Joy L. Higgins,,Omaha,NE,Adam . Reinhardt,,Omaha,NE,Gary L. Beck,,Omaha,NE
LCME Standard 3.5 requires periodic assessment of student learning environments. The Dundee Ready Education Environment Measure (DREEM) questionnaire has shown discriminant and concurrent validity and test-retest reliability (Med Teach 2005; 27:343) and sensitivity to individual perceptions of learning environments (Med Teach 2005; 27:343). Studies indicated DREEM along with open-ended responses generated data useful for improving teaching sites (Edu for Health 2007: 20). The university general pediatric clinic has been rated by students as disorganized and a poor learning environment. Perceptions of the learning environment were expected to improve with a change in management whose stated goals were to support student education.
To determine if the university pediatrics clinic improved as a teaching site under the new management structure.
In January 2013, the clinic came under new management by a private physicians group. During 2011-2012 and 2013-2014, students anonymously completed DREEM after a 2-week outpatient deployment during the 8-week clerkship. DREEM asks 50 questions, rated from Strongly Agree=0 to Strongly Disagree=5. Students wrote suggestions for improving the rotation. Results were grouped by academic year and analyzed using Wilcoxon Rank-sum test. An immersion/crystallization framework was used to identify themes. Two authors independently coded suggestions, then discussed the themes to reach a consensus.
No statistical differences were noted on DREEM subscales between academic years, although subscale ratings improved after the management change. Themes for 2011-2012 focused primarily on better orientation (better expectations of preceptors) and the patient care environment (lack of continuity with preceptors, too many learners). In addition to these in 2013-2014 more structured teaching and a sense of being included in patient care decisions were noted.
Discussion and Conclusion
Prior to 2013, students expressed dissatisfaction with their clinic experiences based on what they perceived as a disorganized and slow clinic. DREEM did not demonstrate statistically significant differences after the management change. Students’ comments provided insight about persistent problems. In 2011-2012 and 2013-2014, thematic analysis indicated a lack of continuity with faculty and lack of clear expectations. DREEM demonstrated a slight improvement after the management change, but the comments provided more details about areas for improvement.