Moroccan medical students’ perceptions of their educational environment

This study aimed to assess students’ perceptions of their educational environment in the Faculty of Medicine and Pharmacy of Rabat, Morocco, using the Dundee Ready Educational Environment Measure (DREEM). A cross-sectional survey was conducted in the Faculty of Medicine and Pharmacy of Rabat, Morocco, in which medical students’ perceptions of their educational environment were assessed using the DREEM criteria during the 2013-2014 academic years. The DREEM inventory encompasses 50 items divided into five subdomains: perceptions of learning, perceptions of teaching, academic self-perceptions, perceptions of atmosphere, and social self-perceptions. The DREEM has a maximum score of 200, which would correspond to a perfect educational environment. The mean scores (±standard deviation) of students’ responses were compared according to their year of study and gender. The responses of 189 postgraduate medical students were included. The mean total DREEM score was 90.8 (45.4%). The mean total scores for five subdomains were 21.2/48 (44.2%), 21.8/44 (49.6%), 13.1/32 (40.9%), 19.0/48 (39.6%), and 15.6/28 (55.7%) respectively. Female students reported higher perceptions of teaching scores than males (P=0.002), and students in their fifth year of study reported significantly higher social self-perceptions scores than those in their fourth year (P=0.03). In this study of the oldest faculty of medicine in Morocco, students perceived the educational environment as having many problems.

Educational environment is an important factor in determining the effectiveness and success of a medical school curriculum [1].Throughout the world, medical educators are attempting to reform the educational environment of medical schools.The evaluation of educational environments provides a baseline for instituting measures leading to curricular reform [2,3].The medical curriculum in the Faculty of Medicine and Pharmacy of Rabat is traditional and discipline-based.It occurs in three cycles, with a total duration that varies from seven years for general medicine to 12 years for specialties.The undergraduate curriculum is as follows: undergraduate preclinical sciences in the first and second years; postgraduate clinical sciences in the third, fourth, and fifth years; a full-time externship at the University Hospital during the sixth year; and a seventh-year internship in a peripheral hospital or another institution in the health system.At the end of the seventh year, once clinical competency has been established, the student defends his or her thesis.In Morocco, the most recent reform of medical education took place in 1983.The Faculty of Medicine and Pharmacy of Rabat (FMPR) is the oldest in Morocco.Students' perceptions of the educational environment are a veritable mirror of the services offered by the Moroccan medical educational system.Assessing the learning http://jeehp.orgJ Educ Eval Health Prof 2015, 12: 47 • http://dx.doi.org/10.3352/jeehp.2015.12.47 environment is very important for identifying both the strengths and weaknesses of the system, and is a prerequisite for embarking on an effective program of reforms.However, no assessment of students' perceptions of the learning environment has been carried out in Morocco, either in a faculty of medicine or in any other university program.It aimed to assess students' perceptions of the educational environment in the FMPR, using the Dundee Ready Educational Environment Measure (DREEM).
We conducted a cross-sectional questionnaire-based survey, in which data were collected from students in the FMPR during the 2013-2014 academic years.The questionnaire was given to postgraduate students in their fourth and fifth years of medical study.All students present in the class during a routine lecture were included.The information sheet gave a brief introduction of the aim of the study and of DREEM.The questionnaire was anonymous and was voluntarily self-administered.Since it was anonymous, a separate consent form was collected.The study protocol and consent procedure were approved by the Rabat Ethics Committee for Biomedical Research.The perceptions of medical students in this study were assessed using the validated DREEM tool.The students were asked to read all the statements and to answer each question using a five-point Likert scale.Higher DREEM scores indicate more positive evaluations.The maximum score of 200 would correspond to a perfect educational environment.A score less than 50 indicates a very poor learning environment, a score of 51-100 indicates a considerable amount of problems, a score of 101-150 is 'more positive than negative, and a score greater than 151 indicates an excellent learning environment.The inventory encompasses five subdomains: perceptions of learning, perceptions of teaching, academic self-perceptions, perceptions of atmosphere, and social self-perceptions.The scores for each item were computed as follows: 4, strongly agree; 3, agree; 2, unsure; 1, disagree; and 0, strongly disagree.The scores for statements relating to negative attributes were computed in the reverse order.Reliability analysis was applied to determine the internal consistency of the DREEM inventory.The internal consistency of items was evaluated using Cronbach's alpha.The Cronbach's alpha value for DREEM in this study was 0.79.Descriptive statistics were computed to evaluate the distribution of study participants according to gender and year of study.Analysis of variance was performed to analyze the variance of group means.The mean scores of male and female students were compared, and the Student' s t-test was used to identify statistically significant differences.In this study, Pvalues less than 0.05 were considered to indicate statistical significance.PASW SPSS ver.18.0 (SPSS Inc., Chicago, IL, USA) was used for data analysis.
A total of 231 questionnaires were distributed; however, 10 students refused to participate and many other questionnaires were missing some responses.Thus, the responses of 189 students were ultimately included in the study (response rate, 82%).Of the students included in the study, 68.3% were female, 31.7% were male, 34.9% were in their fourth year of study, and 65.1% were in their fifth year of study.The mean total DREEM score and mean scores of the five subdomains are presented in Table 1.The total mean DREEM score was 90.8 out of 200.More than two thirds (71.5%) of the students reported that their learning environment had many problems.Table 2 compares the mean DREEM subdomain scores according to year of study and between genders.Female students reported better perceptions of teaching than male students (23.4 ± 5.4 vs. 20.5 ± 4.9; P = 0.002).Students in their fifth year of study reported significantly better social self-perception scores (16.1 ± 3.4 vs. 14.9 ± 3.1; P = 0.03) than those in their fourth year.The overall mean DREEM score in this study was 90.5/ 200.Since the mean scores reported here can be interpreted as providing useful diagnostic information about the strengths and weaknesses of the educational environment as perceived by the student respondents, analyzing our results may help determine the specific curriculum changes that can be made to enhance the perceived educational environment.This study provides factual data about perceptions of the learning environment among medical students in Morocco, as well as guidance about what needs to be addressed in the curriculum.
In conclusion, students perceived the educational environment of FMPR as having many problems.This was the first study to evaluate the educational environment in the Moroccan educational system, and our results should be used to support the decisions of educators in determining priorities for reforms, as well as serving as a template for evaluating the effectiveness of reforms.Further continuous assessments of the learning environment are needed to evaluate the effectiveness of changes once they are introduced.

SUPPLEMENTARY MATERIAL
Audio recording of the abstract.

Table 2 .
Analysis of variance between different years of study and gender for the Dundee Ready Educational Environment Measure subdomains from 189 medical students during the 2013-2014 academic years in Faculty of Medicine and Pharmacy of Rabat, Morocco