Students’ perceptions of their educational environment in a south Indian dental school—A cross-sectional study

Sravan K Yeturu; Vijay S Kumar; Kalyana C Pentapati; Nitin A Krishnan; Swagata Roy; Radhika S Babu

doi:10.4103/jioh.jioh_34_22

ORIGINAL RESEARCH

Year : 2022 | Volume : 14 | Issue : 5 | Page : 518-523

Students’ perceptions of their educational environment in a south Indian dental school—A cross-sectional study

Sravan K Yeturu¹, Vijay S Kumar¹, Kalyana C Pentapati², Nitin A Krishnan³, Swagata Roy¹, Radhika S Babu¹
¹ Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidhyapeetham, Kochi, Kerala, India
² Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
³ Department of Oral Medicine and Radiology, Amrita School of Dentistry, Amrita Vishwa Vidhyapeetham, Kochi, Kerala, India

Date of Submission	28-Jan-2022
Date of Decision	15-Jul-2022
Date of Acceptance	31-Jul-2022
Date of Web Publication	31-Oct-2022

Correspondence Address:
Dr. Vijay S Kumar
Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi 682041, Kerala
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jioh.jioh_34_22

Abstract

Aim: To compare the undergraduate dental students’ perceptions of their educational environment with academic achievement. Materials and Methods: This cross-sectional study used the shortened version of the “Dundee Ready Educational Environment Measure” (DREEM-17) and was administered to 200 students of a dental school in south India using a convenient sampling. DREEM-17 consists of 17 questions under five domains recorded on a Likert scale. Higher scores implied a better perception of the educational environment. Based on the results of university examinations, students were grouped as academic achievers and under-achievers. Independent sample t-test and analysis of variance with post-hoc test were used to evaluate significant differences with gender, academic year, and academic achievement. The relationship between academic achievement and the DREEM scores was evaluated with Poisson regression after adjusting for the academic year. Results: The final analysis included 183 students (91.5% response rate). The majority of the participants were females (92.3%) with a mean age of 20.84 ± 1.41 years. Only 16.9% were under-achievers. There was a significant difference in the total mean scores concerning the academic years (P < 0.001). Under-achievers, as compared to academic achievers, scored lower mean total DREEM (P = 0.005). Regression analysis showed that academic achievers perceived significantly higher DREEM scores after adjusting for the academic year (risk ratio = 0.96; 95% confidence interval = 0.95–0.98; P < 0.001). Conclusion: Academic achievers fared higher DREEM scores than under-achievers. The use of DREEM-17 as a tool for monitoring academic progress might facilitate the identification and implementation of timely interventions to modify any problematic educational situations.

Keywords: Academic Performance, Dental, Education, Environment, Student

How to cite this article:
Yeturu SK, Kumar VS, Pentapati KC, Krishnan NA, Roy S, Babu RS. Students’ perceptions of their educational environment in a south Indian dental school—A cross-sectional study. J Int Oral Health 2022;14:518-23

How to cite this URL:
Yeturu SK, Kumar VS, Pentapati KC, Krishnan NA, Roy S, Babu RS. Students’ perceptions of their educational environment in a south Indian dental school—A cross-sectional study. J Int Oral Health [serial online] 2022 [cited 2023 Oct 5];14:518-23. Available from: https://www.jioh.org/text.asp?2022/14/5/518/359967

Introduction

An optimal educational environment is a prerequisite for effective learning. A standing committee in the United Kingdom has highlighted the importance of educational environment as “a working environment that is conducive to learning is critically important to successful training.”^[1] It is well known that the effects of learning environment are on both academic and clinical. The students’ knowledge, behavior, attitudes, skills, and personality are determined by their learning environment. Learning environment strongly affects the student achievement, satisfaction, and success.^[2]

In the recent decades, there has been a focus on more individualized and learner centric education to achieve excellence in health education. A students’ orientation toward learning is positively related to how the students perceive their educational environment. Knowing how the students perceive their educational environment helps in amending and improving the quality of educational environment.^[3] It is a distinctive key factor that influences the teaching outcome in health sciences. To monitor and access the quality of an academic program or an institution, the input from students plays a key role. Health professional students’ experience regarding the content, structure, and quality of their environment is essential in the assessment and also an important source of information. Individual students perceive differently to various elements of their learning environment. Hence, assessing how students perceive their learning environment on a regular basis helps in improving problematic areas that need attention.

Measuring an educational environment is a difficult task. Various methodologies such as quantitative,^[4] qualitative interview-based,^[5] and questionnaire-based^[6] were used to explore the learners’ perceptions of their educational experience. A variety of tools or instruments such as College and University Environment Scales, Classroom Environment Scales, and the College and University Environment Inventory, etc., were developed to assess the educational environment.^[7] “Dundee Ready Educational Environment Measure (DREEM)”is a questionnaire developed to evaluate educational environment and was previously used in diverse settings.^[8] It was initially designed in English by Roff et al.^[9] It was adapted to various languages^[10],[11] and was a handy tool to evaluate the strengths and weaknesses of the educational environment. It allows for standard comparisons among the medical schools, benchmarks their educational environment, and identifies areas of concern or issues of students, which might be unintentionally ignored by the educators.^[12] It can provide diagnostic analyses of undergraduate and postgraduate educational environment in medical and other health professional institutions. The DREEM tool was used to identify weakness in curriculum,^[13] to assess the impact of new curriculum,^[14] and to identify any gap between students’ expectation and actual experience.^[15]

A recent systematic review highlighted the various areas of concern in the educational environment in Indian dental colleges and the need for strategies.^[16] Another review concluded that individuals’ high DREEM scores were associated with higher academic scores.^[17] Studies have been mostly conducted in medical schools,^{[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28]} whereas such reports are scarce from dental schools^{[7],[25],[29],[30],[31]} with a limited literature on the academic achievement and DREEM scores from India.^{[8],[26],[30],[32],[33],[34]} Hence, the objectives of this study were to assess the undergraduate students’ perceptions of the quality of their educational environment in a dental school in Kerala, India, and to compare the differences in the perceived educational environment between academic achievers and under-achievers. Our null hypothesis was that there would be no significant difference in the perception of educational environment between academic achievers and under-achievers.

Materials and Methods

Setting and design

This descriptive cross-sectional survey was conducted among the Bachelor of Dental Surgery (BDS) students of a dental school in Kochi, south India, from February to June 2017.

Sampling criteria

All the students who completed 1 year in dental school, i.e., students from the second year to the fifth year (Internship) of both regular and supplementary batches were invited to participate using a convenient sampling method. This was a complete enumeration of the available participants, and hence prior sample size calculation was not performed.

The self-administered questionnaire was distributed in lecture halls and clinical departments, and the participants were requested to complete it in 10 min. The educational environment was assessed using a shortened version “Dundee Ready Educational Environment Measure-17” (DREEM-17) as it was reported to be as reliable as the original DREEM-50 questionnaire.^[35] DREEM-17 assesses perceptions in five domains, viz., “students perceptions of learning (SPoL)” (three items), “students perceptions of teachers (SPoT)” (three items), “students academic self-perceptions (SASP)” (three items), “students perceptions of academic atmosphere (SPoA)” (five items), and “students social self-perceptions (SSSP)” (three items). The questions were rated on a Likert scale “strongly agree (5),” “agree (4),” “unsure (3),” “disagree (2),” and “strongly disagree (1)” yielding a maximum possible score of 85. Negative items were reverse coded so that higher score implies more positive perception for all items. Demographic information such as age, gender, and current course year was also collected. Students were categorized as academic “under-achievers” if they had failed in any one or more university exams and as “academic achievers” if they had not experienced a failure during their course of dental education. DREEM-17 was the primary outcome in this study.

Ethical approval and informed consent

The approval from the institutional ethics committee, AIMS, Kochi (IEC-AIMS-2016-DENT-170) was obtained, and written informed consent was sought from all the participants. All the procedures were as per ethical guidelines of the Declaration of Helsinki.

Observational parameters

IBM SPSS version 20 (IBM SPSS Statistics for Windows, Version 20.0, Armonk, NY, USA.) was used for analysis. P < 0.05 was considered statistically significant. Incomplete forms were excluded from the analysis. Mean domain and total scores were calculated and were compared using independent sample t-test and analysis of variance with post-hoc test among gender, academic year, and academic achievement. The relationship between academic achievement (independent variable) and the DREEM questionnaire (dependent variable) was further explored with Poisson regression after adjusting for the academic year. Internal consistency reliability was assessed using Cronbach’s alpha (0.87). The students can read and understand English language; hence, translation to local language was not required. The DREEM-17 questionnaire, English version, was shown to be valid in a previous research.

Results

The final analysis included 183 students with 91.5% response rate. The majority of the students were females (92.3%), and the mean age was 20.84 ± 1.41 ranging from 18 to 24 years. Only 16.9% of the participants were under-achievers [Table 1].

Table 1: Characteristics of the study population

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There were significant differences in the mean domain scores of SPoL, SPoA, SSSP, and the total scores concerning the academic years (P = 0.009, <0.001, <0.001, and <0.001, respectively). Post-hoc comparisons showed that the second BDS students (11.73 ± 1.83) had higher mean SPoL scores than the fourth BDS (10.28 ± 2.14). Similarly, the second BDS students (17.22 ± 4.29) reported higher mean SPoA scores than the fourth (13.68 ± 3.63) and fifth (14.57 ± 3.48) BDS. Also, the third BDS students (16.22 ± 3.07) had higher mean SPoA than the fourth BDS students (13.68 ± 3.63). The mean SSSP score for the second BDS students (9.90 ± 2.76) was significantly higher than the third (8.41 ± 2.03), fourth (6.49 ± 2.4), and fifth (8.45 ± 1.9) BDS students. Also, the mean SSSP scores were higher for the third (8.41 ± 2.03) and fifth (8.45 ± 1.9) BDS than the fourth BDS students (6.49 ± 2.4). The total score was higher for the second BDS students (61.88 ± 10.78) than the fourth (52.06 ± 10.09) and fifth BDS students (56.31 ± 6.56). Also, the third BDS students (58.24 ± 7.48) showed a higher score than the fourth BDS students (52.06 ± 10.09) [Table 2].

Table 2: Comparison of the mean domain and total scores with respect to the academic year

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Significantly lower scores were reported in under-achievers as compared to academic achievers for a mean total DREEM score, SPoT, and SASP domains (P = 0.014, <0.001, and <0.005, respectively) [Table 3]. Poisson regression analysis was done to evaluate the relationship between academic achievement and the DREEM scores. Academic achievers perceived higher DREEM scores after adjusting for the academic year when compared with under-achievers (risk ratio = 0.96; 95% confidence interval = 0.95–0.98; P < 0.001) [Table 4].

Table 3: Comparison of the domain and total scores with respect to academic achievement

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Table 4: Poisson regression analysis to evaluate relationship between academic achievement and DREEM adjusting academic year

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Discussion

This study evaluated the perception of BDS students about their educational environment using a DREEM tool. The DREEM instrument was developed using standard methods of grounded theory and Delphi method from experts of several countries. This method helps in developing a noncultural-specific questionnaire. The use of the DREEM tool may help locate areas of problems of students that may be neglected by educators and administrators unintentionally.

A systematic review reported that higher DREEM scores were associated with academic achievement and positive attitudes toward course.^[17] Pimparyon et al. reported that under-achievement in academics was characterized by less satisfaction with their educational environment.^[36] Similarly, academic achievers scored significantly higher on perceptions concerning educators, their academic atmosphere, and social self-perceptions.^[37] In this study, the under-achievers have significantly lower scores of SPoT, SASP, and the overall DREEM score than the academic achievers.

Studies in the literature have compared gender differences in the perception of educational environment.^{[26],[29],[37]} However, the participants in this study were predominately females because of which gender differences in the perception of educational environment were not possible.

Maximum scores in all domains and also total score were seen in the second BDS students, whereas the minimum scores were seen in the fourth BDS students. It was expected that the third BDS students might have maximum scores because of the shift from preclinical to clinical departments and because of the excitement of clinical exposure for the first time. However, the reason for the fourth BDS students having lower scores may be due to the stress of patient work and upcoming exams in the clinical dentistry subjects unlike the third BDS, and also students find the study load more than they have been previously used to.

Previous studies have compared DREEM scores according to the academic year. Thomas et al. reported significant differences in the total scores between the first- and final-year students.^[8] Ahmad et al. reported higher scores in the first year than in the second year students with respect to SPoL, SPoT, SASP, SSSP, and total DREEM scores.^[31] Al-Samadani et al. showed significant differences in the scores of SPoL, SPoT, SPoA, SSSP, and total DREEM scores among the third-, fourth-, and fifth-year students. The overall DREEM scores were more for the third-year students than the fifth-year students.^[29] Riquelme et al. reported that there were significant differences in all the domains and total DREEM scores except for SASP.^[11] They have reported higher scores in the third and fourth year than the fifth year.

Results of our study vary with the findings of the literature. This may be due to the heterogeneity in the factors such as students, questionnaire type, curriculum, nationality, and teachers’ experience. Various other factors that can modify or affect the perceptions of students about their school may include the variations in pronunciation, dialect, and tone of the English language of teachers and students from different regions, cultures, and religions.

The DREEM instrument was used widely across Europe,^[38],[39] Africa,^[40] Asia,^[7],[41] North America,^[6] and South America^[11] to assess their educational environment. This tool was applied among various health professional institutions such as medical,^{[25],[27],[41]} dental,^{[7],[8],[25],[29],[30]} nursing,^[2],[36] and physiotherapy schools^[27] to evaluate their learning environment.

Perceptions of under-achievers were significantly lower from those of academic achievers among dental students. Hence, the null hypothesis was rejected. To stakeholders of health professions educations, the DREEM could be used to assess the educational environment to identify issues and challenges from a student perspective. Introductory sessions to students are necessary to help them move to the next year in comfort and ease.

The DREEM scores can be used to monitor and compare changes longitudinally after modifications or interventions to a learning environment. There is a need for attention to students during their transition years.

Historically, educational environment was assessed using 50-itemed DREEM questionnaire, which was used for benchmarking.^{[8],[11],[31],[37]} Studies using DREEM-17 questionnaire were scant. Hence, a direct comparison of our score with global scores of other schools or institutions was not possible. We have used the shortened version as it is less resource-intensive and reduces the respondents’ fatigue. There would be a similar result with the use of full version.

This study constituted dental students from a single institution, limiting the generalizability of its findings. However, the students included were from all the years, which gave a bird’s-eye view of the educational environment in our dental school. Owing to the cross-sectional study design, a temporal association could not be determined. The results generated from this study could be useful to other health profession institutions.

Conclusion

Perceptions of under-achievers were significantly lower from those of academic achievers among dental students. Particular attention needs to be given to students during their transition years.

Acknowledgement

We thank all participants of the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Authors’ contributions

Conceptualization: SKY, VSK, PKC; data curation: NAK, SR, RSB; formal analysis: SKY and PKC; methodology: SKY, NAK, SR, RSB; resources: SKY, NAK, SR, RSB; project administration: SKY and VSK; original draft preparation: SKY, NAK, SR, RSB; final draft: SKY, VSK, PKC.

Ethical policy and institutional review board statement

All the procedures have been performed as per the ethical guidelines laid down by the Declaration of Helsinki (1964) and its later amendments.

Patient declaration of consent

Informed consent was obtained for participation in the study and publication of the data for research and educational purposes.

Data availability statement

Data is available on request from corresponding author.

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