Key elements in assessing the educational environment: where is the theory?

Johanna Schönrock-Adema,Janke Cohen-Schotanus,Elisabeth A Van Hell,Tineke Bouwkamp-Timmer

doi:10.1007/s10459-011-9346-8

Abstract

The educational environment has been increasingly acknowledged as vital for high-quality medical education. As a result, several instruments have been developed to measure medical educational environment quality. However, there appears to be no consensus about which concepts should be measured. The absence of a theoretical framework may explain this lack of consensus. Therefore, we aimed to (1) find a comprehensive theoretical framework defining the essential concepts, and (2) test its applicability. An initial review of the medical educational environment literature indicated that such frameworks are lacking. Therefore, we chose an alternative approach to lead us to relevant frameworks from outside the medical educational field; that is, we applied a snowballing technique to find educational environment instruments used to build the contents of the medical ones and investigated their theoretical underpinnings (Study 1). We found two frameworks, one of which was described as incomplete and one of which defines three domains as the key elements of human environments (personal development/goal direction, relationships, and system maintenance and system change) and has been validated in different contexts. To test its applicability, we investigated whether the items of nine medical educational environment instruments could be mapped unto the framework (Study 2). Of 374 items, 94% could: 256 (68%) pertained to a single domain, 94 (25%) to more than one domain. In our context, these domains were found to concern goal orientation, relationships and organization/regulation. We conclude that this framework is applicable and comprehensive, and recommend using it as theoretical underpinning for medical educational environment measures.

Highlights

The educational environment has been increasingly acknowledged as vital for high-quality medical education (Roff 2005; WFME 2003, 2007; Genn 2001a, b)
Since we did not succeed in obtaining the Medical School Learning Environment Survey (MSLES; Marshall 1978) and the Medical School Learning Environment Questionnaire (LEQ; Rothman and Ayoade 1970), we focused our content analysis on the Diagnostic Radiology Clinical Learning Environment Questionnaire (DR-CLE) questionnaire (Bloomfield and Subramaniam 2008), the Dutch Residency Educational Climate Test (D-RECT) (Boor et al 2011), the Surgical Theatre Educational Environment Measure (STEEM) (Cassar 2004), the Anaesthetic Theatre Educational Environment Measure (ATEEM) (Holt and Roff 2004), the Practice-based Educational Environment Measure (PEEM) (Mulrooney 2005), Dundee Ready Education Environment Measure (DREEM; Roff et al 1997), the Postgraduate Hospital Educational Environment Measure (PHEEM) (Roff et al 2005), the Survey of Learning in Hospital Settings (SLHS) (Rotem et al 1995), and the Medical School’s Environment Questionnaire (MSEQ; Wakeford 1981)
The aims of this study were (1) to find a comprehensive theoretical framework that outlines the key concepts that should be measured in ascertaining the quality of the educational environment, and (2) to test the applicability of this framework

Summary

Introduction

The educational environment has been increasingly acknowledged as vital for high-quality medical education (Roff 2005; WFME 2003, 2007; Genn 2001a, b). Examination of recent medical educational environment instruments reveals that there are many differences between them These differences are in part attributable to the fact that the instruments are often tailored to a specific setting of interest (Bloomfield and Subramaniam 2008; Cassar 2004; Holt and Roff 2004; Mulrooney 2005; Roff et al 2005; Rotem et al 1996). Even though differences between settings may call for some tailoring of instrument content (Holt and Roff 2004; Patel and Dauphinee 1985), the array of differences is not restricted to item formulation: it concerns instrument structure (i.e. the organization of items in scales) and scale names From these differences, we gather that up till there is no consensus about which concepts should be measured to ascertain the quality of the medical educational environment adequately

Objectives

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Conclusion