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Year : 2017  |  Volume : 20  |  Issue : 8  |  Page : 958-963

Evaluation of the learning and teaching environment of the Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu Campus

1 Department of Ophthalmology, Faculty of Medical Sciences, University of Nigeria, Enugu Campus, Nigeria
2 Department of Ophthalmology, Federal Teaching Hospital, Abakiliki, Ebonyi State, Nigeria

Date of Acceptance16-Mar-2017
Date of Web Publication11-Sep-2017

Correspondence Address:
O Okoye
Department of Ophthalmology, Faculty of Medical Sciences, University of Nigeria, Ituku Ozalla, Enugu, PMB 01129
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njcp.njcp_414_16

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Purpose: The study aimed at evaluating the learning and teaching environment of undergraduate students of the Faculty of Medical Sciences, University of Nigeria. Methods: The study was a descriptive, cross-sectional survey. The Dundee Ready Education Environment Measure (DREEM) questionnaire was self-administered to the final year medical students during the second semester of 2013/2014 academic year. The 50-items of the questionnaire were sub-divided into five sub-groups: perception of learning, perceptions of teachers, academic self-perceptions, perceptions of atmosphere, and social self-perceptions. Results: The questionnaire was completed by 128 out of the 139 students (92.1%). Of the maximum score of 200, the total mean score was 101.82 ± 20.36 SD. The mean ± SD score of students' perception of learning was 25.97 ± 4.18 (maximum score, 48). The mean ± SD score of teachers was 24.40 ± 4.74 (maximum score, 44), whereas that of students' academic self-perception, perception of atmosphere, and social self-perception was 19.96 ± 5.29 (maximum score, 32), 19.02 ± 7.69 (maximum score, 48), and 11.86 ± 4.22 (maximum score, 28), respectively. Conclusion: The overall mean score shows that the students' perception of their learning environment was more positive than negative according to the practical guide of McAleer and Roff on the interpretation of DREEM questionnaire. However, there are problematic areas revealed by this study that will inform policy formulation and remedial intervention.

Keywords: Environment, learning, medical students, nigeria, teaching

How to cite this article:
Okoye O, Ezisi C N, Ezepue F U. Evaluation of the learning and teaching environment of the Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu Campus. Niger J Clin Pract 2017;20:958-63

How to cite this URL:
Okoye O, Ezisi C N, Ezepue F U. Evaluation of the learning and teaching environment of the Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu Campus. Niger J Clin Pract [serial online] 2017 [cited 2020 Nov 30];20:958-63. Available from:

   Introduction Top

The assessment of the learning and teaching environment is a vital and effective means of acquiring student feedback that ultimately benefits students, teaching staff, and university administrators alike. In the field of education, a curriculum is broadly defined as the totality of student experiences that occur in the education process.[1] The curriculum's most significant manifestation is the educational and organizational environment, which encompasses everything that happens at the educational institution. There is a proven connection between the environment and students' achievement, satisfaction, and success.[2]

Research surveys evaluating the impact of students' perception fall within the 3P model proposed by Biggs.[3] This model conceptualizes the learning process as an interactive system comprised of three sets of variables: the learning environment and student characteristics (presage), students' approach to learning (process), and learning outcomes (product). Furthermore, this model proposes that presage factors (for example, perceptions of the learning environment) can also directly influence learning outcomes. According to Bloom, the learning environment is a network of physical, social, as well as intellectual forces and factors that surround, engulf, and present a challenge to individual students.[4]

According to Genn, “Considerations of the climate in the medical school, along the lines of continuous quality improvement and innovation, are likely to further the medical school as a learning organization with the attendant benefits.”[2] The Dundee Ready Education Environment Measure (DREEM) was developed to assess such an environment and is widely used to evaluate the educational climate in health and medicine.[5] Several investigators within [6] and outside Africa [7] have reported variable favorable and positive findings with regard to the perceptions of medical students' of their learning environment by using DREEM as the research instrument. However, to the best of our knowledge, no data are currently available in Nigeria on the perception of medical students of their learning and teaching environment. This study aims to highlight scientifically some of the problems with the teaching environment that faculty had over the years observed/known anecdotally as well as seeking to fill the gap in information by making both a theoretical and practical contribution to the existing literature on this topic with a focus on Nigeria. The findings of this survey will be useful for evidence-based interventional/remedial policy formulation and effective implementation by stakeholders in medical education, which in turn will improve the quality of academic learning and output among this subset of university students in Nigeria.

   Methods Top

Study participants

The University of Nigeria was founded in 1955 and was open for academic activities in 1960. Located in the southeastern geo-political zone of Nigeria, it comprises the Nsukka and Enugu campuses. The faculty of medical sciences is one of the five faculties at the College of Medicine, University at Enugu. The College of Medicine runs a 6-year (divided into two semesters) program for medical and dental students, which is divided into an initial 3 years of pre-clinical studies and 3 years of clinical studies. It is headed by the Dean at the faculty level and a Provost at the college level.

A cross-sectional descriptive survey was performed to assess the medical students' perception of their learning and teaching environment. Students who had spent a minimum of 2 years at the Faculty of Medical Sciences, University of Nigeria, and who consented to participate in the study were included. The study population consisted of all final year (6th year) medical students on block posting in the second semester of the 2013–2014 academic year.

Study instrument

The study instrument was the English version of the DREEM questionnaire [Appendix 1] [Additional file 1]. DREEM is a questionnaire with 50 items that assesses five domains:[8] students' perception of learning (12 items, with a maximum score of 48), students' perception of teachers (11 items, with a maximum score of 44), students' academic self-perception (8 items, with a maximum score of 32), students' perception of the atmosphere (12 items, with a maximum score of 48), and students' social self-perception (7 items, with a maximum score of 28). Each item is rated on a five-point Likert scale from 0 to 4, where 0 = strongly disagree, 1 = disagree, 2 = unsure, 3 = agree, and 4 = strongly agree. There are nine negative items (items 4, 8, 9, 17, 25, 35, 39, 48, and 50), which are corrected by reversing the scores; thus, after correction, higher scores indicate disagreement with the corresponding item. Items with a mean score of ≥3.5 are considered to represent “true positive points” of the environment; those with a mean score of ≤2 are considered to indicate problem areas; scores in between these two limits indicate aspects of the environment that could be enhanced. The maximum global score for the questionnaire is 200, and the global score is interpreted as follows: 0–50 = very poor; 51–100 = many problems; 101–150 = more positive than negative; 151–200 = excellent.[2]

After the approval by the Ethics and Health Research Committee of the University of Nigeria Teaching Hospital, Enugu, DREEM, along with a respondent information sheet, was handed to all the students present in the class during a routine lecture. The information sheet gave a brief introduction of the aim of the study and of DREEM. The questionnaire was anonymous; it was to be voluntarily self-administered. Since it was anonymous, a separate consent form was not collected. In the event that questionnaires were returned filled, consent was implicit; non-consent was presumed when questionnaires were returned blank. The data were handled and stored in accordance with the tenets of the Declaration of Helsinki (1964, amended in 2008).

Statistical analysis

The data were entered into a Microsoft Excel spreadsheet (Microsoft Co., Redmond, WA, USA), and Statistical Package for Social Sciences version 17.0 (SPSS Inc., Chicago, IL, USA) was used for analysis. The mean and standard deviation were calculated for all of the items. For each of the five domains, scores were calculated as the cumulative total of individual responses for all of the items in that domain; for the comparison of the domain scores, the scores were expressed as the percentage of the maximum score possible.

   Results Top

Of the 139 students present, 129 returned a completed form, so the participation rate was 92.1%.

The total mean score was 101.82 ± 20.36 (maximum score, 200). The mean score for students' perception of teaching/learning was 25.97 (maximum score, 48). The mean score for students' perception of teachers was 24.40 ± 4.74 (maximum score, 44), whereas that for students' academic self-perception, perception of the atmosphere, and social self-perception was 19.96 ± 5.29 (maximum score, 32), 19.02 ± 7.69 (maximum score, 48), and 11.86 ± 4.22 (maximum score, 28), respectively.

[Table 1] shows the interpretation of the mean scores of the DREEM subscales.
Table  1: Interpretation of the scores for the DREEM subscales

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[Table 2] shows a profile of the problem areas.
Table  2: Profile of problem areas  (mean≤2) of learning environment among the medical students

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None of the items have mean scores which indicated that they represented “true positive points” of the environment.

   Discussion Top

Obtaining student feedback is not only a relatively simple procedure, but is also the one that has considerable credibility for several reasons. First, a number of raters provide their input, so its reliability is usually quite high.[9] Second, ratings are provided by those who have consistently observed the teacher over many hours, so they are based on representative behavior. Finally, observations about student learning, the object of instruction, are made by those who have been personally affected and therefore have high face validity.[9]

With regard to the present survey, students were keen on completing the questionnaire, as evidenced by the high participation rate of 92.1%. This is lower but comparable to that of a similar study conducted at Suez Canal University (96.9%).[6] The high participation rate in both studies is probably a result of the brief explanation of the purpose of study that was provided to the students and their belief that the study outcomes could influence a positive change in their learning environment. This is in contrast to the low response rate of 44.6% reported in a similar study at King Saud University.[10] The low participation in their study was probably because the students were afraid of participating and of its impact on their exam results (as a reflection of the authoritarian atmosphere in the school, evidenced by the lower DREEM score of 89.9).[10] Thus, optimal research atmosphere enhanced by creating confidence among study participants is suggested to improve participation rates especially in students-related surveys.

The total mean DREEM score in this study (101.82) is interpreted according to the practical guide by McAleer and Roff as being more positive than negative (101–150).[11] This is lower than the overall DREEM scores reported for the Faculty of Medical Sciences at Suez Canal University in Egypt (113.3),[6] Nepalese Medical School (130),[12] Dundee Medical School (139),[13] and Miles and Leinster United Kingdom (142.9).[14] On the other hand, our DREEM scores were higher than those reported at King Saud University Medical School (89.9).[10] Overall, higher values of DREEM score are obtained in the medical schools in the west [13],[14] when compared with those of Africa [6] and middle east.[10],[12] This could be a reflection of the difference in the socio-economic status of the two groups that in turn can influence the quality of human and infrastructural resources available to the institutions for optimal teaching and learning environment.

In this study, the subscale scores indicate that four of the five items were equally perceived to be moving in the right direction and perceived as more positive than negative. However, the scores for subscale 5 (social self-perception) indicated that the students were not very happy with this aspect of the environment. This is in agreement with the findings reported for medical students at Suez Canal University, Egypt, according to which the social self-perception score was 14.2.[6] Moreover, the College of Medicine, King Saud University, reported that the social perception subscale score was the lowest, with a mean score of 13.[10] Several other related studies have reported the academic self-perception subscale to have the lowest score.[12],[15] All these findings may reflect the burden of the heavy academic curriculum in medical schools. Institutional policy changes and implementation that will encourage religious, sporting, and entertainment activities among medical students and provide a student-friendly curriculum are strongly recommended.

In this study, no individual item scored more than 3.5. This means that no item qualified as a “true positive point,” according to the practical guide of McAleer and Roff.[11] Although some items were interpreted as “aspects of the environment that could be enhanced,” a total of 19 items scored less than 2 and were interpreted as “problem areas” [Table 2]. Out of the 19 items, three belonged to subscale 2 (students' perception of teachers), one belonged to subscale 3 (academic self-perception), ten belonged to subscale 4 (perception of the atmosphere), and five belonged to subscale 5 (social self-perception). The three lowest scores of 0.81 (enjoyment outweighs the stress of studying medicine), 0.88 (there is a good support system for students who are stressed), and 0.88 (I am rarely bored on this course) are all stress-related problem areas. In addition, the low score obtained in subscale 2 could be due to the defective instructional method and teacher's attitude that potentially can precipitate a stressful atmosphere for the students. Clinical teachers need to be trained in providing constructive feedback so that students are encouraged to take responsibility for their own learning.[16],[17] Ability to give a timely and specific feedback is an important skill that sets students on the right path to learning. Excessively harsh criticism, on the other hand, or the absence of feedback of any kind, is considered to be discouraging and damaging to students' self-confidence.[18] At a glance, most problem areas are as seen in subscale 4 border on the atmosphere of study. As collaborated by Youssef et al., these findings reveal an obviously dysfunctional medical educational system that underscores the contradiction to our innovative educational pattern, with an overemphasis on factual learning and disconnect from the complaints of the students.[6] A comprehensive policy review involving all educational stake-holders (students, teachers and the government) that targets specific problem areas is hereby suggested.

Although this study has concentrated on a single center, single-class evaluation of students' perception of learning and the teaching environment at a medical school/faculty of a Nigerian University, a multi-center study comparing different classes and centers in addition to the direct impact of these indices on academic performance will be worthwhile.

   Conclusion Top

The DREEM mean score for measurement of the learning and teaching environment at the medical school of the University of Nigeria Enugu was “more positive than negative.” Several individual items were interpreted as problem areas in four out of the five subscales of the study instrument. Therefore, there is a need for interventional policy formulation and implementation such as the provision of leisure and play facilities and the adjustment of medical school academic program to effectively address these problem areas, which will in turn help to improve the learning and teaching environment for medical students at this institution, and subsequently improve academic performance as well.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Wiles J. Leading Curriculum Development. California: Corwin Press; 2009.  Back to cited text no. 1
Genn JM. AMEE Medical Education Guide No 23 (part 1): Curriculum, environment, climate, quality and change in medical education - A unifying perspective. Med Teach, 2001;23:337-44.  Back to cited text no. 2
Biggs JB. Teaching for Quality Learning. Buckingham, U.K.: Society for Research into Higher Education and Open University Press; 1999.  Back to cited text no. 3
Bloom BS. Stability and Change in Human Characteristics. New York, USA: John Wiley and Sons; 1964.  Back to cited text no. 4
Miles S, Swift L, Leinster SJ. The Dundee Ready Education Environment Measure (DREEM): A review of its adoption and use. Med Teach 2012;34:e620-34. doi: 10.3109/0142159X.2012.668625. Epub 2012 Apr 3.  Back to cited text no. 5
Youssef WT, Wazir YME, Ghaly MS, Khadragy RAE. Evaluation of the learning environment at the Faculty of Medicine, Suez Canal University: Students' Perceptions. Intellect Prop Rights: Open Access 2013;1:102. doi: 10.4172/ipr. 1000102.  Back to cited text no. 6
Shankar PR, Dubey AK, Balasubramanium R. Students' perception of the learning environment at Xavier University School of Medicine, Aruba. J Educ Eval Health Prof. 2013;10:8.  Back to cited text no. 7
Roff S, McAleer S, Harden RM, Al-Qahtani M, Ahmed AU, Deza H, Groenen G, Primparyon P. Development and validation of the Dundee Ready Education Environment Measure (DREEM). Med Teach 1997;19:295-9.  Back to cited text no. 8
Hoyt DP, Pallet WH. Appraising teaching effectiveness: Beyond student ratings. IDEA paper, 1999 no. 36. IDEA Center, Center for Faculty Evaluation and Development, Kansas State University.  Back to cited text no. 9
Al-Ayed IH, Sheik SA. Assesment of the educational environment at the College of Medicine of King Saud University, Riyadh. East Mediterr Health J 2008;14:953-9.  Back to cited text no. 10
McAleer S, Roff S. A practical guide to using the Dundee Ready Education Measure (DREEM). AMEE Medical Education Guide No. 23 Curriculum, environment, climate, quality and change in medical education; a unifying perspective. Association of Medical Education in Europe, Dundee, UK. 2002.  Back to cited text no. 11
Roff S, McAleer S, Ifere OS, Bhattacharya S. A global diagnostic tool for measuring educational environment: Comparing Nigeria and Nepal. Med Teach 2001;23:378-82.  Back to cited text no. 12
Varma R, Tiyagi E, Gupta JK. Determining the quality of educational climate across multiple undergraduate teaching sites using the DREEM inventory. BMC Med Educ, 2005;5:8.  Back to cited text no. 13
Miles S, Leinster SJ. Medical students' perception of their educational environment expected versus actual perceptions. Med Educ 2007;41:265-72.  Back to cited text no. 14
Al Hazmi A, Al Hyiani A, Roff S. Perceptions of the educational environment of the medical school in King Abdul Aziz University, Saudi Arabia. Med Teach 2004,26:570-3.  Back to cited text no. 15
Veerapen K, McAleer S. Students' perception of the learning environment in a distributed medical programme. Med Edu Online 2010,15.doi. 10.3402/meoVi5io. 5168.  Back to cited text no. 16
Unnikrishnan B, Rekha T, Mithra PP, Kumar N, Reshmi B. Perceptions of medical students about their educational environment in Community Medicine in a medical college of coastal Karnataka. Indian J Community Med. 2012;37:130-132.  Back to cited text no. 17
Tokuda Y, Goto E, Otaki J, Jacobs J, Omata F, Obara et al. Undergraduate educational environment, perceived preparedness for postgraduate clinical training, and pass rate on the National Medical Licensure Examination in Japan. BMC Med Educ 2010;10:35.  Back to cited text no. 18


  [Table 1], [Table 2]


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