and pathophysiology courses, students who took the clinical course gave the teaching
environment a higher ranking.

It's interesting to note that a significant discrepancy was made between this observation and
data from a medical school in India. In the Indian setting, first-year students performed better
across all DREEM domains than those taking part in clinical instruction. However, in the current
study, participants who took the clinical course reported a higher overall DREEM score than
those who spent their first year engaged in the underpinning basic sciences and
pathophysiology curriculum.

55
Chapter 5

CONCLUSION
In conclusion, this study has illuminated various critical aspects regarding the Students'
Perception of the Educational Environment within our Independent Medical College. Through a
comprehensive examination of students' perspectives and experiences, we have gained
valuable insights into the dynamics of our educational system.

Overall, our study's findings show that our student cohort has a favorable opinion of the
educational environment (EE). Particularly as compared to their peers in the clinical branches,
fourth-year students showed more positive evaluations. These findings provide encouraging
new understandings of our educational system. The fact that our students placed a great focus
on empathy as a fundamental quality and showed a high level of confidence in their ability to
perform in exams is noteworthy. They also acknowledged the connection of their educational
journey to healthcare requirements. These favorable features highlight the beneficial elements
of our educational environment and validate our efforts in a few crucial areas.

Our investigation did, however, highlight a number of areas that need improvement and
attention. A concentration on rote factual learning and authoritarian teaching methods are two
educational techniques that have drawn criticism. Significant areas of dispute were the
observation of a more teacher-centered approach and sporadic difficulties in teacher-student
relations. The teaching and learning methods that had been successful for the students at IUH
when they switched from the preclinical phase to the clinical batch continued to be helpful.
They also mentioned how the IUH learning environment had a beneficial effect on their
confidence levels, especially with regard to their faith in passing the course.

These students learned that the teaching strategies and study approaches they had used during
the preclinical phase remained effective when they transitioned to the clinical phase. This
consistency in their learning strategy demonstrated that the techniques they had honed earlier
in their academic careers were flexible and well-suited to the requirements of their present
schoolwork.

We want to use this insightful input to influence and direct our actions focused on
strengthening and improving our EE in response to these findings. We acknowledge the need
for pedagogical change, with an emphasis on implementing more learner-centric strategies and
encouraging honest and fruitful teacher-student interactions. Our goal is to establish a learning

56
atmosphere that not only conveys information but also supports the holistic growth of our
students by encouraging cooperation, critical thinking, and problem-solving abilities.

The study's findings show that all of the participants' perceptions of the educational
environment (EE) are typically positive. It's noteworthy that kids recognized this environment's
numerous advantages. They expressed gratitude for the professors' knowledge, indicated
contentment with their interactions with their peers, and showed a high degree of confidence
in their capacity to do well on exams.

The report did, however, also point out several areas that needed improvement. Notably, some
students described encountering authoritarian teaching styles, an excessive emphasis on
factual learning and rote memorization, a propensity for overly teacher-centered instructional
methods, sporadic instances of teacher annoyance, and a recognized need for a support system
to help students cope with stress.

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