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Psychology and Psychotherapy: Research Studys

Students Perceptions of the Educational Environment: A Cross-Sectional Study from a Moroccan Medical University

Benali A* and Chichou H

Department of Psychiatry, Morocco

*Corresponding author: Benali A, Department of Psychiatry, Morocco

Submission: July 03, 2020Published: July 15, 2020

DOI: 10.31031/PPRS.2020.03.000576

ISSN 2639-0612
Volume4 Issue1


Introduction: The quality of the educational environment has frequently been identified as crucial to effective learning.

Purpose: To evaluate student’s perceptions on the educational environment and to identify the effect of gender, year of study and age on students’ perceptions of their educational environment.

Method: This was a cross-sectional descriptive and analytical study, using the DREEM questionnaire, with 380 students from the Faculty of Medicine and Pharmacy of Marrakech (3rd, 4th, 5th, 6th, 7th and 8th year), during the academic year 2017- 2018.

Result: We recruited 358 students in a period of 2 weeks (from 15/01/2018 to 30/01/2018), achieving a response rate of 94.2%. There was a predominance of females (66.48%). The mean age was 22.20±149 years. The mean total score of DREEM was 86.5±29.194 which indicates the existence of several significant problems. Among the 50 items of the DREEM score, we noted 35 areas of concern (Score≤2), and item 3 «There is a good support system for students when they experience stress" had the lowest score. The factors associated with a poor perception of the educational environment are the female gender and the age>21 years. The wish and the recommendation of medical studies were associated to a good perception of the educational environment.

Conclusion: In this study, students perceived the educational environment as having many problems. The findings of this study were useful to identify areas in need of improvement.


Curriculum is considered to be the most holistic, inclusive and comprehensive entity and notion in education. This aspect of holism and comprehensiveness leads one to define curriculum as everything that is happening in the classroom, department, faculty, medical school or the university as a whole [1]. Educational environment is one of the most important determinants of an effective curriculum. There is a proven connection between the environment and the valuable outcomes of students’ achievement, satisfaction and success Roff et al. [2]. Developed the Dundee Ready Education Environment Measure (DREEM), an international, culturally non-specific, generic instrument that provides global readings and diagnostic analyses of undergraduate educational environments within health professions institutions. It generates a profile of a particular institution’s environmental strengths and weaknesses [2]. Each year thousands of doctor’s graduates from Moroccan medical faculties. As these students enter their professions, their level of competence is not only a reflection of the educational institution they attended; it is of the utmost importance to all their future patients and the broader community generally. An important component of academic strengthening and curricula renewal is the evaluation of the quality and structure of health science programs. After all, it has been suggested that a positive learning environment as a student can lead to increased satisfaction, achievement and success as a practitioner post-graduation [3,4]. A motivating learning environment fosters deep self-directed learning in the student and subsequently good medical practice in the physician. Consequently, demotivating elements such as perceived bias, poor role models, information overload, teacher centered, or disorganized teaching need to be identified and eliminated [5]. Therefore, the aim of this study is to evaluate students’ perceptions, recorded on the DREEM inventory, of the overall education environment as well as specific aspects of this learning environment. A second aim of this study is to investigate whether the education environment or aspects of it are perceived more or less favorably for students of different year levels, age or gender.

Material and Methods


The Dundee Ready Education Environment Measure (DREEM) is a questionnaire developed by Roff et al. [2] to measure the educational environment in health professional education programs. The questionnaire was developed using a Delphi approach involving a range of professional health educators in different settings and countries. The DREEM contains 50 statements. Each statement is assessed using a 5-point Likert scale ranging from strongly agree to strongly disagree.

Items are scored as follows:

Strongly disagree (0)

Disagree (1)

Uncertain (2)

Agree (3)

Strongly agree (4)

However, nine of the 50 items (4, 8, 9, 17, 25, 35, 39, 48 and 50) are negative statements and are reverse scored. The 50-item DREEM has a maximum score of 200 indicating the ideal educational environment.

It is also divided into five subscales:

  1. Students’ perceptions of learning (12 items, max score 48)
  2. Students’ perceptions of teachers (11 items, max score 44)
  3. Students’ academic self-perceptions (8 items, max score 32)
  4. Students’ perception of atmosphere (12 items, max score 48)
  5. Students’ social self-perceptions (7 items, max score 28)

The DREEM can be used to pinpoint more specific strengths and weaknesses. Items with mean scores≥3.5 are considered as highly positive points. Items with mean scores between 2 and 3 indicate aspects of the environment that could be improved. While items with a mean of 2 or less should be examined more closely as they indicate problem areas.

Subjects and settings

This cross-sectional study was conducted in the Faculty of Medicine and Pharmacy of Marrakech in January 2018. The questionnaire was distributed to clinical stage medical students (3rd, 4th, 5th and 6th years) in the University Hospital Mohammed VI of Marrakech, several sessions were organized within many hospital departments to explain the interest and purpose of the study. Then, the students, having accepted to participate in the survey, received the questionnaires to fill, while respecting their anonymity. These questionnaires, once completed, were given to the secretaries of each service. The students of the 7th and the 8th year received for their part the questionnaire directly within the faculty of Medicine and Pharmacy of Marrakech. Given the personal nature of certain questions in this survey, the questionnaire was also made available in electronic format in order to respect the privacy of students and to promote their sincerity.

Statistical analysis

The Data were analyzed using Excel 2010 and the statistical analyzes were performed by the ANOVA test. A P-value <0.05 served as the cut-off value for statistical significance.


The response rate was 94.2% (total 358 out of 380 students). Among the 358 students, 120(33.52%) were male and 238(66.48%) were female. The mean age of participants was 22.2(SD 2.149) years. Considering year of study, there were 93(25.98%) third year, 90(25.14%) fourth year, 82(22.91%) fifth year, 53(14.8%) sixth year, 8(2.23%) seventh year and 32(8.94%) eighth year students. 279(77.93%) students chose to study medicine, and 207(57.82%) wouldn’t recommend medical studies to their friends. The mean DREEM total score was 86.5(SD 29.194). Total DREEM scores ranged from 11 to 185. The descriptive statistics for each of the five DREEM subscales are presented in Table 1. The highest score was found in the subscale of students’ perceptions of teachers (21.71/44(49.3%)), and the lowest score was found in the subscale of students’ perceptions of learning (17.38/48 (36.2%)).

Table 1 shows the individual item analysis of DREEM according to the five different subscales. 35 items scored less than two. Among them, 12 items were from the students’ perceptions of learning subscale, four items were from the students’ perceptions of teachers subscale, four items were from the students’ academic self-perceptions subscale, 11 items were from the students’ perceptions of atmosphere subscale and four items were from the students’ social self-perceptions. The remaining 15 items scored between 2 and 3; there was no area of excellence (Item score ≥3.5). The lowest score was 0.57 for Item 3 “There is a good support system for students who get stressed”.

Table 1: Individual item analysis for each subscale of DREEM.


Total DREEM score and sub-scale scores were derived for males and females separately; males consistently reported higher scores than female students across all disciplines Table 2. However, there was a significant difference only in two subscales, students’ academic self-perception (p=0.04) and students’ social self-perception (p=0.03). There were four individual items with statistically significant mean scores between male and female students Table 3. Male students’ scores were significantly higher than male students’ scores in three of the four items listed.

Table 2: The total DREEM score and its components among female and male students.

Table 3: Statistically significant differences between male and female students.


There was a significant difference between age and the global DREEM and 3 DREEM subscales scores, with students younger than 21 having more positive perceptions of their learning environment than older students Table 4. Statistically significant relationships were observed between age and 7 individual items Table 5.

Table 4: The comparison of the total DREEM score and its components by age.

Table 5: Statistically significant differences according to age.

Year of study

Total DREEM score and sub-scale scores were derived for students in different years of study and summarized in Table 6. In general there appeared to be a slight reduction in scores with progression through the course of study, and the ANOVA conducted on the total and the subscales DREEM scores found Year of Study to be significantly associated with only one subscale, students’ perceptions of teachers (p=0.0005). Statistically significant year level differences were also noted for 11 items Table 7.

Table 6: The comparison of the total DREEM score and its components by year of study.

Table 7: Statistically significant differences according to age.


The high response rate (94.2%) obtained in our study was due to the brief introduction given to students about the aim of this study, which convince them that the results of such a study would lead to significant changes in their learning. The students also perceived it as an ideal opportunity to express their opinions.

The response rate in other similar studies ranged from 44.6% to 96.9%. This showed that our response rate was among the highest, indicating that our students were keen to participate in such study to improve their school. This response rate is comparable to that obtained in Canada (91%) [3] and in Australia (90%) [6]. On the other hand, the lowest response rate obtained in King Saud University (44.6%) was explained by students’ fears of participation in their study and its impact on their exam results [7]. A study in Singapore reported that 79 (80.6%) of the 98 studies which reported DREEM scores showed total DREEM scores between 100 and 150, and only 3 studies reported excellent scores between 150 and 200 [8]. The global DREEM score of 86.5/200 indicated the existence of many significant problems in the educational environment. As far as we can verify, our study had the lowest score reported among published studies using the relatively recently validated DREEM inventory. The highest score was reported in Turkey and was of 156.91 [9]. This cry from students is, unfortunately, only too common to medical and many other healthcare programs due in no small part to the quantity and quality of information that has to be absorbed during the time of studies.

The local studies, that used DREEM, showed fairly similar results: 90.5/200 in the Faculty of Medicine and Pharmacy of Rabat [10] and 99.2/200 in the Faculty of Medicine and Pharmacy of Fes [11]. Internationally, overall DREEM scores reported were 89.9/200 in Saudi Arabia [7], 94.65/200 in South Korea [12], 108.5/200 in Brazil [13], 117.2/200 in Peru [14], 131.1/200 in Thailand [15] and 135.44/200 in Mexico [16]. Among the subscale scores, students’ perception of learning was lowest in our study (36.2%). This is very close to the score of 38.3% reported by Andalib [17] and of 39.58% reported by Till [3], but lower than the score of 71.7% (34.42/48) [18] reported by Vaughan [6]; Table 8.

Table 8: Comparison of DREEM scores at the faculty of medicine of marrakech and other studies.

The perception of learning atmosphere, which other studies showed to have significant impact on students’ behavior, academic progress, and sense of well-being, scored low in the present study. The students appear unable to concentrate, memorize or enjoy the courses while the atmosphere is not relaxed during lectures or trainings. Many studies reported generally similar findings [7,19,20]. Medical students everywhere seem to share similar concerns as reported in studies that utilized the DREEM instrument [21,22]. It is interesting that most areas of concern are related to what is taught rather than how it is taught and allude to the curriculum content rather than its delivery. There were 35 items that scored below 2, which indicated problematic areas of the learning environment. Item 3 (There is a good support system for students who get stressed) had the lowest score (0.57) in the questionnaire. This item also scored the lowest in other studies [19,23]. A study in Greece [23] found 19 problem areas, another study in Germany [24-26] reported 18 items with scores below 2, while a study in Iran [27] objectified the existence of 22 problem areas.

In our study, no area of excellence (Score≥3.5) was reported, which is in agreement with many studies. [24,28-33]. This study revealed significantly higher scores for males in ASP and SSP, for students younger than 22 years old for PoT, ASP and PoA and for junior classes for ASP. Some studies found a statistically significant difference between genders, with females in general, being more critical concerning the quality of teaching and general climate of the school [21,34] which is in agreement with the present study. Others, however, reported that mean total score for males were less than females students [5,35-39]. In general, it appears that gender is not associated with a consistent pattern of perception of educational environment although there is a longstanding evidence that males and females typically exhibit different learning styles [40]. Male students had a more positive perception about the role of the faculty in building their self-confidence, developing students’ problem-solving skills and their learning ability.

These findings were concordant with the results reported in Saudi Arabia [19]. On the other hand, female students had a more positive perception of the atmosphere during classes, which coincides with the results obtained in Sri Lanka [41]. The perception of environment, in this study, varied between levels of enrolment. This result is in agreement with an English study that showed that perceptions of the educational environment, learning, teachers and of atmosphere were significantly superior for first year students over second year students [42]. However, a local study reported significantly higher scores in SSP for students in their fifth year of study than those in their fourth year [10]. This cry from students is, unfortunately, only too common to medical students and many other healthcare professions programs, due in no small part to the quantity and the quality of information that has to be absorbed during the time of studies.


The DREEM questionnaire has been useful in identifying the strengths and the major defects of the educational environment in our faculty. The problematic areas are clear indications of where the priorities for reform should take place at the study site. A larger study may need to be undertaken to verify the above results and conclusions, and more importance should be given to the students’ perception of the learning environment, as it can be used to initiate change and improvement.


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