MAMCJMS_51_17R5

MAMC Journal of Medical Sciences

Original Article

Medical Students’ Opinion and Perception of the Education

Environment in a Medical College of Delhi, India
Sandeep Sachdeva, Nidhi Dwivedi
Department of Community Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India

Abstract
Objective: To assess students’ opinion and perception regarding education environment in a government medical college of Delhi, India.
Materials and Methods: Dundee Ready Educational Environment Measure (DREEM), a universal, culturally nonspecific, generic 50-item
inventory tool was used. Each item is rated on a five-point Likert scale with score ranging from 0 to 4 where 0 = strongly disagree,
1 = disagree, 2 = unsure, 3 = agree, and 4 = strongly agree. MBBS students of three batches (2nd, 3rd, and 4th year) were considered in the
present cross-sectional study. Results: A total of 117 (84.1%) available students could be contacted in person, out of whom 71 (60.7%) were
males; 94 (80.3%) passed their 12th class from private/convent school; nearly 88 (75.2%) students opined that administration is student-
supportive; and 111 (94.8%) were in self-assessment state of “happiness.” The overall mean DREEM inventory score (range, 0–200) among
all the respondents was 130.34 (±15.76), which is suggestive of “more positive than negative.” Statistically (P < 0.05) higher DREEM score
was found among senior medical students [score, 136.5 (4th year) vs. 131.9 (3rd year) vs. 123.6 (2nd year)]; those medical students who were
globally satisfied (score, 131.2 vs. 119.3); satisfied getting admitted in current medical college (score, 133.0 vs. 115.7); and who opined that
administration is student-supportive (score, 133.4 vs. 120.9). Gender, type of school, marks in 12th class, native place, current residence,
supplementary (extra attempt) in university exam, current mental state (sad/happy), and professional satisfaction had no statistical bearing on
overall DREEM score. Overall, none of the inventory item (score range, 0–4) had an avg. score more than 3.5, but the score of the majority (42/
50, 84.0%) of question items in the present study was in the range of 2–3 points indicating the aspects of the environment that could be
improved or enhanced. Conclusion: Within limitations, the study gauges the experiential learning environment from the students’ perspective
indicating overall positive results and moving in right direction. Some challenges inherent with medical education and critical areas requiring
strengthening were listed including social and leisure time student involvement.

Keywords: Academics, audit, communication, DREEM instrument, evaluation, faculty feedback, health research, pedagogy, quality control,
medical education, satisfaction, social life, students, teachers, teaching, training

INTRODUCTION In this context, a study was undertaken to evaluate the quality

of education environment in a medical college as perceived
Optimal education climate is an important determinant for
by medical students using globally accepted Dundee Ready
effective learning to occur.[1,2] Evidences exist which indicate
Educational Environment Measure (DREEM) inventory tool.
that the educational environment experienced by students has
This study would provide an opportunity for the sensitization
an impact on satisfaction with the study course, perceived
well being, aspirations, and academic achievement.[3,4]
Students’ opinion and the perception of the quality of their Address for correspondence: Dr. Sandeep Sachdeva, Department of
teaching environment are now recognized as valid indicators Community Medicine, North DMC Medical College and Hindu Rao Hospital,
of the appropriateness of curricula and educational settings.[5] New Delhi 110007, India.
E-mail: sachdevadr@yahoo.in

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DOI: How to cite this article: Sachdeva S, Dwivedi N. Medical Students’

10.4103/mamcjms.mamcjms_51_17 Opinion and Perception of the Education Environment in a Medical
College of Delhi, India. MAMC J Med Sci 2017;XX:XX.

© 2017 MAMC Journal of Medical Sciences | Published by Wolters Kluwer - Medknow 1

 Sachdeva and Dwivedi: Medical education

of stakeholders for a timely and apt feedback for corrective
intervention and resource mobilization.
MATERIALS AND METHODS
The Dundee Ready Educational Environment Measure
instrument
The DREEM, a universal, culturally nonspecific, generic,
reliable, and diagnostic inventory tool was used to assess
students’ perceptions about the educational environment.
DREEM has been widely used to gather information about
the quality of education environment in many institutions
across the globe.[6-9]
DREEM is a 50-item inventory questionnaire, consisting of
five subscales:
(1) Students’ perceptions of learning (SPL) − 12 items;
maximum score is 48;
(2) Students’ perceptions of atmosphere (SPA) − 12 items;
maximum score is 48;
(3) Students’ perceptions of teachers (SPT) − 11 items;
maximum score is 44;
(4) Students’ academic self-perceptions (SASP) − 8 items;
maximum score is 32;
(5) Students’ social self-perceptions (SSSP) − 7 items;
maximum score is 28.
Each item is rated on a five-point Likert scale with score
ranging from 0 to 4 where 0 = strongly disagree, 1 = disagree,
2 = unsure, 3 = agree, and 4 = strongly agree. There are nine
negative items (items 4, 8, 9, 17, 25, 35, 39, 48, and 50), for
which correction is made by reversing the scores; thus after
correction, higher scores indicate disagreement with that
item. Items with a mean score of ≥3.5 are true positive
points; those with a mean of 2 are problem areas; scores
in-between these two limits indicate the aspects of the
environment that could be enhanced. The maximal global
score for the ques­tionnaire is 200, and the global score is
interpreted as follows: 0–50 = very poor; 51–100 = many
problems; 101–150 = more positive than negative; and
151–200 = excellent.[10] The guide to interpreting DREEM
score is given in Table 1. The examination of the individual
items by looking at the mean score obtained across all
participants enables the identification of specific strengths
and weakness within the educational environment.
In addition, the sociodemographic details of students such
as gender, native place, type of school, percentage of
marks obtained in 12th class, supplementary attempt in
previous university examination, and current residence
(hostel/day scholar) were also taken. The subjective (self)
assessment of satisfaction (yes/no) with regard to medical
profession, admission in current college, and global (overall)
satisfaction was also documented.
Background information
The current government medical college under the aegis of
North Delhi Municipal Corporation started in the year 2013
following approval from Medical Council of India (MCI),
and it is affiliated to Guru Gobind Singh Inderprastha
University and admits 50 students per batch through
a competitive entrance examination. The 1000-bedded
multispecialty hospital associated to this college was
established way back in the year 1958 that has evolved
and expanded over the years.
Data collection
MBBS students of three batches (2nd, 3rd, and 4th year) were
considered in the present cross-sectional study. Students were
briefed about the study objectives, voluntary nature
of participation, and confidentiality of data collection.
However, none of them declined to participate. Out of the
150 permitted (50 per batch) seats, only 139 were filled. Thus,
a total of 117 (84.1%) available students could be contacted in
person who completed the questionnaire under direct
supervision.
Data management and statistical analysis
The data were entered into a Microsoft Excel spreadsheet and
analysis performed using the Statistical Package for the
Social Sciences version 20.0 software (IBM, New York,
USA). The internal consistency and reliability of this study
was found to be 0.86 (Cronbach alpha). The results of the
DREEM were considered at three levels: (i) individual items,
(ii) subscales, and (iii) overall DREEM. The raw scores

Table 1: The guide to interpreting DREEM score

Score Total DREEM score Score Perception of teachers Score Perception of atmosphere
0–50 Very poor 0–11 Very poor 0–12 Very poor
51–100 Plenty of problems 12–22 In need of some retraining 13–24 In need of some retraining
101–150 More positive than negative 23–33 Moving in right direction 25–36 Moving in right direction
151–200 Excellent 34–44 Model teachers 37–48 Model teachers

Score Perception of learning Score Academic self-perception Score Social self-perception

0–12 Very poor 0–8 Feeling of total failure 0–7 Miserable
13–24 Teaching viewed negatively 9–16 Many negative aspects 8–14 Not a nice place
25–36 More positive than negative 17–24 Feeling more on positive side 15–21 Not too bad
37–48 Teaching highly thought of 25–32 Confident 22–28 Very good socially

2 MAMC Journal of Medical Sciences ¦ Volume XX ¦ Issue XX ¦ Month 2017

 Sachdeva and Dwivedi: Medical education
obtained for the items making up each of the five subscales
were summed for each participant, and then the mean of this
summed score was taken to give a subscale summary score
and these were further summed up to give an overall DREEM
score. Students who ever had a supplementary (extra) attempt
in the university exam were labeled as underachiever and
others as academic achievers for comparison purpose.
Student’s t test and one-way analysis of variance
(ANOVA) are used to compare the averages of five
domains based on different characteristics.
RESULTS
Out of 117 students, 71 (60.7%) were male and 46 (39.3%)
female; the native place of 77 (65.8%) students was Delhi and
the rest (34.2%) were from states outside Delhi but within
India; 79 (67.5%) students were staying in hostel; 94 (80.3%)
students passed their 12th class from private/convent school
whereas the rest (19.7%) were from government school and
22 (18.8%) students had a supplementary attempt in previous
professional university exam. The self-assessment of current
mental state of 6 (5.1%) students was sad while the remaining
111 (94.8%) were happy; and nearly 88 (75.2%) students
opined that administration is student-supportive.
The overall mean DREEM inventory score (range: 0–200)
among all the respondents was 130.34 (±15.76), which is
suggestive of “more positive than negative.” Details are
shown in Table 2. The mean score of DREEM subscales/
domain is as follows: SPL was 31.48 (range: 0–48); SPA
(31.62, range: 0–48); SPT was 29.0 (range: 0–44); SASP
(18.33, range: 0–32); and SSSP (17.01, range: 0–28).
Percentage-wise subdomain score among all medical
students is shown in Figure 1.
The domain-wise score of DREEM inventory according to
the background characteristics of students is shown in
Table 3. Statistically (P < 0.05) higher DREEM score was
found among senior medical students [score, 136.5 (4th year)
vs. 131.9 (3rd year) vs. 123.6 (2nd year)]; those medical
students who were globally satisfied (score, 131.2 vs.
119.3); satisfied getting admitted in current medical
Table 2: Summary score in five subdomains of DREEM inventory tool
SN Five subdomains of DREEM inventory Mean score (SD) among all
including range of score the MBBS students
A Students’ perception of learning − SPL 31.48 (±4.65)
(0–48)
B Students’ perception of atmosphere − SPA 31.62 (±5.4)
(0–48)
B Students’ perception of teachers − SPT 29.02 (±3.95)
(0–44)
D Students’ academic self-perception − SASP 21.22 (±3.24)
(0 − 32)
E Students’ social self-perception − SSSP 17.01 (±3.4)
(0–28)
Over-all DREEM score (0–200) 130.3 (±15.76)
MAMC Journal of Medical Sciences ¦ Volume XX ¦ Issue XX ¦ Month 2017
college (score, 133.0 vs. 115.7); and who opined that
administration is student-supportive (score, 133.4 vs.
120.9). The gender, type of school, marks in 12th class,
native place, current residence, supplementary (extra
attempt) university exam, current mental state (sad/happy),
and professional satisfaction had no statistical bearing on
overall DREEM score.
Item-wise DREEM inventory score according to
underachiever and academic achiever students is given in
Table 4. The three probable problem areas (score <2.0) which
call for attention include: (i) the teaching overemphasizes
factual learning (mean score: 1.58); (ii) the teachers are
authoritarian (mean score: 1.75); and (iii) I am able to
memorize all I need (mean score: 1.87).
DISCUSSION
A cross-sectional, descriptive study was undertaken to assess
opinion and perception of medical students regarding
education environment in a government medical college of
Delhi, India using generic DREEM inventory tool. The
overall mean score (range, 0–200) among medical students
was 130.34 (±15.76) that is suggestive of overall positive
results and education environment moving in right direction.
The study gauges the experiential learning environment from
the students’ perspective without any undue emphasis on
infrastructure or allied logistics related issues. DREEM
inventory tool provides an opportunity for the evaluation
and feedback of education environment in a health institution
from students’ perspective only; therefore, it has its own set of
inherent limitations.
According to the studies conducted among medical students
in India using DREEM inventory, the overall mean score in
our study (130.3) was found to be higher than 101 (University
College of Medical Sciences, Delhi), 115.2 (Udaipur,
Rajasthan), 116.5 (Darbhanga, Bihar), 121.8 (Pune,
Maharashtra), 122.4 (Belgaum, Karnataka), 123 (Mumbai,
Maharashtra), 123 (Mangalore, Karnataka), 126.3 (Army
College of Medical Sciences, Delhi) but slightly lower
than 131.6 (Bhavnagar, Gujarat).[11-19] The near similarity
Avg. score among all MBBS Inference
students out of 100 points
65.4% More positive than
negative
65.8% Moving in right
direction
65.9% Moving in right
direction
66.2% Feeling more on
positive side
60.7% Not too bad
65.0% More positive than
negative
3
 Sachdeva and Dwivedi: Medical education

of the findings could perhaps be because this institution as opportunity, and threat) analysis of a medical college
others have been able to maintain satisfactorily the minimum in Kerala also reported similar observations.[20] As there is
standards and the operational guidelines set by the regulatory no information with regard to status of education environment
body in the country, that is, MCI. In addition to this, the length in a medical college with adverse/unsatisfactory regulatory
(years) of running an institution could be another determinant (MCI) inspection report that may throw surprising results for
leading to such results. A SWOT (strength, weakness, comparison.
Further, a small batch of 50 MBBS students leads to better
Percentage score of DREEM tool amongst all medical students
and strong student–teacher interaction; doubt clearance/
clarification; quick feedback and relaxed environment
SPL 65.4% during tutorials with still smaller batches. However,
SPA 65.8%
some areas need strengthening and introspection,
especially teaching style, concerning the item “teachers
SPT 65.9%
are authoritarian” and infrastructure-associated issues
SASP 66.2% such as hostel accommodation. The sensitization of
teachers is needed to act as role model, change agent,
SSSP 60.7%
facilitator, in making the environment more congenial, and
Total DREEM score 65% also in better managing the students in changing
sociopolitical and information technology dynamics
Figure 1: DREEM score among all medical students out of 100 points in India. Hostel accommodation and leisure time

Table 3: Mean scores (±SD) of five domains of DREEM as per background characteristics
Variable SPL SPT SASP SPA SSSP Total
Gender Male 31.46 (5.1) 29.07 (4.4) 21.20 (3.5) 31.45 (6.3) 16.51* (3.6) 129.69 (17.9)
Female 31.50 (4.0) 28.93 (3.2) 21.26 (2.9) 31.87 (3.6) 17.78* (2.9) 131.35 (11.8)
School Government 31.48 (3.6) 28.74 (3.8) 22.30 (2.3) 32.26 (4.3) 17.30 (3.2) 132.09 (11.9)
Private 31.48 (4.9) 26.67 (3.6) 20.96 (3.4) 31.46 (5.7) 16.94 (3.5) 129.91 (16.6)
Native place Delhi 31.70 (4.7) 29.13 (3.9) 21.47 (3.2) 31.83 (5.4) 17.10 (3.3) 131.23 (16.1)
Other 31.05 (4.5) 28.80 (4.1) 20.75 (3.3) 31.2 (5.5) 16.83 (3.5) 128.63 (15.1)
Residence Hostel 30.82* (4.7) 28.94 (3.9) 20.87 (3.3) 31.33 (5.3) 16.81 (3.7) 128.77 (15.7)
Day scholar 32.84* (4.2) 29.18d (4.2) 21.95 (2.9) 32.21 (5.4) 17.42 (2.6) 133.61 (15.5)
12th class marks <90% 30.88 (4.68) 28.96 (3.88) 20.78 (3.41) 31.73 (5.35) 16.42* 128.76 (15.8)
(3.43)
≥90% 32.28 (4.5) 29.01 (4.09) 21.82 (2.93) 31.46 (5.56) 17.80* 132.46 (15.7)
(3.23)
Satisfaction (profession) Satisfied 31.57 (4.7) 29.02 (3.9) 21.35 (3.07) 31.77 (5.3) 17.17* 130.89 (15.8)
(3.34)
Not 29.83 (3.31) 28.83 (4.83) 18.83 (5.3) 28.67 (6.59) 14.0*(3.4) 120.17 (12.5)
satisfied
Satisfaction (college) Satisfied 32.09* (4.1) 29.37* (3.9) 21.71* (2.9) 32.41* (4.8) 17.41* (3.3) 133* (13.6)
Not 28.11* (5.8) 27.05* (3.8) 18.56* (3.6) 27.22* (6.4) 14.78* (3.3) 115.72* (18.9)
satisfied
Satisfaction (global) Satisfied 31.64 (4.6) 28.88 (3.9) 21.44* (3.1) 32.04* (5.0) 17.24* (3.3) 131.26* (15.2)
Not 29.44 (5.1) 30.55 (3.6) 18.67* (3.7) 26.44* (7.4) 14.22* (4.1) 119.33*
satisfied (19.35)
Current mental status Sad 32 (1.67) 30.66 (2.50) 20.17 (5.04) 29.33 (3.98) 14.83 (3.31) 127 (9.71)
Happy 31.45 (4.75) 28.93 (4) 21.28 (3.14) 31.74 (5.46) 17.12 (3.38) 130.52 (16.03)
Administration is student- Agree 32.43* 29.59* 21.84* 32.31* 17.27 (3.50) 133.44*
supportive (4.14) (3.58) (3.01) (5.27) (14.92)
Disagree 28.59* 27.28* 19.34* 29.52* 16.21 (2.99) 120.93*
(4.95) (4.56) (2.99) (5.35) (14.71)
MBBS batch 4th year 32.48* 28.75 (4.05) 23.03* 34.0* (3.85) 18.30* 136.58*
(4.33) (2.63) (2.73) (12.80)
3rd year 32.63* 29.44 (4.14) 21.46* 31.09* 17.27* 131.91*
(4.35) (2.94) (5.89) (3.31) (15.47)
2nd year 29.46* 28.78 (3.73) 19.51* 30.24* 15.68* 123.68*
(4.61) (3.17) (5.44) (3.58) (16.07)
SPL = Students’ perception of learning, SPT = Students’ perception of teachers, SASP = Students’ academic self-perception, SPA = Students’ perception of
atmosphere, SSSP = Students’ social self-perception. *P < 0.05.

4 MAMC Journal of Medical Sciences ¦ Volume XX ¦ Issue XX ¦ Month 2017

 Sachdeva and Dwivedi: Medical education

Table 4: Average scores (mean ± SD) of 50 items of DREEM inventory among medical students (underachiever and
academic achiever)
Questions Overall U-A (mean ± SD) Achievers (mean ± SD) P
(mean ± SD)
(A) Students’ perception of learning (SPL)
1–I am encouraged to participate during teaching sessions 2.79 (0.76) 2.80 ± 0.77 2.77 ± 0.75 0.88
7 − The teaching is often stimulating 2.63 (0.79) 2.63 ± 0.76 2.64 ± 0.95 0.98
13 − The teaching is student-centered 2.71 (0.79) 2.74 ± 0.76 2.59 ± 0.91 0.43
16 − The teaching helps to develop my competence 2.79 (0.90) 2.78 ± 0.86 2.86 ± 1.04 0.69
20 − The teaching is well focused 2.95 (0.64) 2.95 ± 0.57 2.95 ± 0.90 0.96
22 − The teaching helps to develop my confidence 2.66 (0.67) 2.68 ± 0.69 2.55 ± 0.60 0.38
24 − The teaching time is put to good use 2.80 (0.76) 2.87 ± 0.72 2.50 ± 0.86 0.03
25 − The teaching over emphasizes factual learning 1.58 (0.87) 1.57 ± 0.92 1.64 ± 0.66 0.74
38 − I am clear about the learning objectives of the course 2.88 (0.60) 2.91 ± 0.60 2.77 ± 0.61 0.36
44 − The teaching encourages me to be an active learner 2.69 (0.77) 2.72 ± 0.71 2.59 ± 1.00 0.49
47 − Long term learning is emphasized over short term learning 2.67 (0.93) 2.67 ± 0.92 2.64 ± 1.00 0.87
48 − The teaching is too teacher centered 2.32 (0.92) 2.39 ± 0.91 2.0 ± 0.87 0.07
(B) Students’ perception of teachers (SPT)
2 − The teachers are knowledgeable 3.32 (0.63) 3.36 ± 0.56 3.18 ± 0.85 0.24
6 − The medical consultation is patient centered 2.60 (0.86) 2.53 ± 0.87 2.91 ± 0.75 0.06
8 − The teachers ridicule the student 2.38 (0.94) 2.45 ± 0.92 2.05 ± 0.99 0.07
9 − The teachers are authoritarian 1.75 (0.97) 1.80 ± 0.95 1.55 ± 1.05 0.27
18 − The teachers have good communication skills 3.01 (0.70) 3.02 ± 0.70 2.95 ± 0.72 0.69
29 − The teachers are good at providing feedback to students 2.81 (0.77) 2.80 ± 0.79 2.86 ± 0.64 0.72
32 − The teachers provide constructive criticism here 2.58 (0.82) 2.54 ± 0.84 2.77 ± 0.75 0.22
37 − The teachers give clear examples 2.84 (0.64) 2.83 ± 0.63 2.86 ± 0.71 0.83
39 − The teachers get angry in teaching sessions 2.36 (0.86) 2.36 ± 0.86 2.36 ± 0.85 0.98
40 − The teachers are well prepared for their class 3.14 (0.74) 3.18 ± 0.70 2.95 ± 0.90 0.20
50 − The students irritate the teachers 2.23 (1.0) 2.15 ± 0.95 2.59 ± 1.18 0.06
(C) Students’ academic self-perception (SASP)
5 − Learning strategies which worked for me before continue to work 2.39 (0.95) 2.41 ± 0.91 2.32 ± 1.13 0.68
for me now
10 − I am confident about my passing this year 3.22 (0.77) 3.17 ± 0.81 3.45 ± 0.51 0.11
21 − I feel I am being well prepared for my profession 2.79 (0.71) 2.83 ± 0.68 2.64 ± 0.85 0.25
26 − Last year’s work has been a good preparation for this year’s 2.61 (0.81) 2.68 ±0.76 2.27 ± 0.94 0.03
work
27 − I am able to memorize all I need 1.87 (0.92) 1.88 ± 0.91 1.82 ± 1.00 0.76
31 − I have learnt a lot about empathy in my profession 2.91 (0.74) 2.91 ± 0.73 2.95 ± 0.79 0.78
41 − My problem solving skills are being well developed here 2.53 (0.84) 2.54 ± 0.80 2.50 ± 1.01 0.85
45 − Much of what I have to learn seems relevant to a career in 2.89 (0.82) 2.92 ± 0.83 2.77 ± 0.75 0.46
healthcare
(D) Students’ perception of atmosphere (SPA)
11 − The atmosphere is relaxed during ward teaching 2.72 (0.91) 2.75 ± 0.93 2.59 ± 0.80 0.47
12 − This course is well time-tabled 2.82 (0.90) 2.81 ± 0.89 2.86 ± 0.94 0.80
17 − Cheating is a problem on this college 2.38 (1.12) 2.38 ± 1.18 2.41 ± 0.85 0.89
23 − The atmosphere is relaxed during lectures 2.70 (0.84) 2.71 ± 0.85 2.68 ± 0.84 0.91
30 − There are opportunities for me to develop interpersonal skills 2.54 (1.08) 2.55 ± 1.05 2.50 ± 1.23 0.85
33 − I feel comfortable in teaching sessions socially 2.89 (0.67) 2.94 ± 0.62 2.68 ± 0.84 0.11
34 − The atmosphere is relaxed during tutorials/seminars 2.69 (0.93) 2.71 ± 0.92 2.64 ± 1.00 0.76
35 − I find the experience disappointing 2.7 (0.85) 2.80 ± 0.79 2.27 ± 0.99 0.03
36 − I am able to concentrate well 2.45 (0.84) 2.45 ± 0.85 2.45 ± 0.80 0.99
42 − The enjoyment outweighs the stress of study course 2.18 (1.10) 2.22 ± 1.04 2.00 ± 1.31 0.39
43 − The atmosphere motivates me as a learner 2.59 (0.86) 2.69 ± 0.75 2.14 ± 1.17 0.04
49 − I am able to ask questions when I want to 2.95 (0.76) 3.06 ± 0.68 2.45 ± 0.91 0.07
(E) Students’ social self-perception (SSSP)
3 − There is a good support system for students who get stressed 2.10 (1.11) 2.11 ± 1.10 2.09 ± 1.19 0.96
4 − I am too tired to enjoy the course 2.32 (1.11) 2.39 ± 1.09 2.05 ± 1.17 0.19
(Continued )

MAMC Journal of Medical Sciences ¦ Volume XX ¦ Issue XX ¦ Month 2017 5

 Sachdeva and Dwivedi: Medical education
Table 4 (Continued)
Questions
(mean ± SD)
14 − I am rarely bored on this course
15 − I have good friends in this college
19 − My social life is good
28 − I seldom feel lonely
46 − My accommodation is pleasant
U-A = underachiever.
involvement of students are the other areas that need
suitable betterment.
The domain under “student social self perception” (SSSP),
which includes items such as support system for students,
boredom of course, social life, feeling of loneliness, and
tiredness, could garner “not bad” score (average score 17.1
out of a maximum of 28) among DREEM inventory. This
domain reflects the inherent challenges of the course that call
for attention, student support system, and individual
counseling. The low scores are comparable to the majority
of studies conducted in India such as 17.7 (Gujarat), 17.7
(Mumbai), 14.4 (UCMS, Delhi), and 14.1 (Udaipur).
However, even under this domain, girls scored statistically
(P < 0.05) higher and better than males (17.7 vs. 16.5);
students with at least 90% marks in 12th class; students who
were professionally satisfied; students who were satisfied
getting admission in this college; and senior batches of
students also scored high.
Overall, none of the DREEM inventory item had an
average score more than 3.5, but the majority of scores
in the present study were in the range of 2–3 points (range
0–4) indicating the aspects of the environment that could be
improved or enhanced. Logically speaking, because this
instrument measures the experiential learning, senior
students had higher mean score than their juniors and
the finding was found to be statistically significant. This
is again similar to those reported in other studies.[11,18,21] In
our study, out of all the listed background variables,
“getting admission in present medical college” had a
statistically significant bearing on all the subdomains of
DREEM inventory tool.
The duration of MBBS course in medical college of India is
four-and-half years followed by 1-year internship. The
students are systematically and in structured way exposed
to different subject streams (preclinical, paraclinical, and
clinical) through processes prescribed under MCI with
students to keep the record of daily activity/learning in a
log book. Teaching, learning dynamics, and evaluation
process form the core activity of student–teacher
interaction in any institution. Motivated faculties
are constantly engaged in building knowledge base,
transforming attitude, and implementing innovating
methods from a large bouquet of training methods,
evaluation, and also have received the highest attention of
medical researchers in Indian setting.[22-24]
6 MAMC Journal of Medical Sciences ¦ Volume XX ¦ Issue XX ¦ Month 2017
Overall U-A (mean ± SD) Achievers (mean ± SD) P
2.12 (1.08) 2.11 ± 1.07 2.18 ± 1.18 0.77
3.07 (0.90) 3.09 ± 0.90 2.95 ± 0.90 0.51
2.97 (0.78) 2.97 ± 0.79 3.0 ± 0.76 0.87
2.10 (1.09) 2.07 ± 1.07 2.23 ± 1.15 0.55
2.32 (1.25) 2.28 ± 1.27 2.45 ± 1.18 0.57
The stimulating and involving education environment created
in medical institutions by some of the esteem faculties makes
learning active, interesting, and life-long. Inter-alia, need for
cramming of the subjects becomes less critical. Inquisitive,
novice, and innocent curious questions of the students can be
best handled by understanding and matured faculties. Such
practice needs to be nurtured with tender care. The
development and growth potential of an individual is
directly correlated with the depth of knowledge, positive
attitude, and diverse skills s/he possesses and demonstrates
whether at undergraduate or higher level of functioning.[25]
Many institutions in India have introduced innovative
training methods based on integrated teaching or problem/
investigation report/field based learning, evidence-based
medicine, and some of them are equipped with high-end
research, clinical, simulation, and communication skill labs.
Medical education environment in the country is evolving for
better, yet it needs a time-bound overhaul to overcome
diverse uninspiring challenges and also to be in sync with
newer competencies, digital technology, and changing
time.[26-29] Stakeholders, be it student, faculty, or admini-
strator, are constantly engaged in discussion, debate, and
meetings for overcoming the crises situation and suggest
way forward. Nontransparent interactions, favoritism,
commercialization of medical education, and corruption
have been the main stumbling blocks in its road to
recovery. For the last couples of years, the thrust of
medical education in country has been to increase the
production of doctors and allied health staff, albeit
increasing quantity is having a toll in terms of poor quality
of doctor training including inadequate knowledge and skill
transfer.[30,31] The current number of medical colleges in
India stood at 474 with annual MBBS seats of 60,000 plus
while the number of postgraduate degree/diploma seats are
nearly half. Considering the stiff challenge in securing
a postgraduate seat in India, a significant number of
undergraduate students are preparing for postgraduate
entrance exam starting from 2nd year onwards. It can be
though attributed to early start and purposeful planning but
also indicating a case scenario of intense peer pressure and
rising stress.
In the backdrop of this journey, it was realized that teaching
shifted from black-board to power point with medical
education largely being drifting toward western concept
that carried little ethos, sentiments, and fragrance of vast
 Sachdeva and Dwivedi: Medical education
rural and diverse democratic country such as India.[28,32]
There has been a predominance of “theoretical” knowledge
transfer and subject cramming. However, it was noted during
the last decade that there has been a compensatory increase in
skill transfer, clinical case, and practical exposure of medical
students through cutting down the time period of more
“theoretical”-oriented preclinical subjects. Three months
internship period has been reduced to 2 months in the
department of community medicine again on the same
premise. In times to come, we would witness more such
pruning; however, there are reservations against this
phenomenon.[33] With the rising materialistic aspirations,
clinical–social case discussion and doctor–patient comm-
unication are witnessing a downward trend. Inter-alia, the
proposed National Medical Commission that would replace
current MCI may usher the next wave of change in medical
education in India.Medical education is an encompassing
term that considers various factors such as curriculum,
learning and teaching methodologies, outcome and
assessment, skill transfer, group dynamics, teacher–student
relationship, self-development, and peer development. The
students’ perception of their environment was shown to
have a significant impact on their behavior and academic
progress.[34] Students in present medical college get admitted
through a highly competitive entrance exam and hence can be
considered to be above average with self-drive and
motivation for learning. However, the exact reasons for
low scores for some of the subdomains of DREEM
inventory could not be elucidated but the difference could
be attributed to students’ personality, emotional factors,
aspirations, challenging exposures in childhood, and
socioeconomic-cultural upbringing, among others. In
conclusion, overall students indicated progressive and
positive developmental milieu in the present study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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