Council on Medical Student Education in Pediatrics


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COMSEP Meeting in Ottawa, ON

Poster Presentation:

Mixed Methods Evaluation of University Hospital Learning Environment

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.