Perception of 1 st MBBS students about educational environment through ‘DREEM’ questionnaire

A S T Background: In an undergraduate (UG) medical education program, the educational environment is a critical factor of effective outcomes. Because it is a proven approach for this assessment in medical schools, the Dundee Ready Education Environment Measure (DREEM) was employed in this study. Aim and Objectives: 1. To assess the student’s perception of the educational environment using the Dundee Ready Educational Environment Measure (DREEM) questionnaire among 1st-year undergraduate medical students. 2. To identify the strengths and weaknesses in student’s educational environment. Materials and Methods: A cross-sectional study was carried out among ﬁrst-year medical students. To obtain student perceptions of the educational environment, a widely accepted DREEM questionnaire was employed. The DREEM questionnaire is divided into ﬁve sections, each of which has 50 statements that are rated on a ﬁve-point Likert scale (0–4). The questionnaire was distributed to consented individuals (n=150) after receiving ethical approval. The ﬁlled questions were collected and statistically evaluated. The data were presented as mean and standard deviation, frequency, and percentages. The responses were analyzed and interpreted using McAleer and Roff’s practical recommendations. Results: There was a 100% response rate. The average DREEM score was 124.9 (cid:6) 50 (62.46%). Among the ﬁve DREEM dimensions, students’ perceptions of learning received the highest score while students’ perceptions of the environment received the lowest %).Statements have good friends in this college”, social life is good” and am conﬁdent about passing this year” scored 3 of 4 points. Conclusion: more than negative according the total


Introduction
The "educational environment," which encompasses everything that takes place in the classroom, department, faculty, or university, is crucial to the success of undergraduate medical education. 1,2 The educational learning environment. It is vital to first understand students' perceptions of the educational environment before developing and implementing a comprehensive curriculum. It will also help stakeholders and teaching faculty reflect on their activities and take corrective action so that a highquality educational environment can be maintained.
Students' perceptions of the educational environment in medical schools have been examined and analyzed using a number of ways by medical educators. The Dundee Ready Education Environment Measure (DREEM) is a widely used and internationally validated study tool for assessing students' perceptions of their learning environment. 3 As medical educators, we are continuously considering how to improve medical education or curriculum by adding or changing instructional approaches.
Medical students participate in a variety of learning activities in the medical college's surroundings. 4 Students' achievement, happiness, motivation, and success are all influenced by their educational environment, according to studies conducted around the world. [5][6][7] In India also, various agencies like the National Assessment and Accreditation Council have emphasized the educational environment as one of the important criteria in improving the quality system of an institution. 8 World-wide medical educators are making an effort to reform the educational environment to make it studentfriendly without compromising the standards and the quality of learning. 9 The Dundee Ready Educational Environment Measure (DREEM) is a highly generic and internationally validated study tool used to assess student perception about their educational environment. 10 Zydus Medical College being a rural medical college from Dahod, Gujarat strives to provide outstanding competent facilitators and supportive infrastructure. So far, a review of the literature has revealed that very few researches have been conducted in this portion of the state. Our institute hasn't even conducted a study using DREEM surveys.
However, we have relatively little information about student views on these issues. This motivated us to assemble baseline data on students' perceptions of our medical institute's educational environment in order to identify areas of strength and weakness, as well as chances for improvement.
Hence, we planned a study aimed to assess the Perception of 1st MBBS Students about the Educational Environment at a single medical college, using the 'DREEM' Questionnaire and also to identify the strengths and weaknesses in student's educational environment.

Material and Methods
A cross-sectional questionnaire-based study was done among 1st-year medical undergraduate students at Zydus Medical College and Hospital, Dahod, from June to September 2019 to analyze their perceptions on the institute's educational environment.
The study was conducted using a straightforward sample methodology, and all 150 students were invited to participate. The Institutional Ethical Committee gave their approval to the project.
Students were given an explanation of the study and were told that all data collected would be de-identified so that their participation would remain anonymous.
A prevalidated globally accepted DREEM questionnaire 10 was used as a survey tool to gather information on student's perception of educational environment offered by the institution. The completion of the questionnaire implied the students' consent.
The goal of the study and the requirement for confidentiality were explained to the students. Students (n = 150) were given the DREEM questionnaire. The entire questionnaire was collected after half an hour. The filled questions were gathered and analyzed statistically. Continuous variables were described as mean and SD, categorical variables were presented as frequency and percentage. McAleer and Roff's practical guidelines 10 were used to analyze and interpret the responses.
The DREEM questionnaire is divided into five categories, each of which has 50 statements that are rated on a five-point Likert scale ranging from strongly agree (4) to strongly disagree (0). Negative remarks, on the other hand, were assessed in reverse order. The maximum score for these 50 criteria was 200, indicating an ideal condition. The five domains of DREEM inventory were as follows: (Table 1) 1. Student's perceptions of learning (SPoL -12 items/48 marks 2. Student's perceptions of teachers (SPoT -11 items/44 marks 3. Student's academic self-perception (SASP -8 items/32 marks 4. Students perception of atmosphere (SPoA -12 items/48 marks 5. Student's social self-perceptions (SSSP -7 items/28 marks A Microsoft Office Excel spreadsheet was used to compile the data. The means and standard deviations of the data were computed. All students' total and domain scores were computed. The statistical software SPSS version 20.0 was used to analyze the data (IBM Corp., Armonk, USA).

Observations and Results
A total of 150 students agreed to take part in the study and filled out the questionnaire (response rate was 100 percent). The global DREEM mean score was 124.9 ± 50 (62.46%). Among the five domains of DREEM, student's   *Negative statements, ** Items with score more than 3, # Items with score < 2 perception of learning was scored highest (65.63%) and student's perception of atmosphere was scored least (59.31%). (Table 2) Table 3 shows the individual item analysis for each DREEM inventory domain. Highest was scored for the students confidence of passing the exams this year, good friends in the college and good social life and least was scored for teachers ridiculousness, cheating problem and course content.
The more constructive responses were on student's confidence, teacher's knowledge, encouragement to participate in teaching session, teacher's preparedness, and on having good friends in the campus.

Discussion
The educational environment is one of the most significant aspects of an effective curriculum, and it also helps with program evaluation.
In this regard present study was conducted to examine the educational environment offered by our institution using a validated DREEM questionnaire.
The current study's total mean DREEM score was 124.92±50.39, indicating a "more positive than negative perception." This is analogous to a number of studies carried out in India and overseas. [11][12][13] According to the findings, students' perceptions of learning were "more positive," and their perceptions of teachers were "going in the right direction." Academic selfperception and ambient perception were found to be on the "more favorable side," while social perspective was found to be "not too bad." The overall mean scores for the five domains in this study ranged from 59.31% to 66.63%. This demands immediate corrective action in order to create and sustain a high-quality learning environment for students.
Among the five DREEM dimensions, students' perceptions of learning received the highest score (65.63%), while students' perceptions of the environment received the lowest (59.31%). These results are following other studies. 14- 16 At this study, three statements obtained more than three scores: "I am confident about passing this year," "I have nice friends in this college," and "My social life is good." This indicates that the institution's learning environment was of high quality. Students said the professors were wellinformed and guided them through all areas of the medical program, and that they were well-prepared for the classes. The fact that students were routinely exposed to formative assessments in this school may have contributed to their confidence in passing this year. These findings are based on a few investigations conducted in India. 17 On the other side, the items like "faculty reticule and dismiss the students", "cheating is the problem in this medical school" and "I find the experience here as disappointing "had less than 2 scores. In this aspect, it is important to sensitize the faculty that respect for the student is critical to the learning process. Also implementing strict rules and regulations will help the students to overcome the thought of cheating and disappointing experience. This is the first-ever study of medical students' perception of the educational environment at this institution and thus provides a baseline report to track the effects of a constructive learning environment over some time in the future. The educational environment at our institution was seen positively by the students in general.

Limitations
1. Cross-sectional study. 2. Involved only 1 st -year students. 3. Student's perception of the educational environment depicts the learning experiences from basic subjects only which was of 11 months duration. 4. A constructive framework of reflection will be more appropriate to assess the learning environment.

Conclusion
The educational atmosphere at this institution was rated as more positive than unfavorable by students. The more constructive responses were on student's confidence, teacher's knowledge, encouragement to participate in a teaching session, teacher's preparedness, and on having good friends on the campus. The highlights of our study can be addressed with positive perceptions to improve and strengthen the educational environment in our institute.

Source of Funding
None.

Conflict of Interest
The authors declare no conflict of interest.