Assessment two stage at 2011 and 2015

Assessment of the educational environment is an important element of program evaluation.15,42 We have used DREEM to compare the perceptions of midwifery, nursing, radiology, operation room nursing, laboratory sciences, medical emergency, and anesthesia students of RUMS in two stage at 2011 and 2015 concerning their educational environment.

      The overall mean  DREEM score for our subjects between first and second stage of survey was found to be improved 113.5/200 (56.9%; 95% CI: 55.67%–57.03%) .But the mean DREEM at both stages were well within the range (101–150), that is thought to indicate a “more positive than negative” perception of environment.43 Although this changes is considerable after four years but there is opportunity to reach maximum score with positive intervention for prompt the educational environment.There are also growing in scores of five DREEM domains, the greatest progress was seen in Students Academic self -Perception(SASP) (   %) and Students Social Self- Perception(SSSP) ( %).This increasing may revealed that some  emotional  factors effects on educational environment.   ??????

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Paramedical College has higher means difference scores than the nursing and midwifery College in total score respectively. The differences in the total DREEM score may be attributed to several factors related to the curriculum, faculty profile, subjects offered, types of academic requirements, different educational programs, and teaching methods together with socio-demographic characteristics of studied students.


    The operation room nursing, anesthesia, and laboratory sciences students had higher mean scores difference than the other courses. DREEM overall scores for a Chinese nursing school40 and medical schools in Sri Lanka, Nepal, Nigeria, Saudi Arabia, the UK (Birmingham), Chile, Kuwait, Sweden, Jamaica, Trinidad, Dental School of Malaysia and International Medical University(Malaysia),44 University of British Columbia Medical School,4 India45 and Australia,26 the International University of Management (Bachelor of Nursing),46 Indonesian nursing students,47 and similar studies20,31,32,43,48–51 were in the same range (score 101–150), and based on the DREEM interpreting guide , are considered to be more positive than negative.There are also a few studies that have confirmed higher overall mean DREEM scores. A Malaysian private nursing college52 and a nursing school in China reported high mean DREEM scores of 134.42 and 131.26, respectively.53 A series of UK learning environment studies recorded a high mean DREEM score of 142.91.35 Reasonably high mean DREEM scores were found in a study in the UK at different teaching hospital centers (139.20)42 and in seven major medical sciences courses at Monash University in Australia (137.3; 68.7%).26 The results of these studies propose that the nursing, midwifery, and paramedical schools of RUMS have achieved a more positive than negative status, which is just a level lower than the highest category of achievable scores. Students of innovative curricula have a tendency to show more satisfaction with their educational environments compared to students of traditional curricula. Higher DREEM scores tend to indicate more student-centered curricula, while those offering conventional curricula commonly score less than 120 out of 200.11,15,31

     The score descriptors2 that define the level of improvement descriptors for the subscale scores of the actual DREEM, indicate that students’ perceptions of learning were positive and that their perceptions of the teachers were moving in the right direction. Their academic self-perception was found to be more positive, their perception of the atmosphere was that “a more positive atmosphere”, and the students’ social self-perception was “not too bad”. Our sample’s mean perceptions expressed as a percentage were between 53.447%–56.875% over five domains. These mean scores indicate that there was room for improvement in the aspects being measured by the DREEM in their school. This is similar to those in the validated DREEM study.54 The students perception can be used to initiate change and improvement. Medical education is very expensive and academic failure is wasteful both to society and to the individual. Consequently, we need to ensure that the environment is as conducive as possible to learning, thus reducing the risk of academic underachievement.

The significant differences between female and male students at both stage suggests that perceived factors such as curriculum, structure, focus and goals are different for females and males. There was a statistically significant difference between sexes in the overall DREEM score, and in terms of the individual subscales, learning, academic, and social perceptions were the areas that showed the greatest difference between sexes, which is similar to the results from studies conducted in Australia,26 Sweden,55Nigeria,39 and Dundee Medical School, where female students’ perceptions were more positive.31Conversely, our results are statistically significantly different to those of studies carried out in the Middle East,23,56 Trinidad,51 Sri Lanka,50 and in India,45 which reported no significant sex differences between females and males.54 This suggests that the female students perceived factors such as curriculum, structure, focus, and goals more positively than their male counterparts and that the female students appeared to be happier than the males. It is not clear the extent to which this trend, and indeed, the trend that females perceived their course environments more favorably overall, can be generalized to other institutions. On the one hand, there is long standing evidence that both sexes couldn’t perceive their courses in an almost identical way and have the different learning style.,57 which could describe alterations in the way they learn, and the environments generally, are perceived in the present study or can probably be accounted .

for by the different types of curricula.58

students Perceptions of learning, the teacher, and atmosphere varied according to the students’ year-level of enrollment. In our results at both stage, students in first year had the highest mean score than The second, third, and fourth year students’, that in second stage was higher than first stage ; these difference are in line with other study .,46 Mohd Said et al. stated an inclination for reduced scores in the senior years. It was recommended that this trend could be due to the fact that students genuinely believed that the learning environment was deteriorating, and thus were mentally tired of being a student and looking forward to leaving student life. The students’ perceptions in first year could have been high initially, and dissatisfaction may have crept in as the novelty of joining a health science student body wore off unlike in other studies;26,32 this difference does not follow a consistent pattern year to year. Further investigation of each course separately, and perhaps individual items, is required to help clarify these differences.

The impression that teachers are experienced and well-prepared for their classes but are too authoritarian and strict has also been listed by other studies.4,13,38,46,59 Assessments, which are an integral part of the educational process, need to be carefully planned and executed. They need to have clear objectives with provision for feedback so that remediation is available to those students who underperform and require additional support and monitoring. The experience of stress symptoms, eg, hostility, depression, and other debilitating effects, has been documented. The college environment is not the only source of stress; which is also influenced by the students’ personality type, sex, sociocultural differences, and emotional intelligence, etc. A formal or informal support system could be developed so as to make the students more “positive” and more in “control of their education”, which would help alleviate their stress59 and make the learning experience more enriching and fulfilling.60

While this study offers a appreciated awareness into the course environment as perceived by RUMS undergraduate students, it would be useful to conduct similar study at another universities as well as at international institutions. Other limitations should also be acknowledged. Firstly, individual items were not analyzed, and qualitative data were not collected in order to more deeply address specific problems or highlight strengths within the university or particular courses. Paramedical College has higher means difference scores than the nursing and midwifery College at 2011 and 2015 in total score respectively. The differences in the total DREEM score may be attributed to several factors related to the curriculum, faculty profile, subjects offered, types of academic requirements, different educational programs, and teaching methods together with socio-demographic characteristics of studied students.

Comparison of The mean scores (total and its five subscales) at 2015 was higher than 2011.The significant differences between both stages of study suggests that perceived factors such as curriculum, structure, focus and goals are different for females and males. Both sexes couldn’t perceive their courses in an almost identical way and have the different learning style. A previous study in Saudi Arabia revealed the learning style did not vary with student’s sex 30. Differences in the total DREEM scores and mean scores for sub-domains between male and female students have been reported in other studies 31, 32, 13,33,and 27 although the results have not been consistent regarding whether either gender has higher mean scores for the total score, sub-domain scores, or individual DREEM item scores. This variation in the scores may be related to the gender profile of the respondents and may warrant further study.

 The mean scores of the total scale and its five subscales vary with study year at both stage of survey (2011 v 2015). All students are exposed to the same curricula, academic requirements and teaching methods together with the similarity of their socio-demographic characteristics. This disagrees with   in Gaza. Previous studies reported consistent findings regarding which study year reported better EE. Most of studies found that freshmen students reported better either total DREEM scores or some of its subscales than seniors 25, 13, 29,  28. However, the reverse was reported from Saudi Arabia 26  and Philippines27.

 Even though the fact that traditional didactic courses are still taught in the two colleges studied, paramedical faculty has higher means of scores than the nursig & midwifery  College in total score  is reflects the changeability of the EE




  Most of the DREEM domains were perceived improved  as positive by the students indicating a healthy educational environment in the Colleges. These can be much more improved with the ongoing accreditation program. Some problematic areas identified should be looked into for exact causes and rectification. Recommendations The results indicate that there is need for further enhancement in EE for more effective learning. The problem areas require remedial steps.The findings of this study are important for the development of nursing education curricula in Egypt.Corrective measures are to be taken to address the areas of weakness in the EE. DREEM surveys need to be repeated periodically to monitor the situation after implementation of any corrective measures.In depth qualitative research relating to the items that were scored as unsatisfactory i.e. negative items may help to learn what the main problems are and how they might be addressed. Study limitations: Nursing colleges of private universities were not included as they have different educational system and admission policy. The self-report nature of the study may contribute to bias.Qualitative data was not collected in order to address the specific problems more deeply or highlight strengths within the university or particular courses.Also the study offers no comparison with the students’ expectation of learning environment. Conflict of interest: None


This study suggests that students enrolled in the medical sciences courses at RUMS generally hold positive perceptions toward their course environment. Superior perceptions held by females and variations between year levels are consistent with results from other research. These, as well as differences between courses and study pathways, should be further investigated by analysis of specific items and subcohorts.

The DREEM gives a clear indication of the priorities for reform of the curriculum. These results can also serve as a baseline for a longitudinal quality assessment of students’ perceptions for the colleges of RUMS, and it is necessary for improving the educational environment quality and effectiveness of an educational program in students learning, it enhances the ability for learning and makes a significant interest to student learning, motivation and learning outcomes, academic progress, and sense of well-being.