To the best of our knowledge, this is the first DREEM study reported from a private medical school in Sudan. The major finding is that the overall DREEM score of 130/200 indicates a more positive than negative educational environment in the Al-Nahda medical program. This result is in-line with Ahmed et al., and Salih et al., who conducted studies in public national universities in Sudan, namely the University of Al-Gezira and Bahri University where scores of 122/200 and 125.2/200 were obtained, respectively [13, 14]. The positive scores in these studies, as well as our own, point to a well-established infrastructure, an integrated and student-centred curriculum, skilful teachers and a good social-environment. Each of these aspects has been key for Al-Nahda College since its establishment. The result is comparable to other international medical schools like Ziauddin University in Pakistan (117/200), King Abdul Aziz University (102/200), Taibah University (120/200) and Qassim University in Saudi Arabia (112/200) [16–19]. However, the score exceeds that of medical schools at Jazan University (96.5/200), King Saud University in Saudi Arabia (90/200), and Guilan Medical University in Iran (100/200). Scores from these institutes indicate educational environments with many problems [20–22] despite the fact that these three institutes were established in economically powerful countries with ample logistics and resources. Students perceive a negative educational environment, suggesting that economic power is not the only determinant of the educational environment and there are other factors beyond the facilities of the educational environment . The DREEM inventory was used to measure the educational environment as it is widely accepted as a reliable way to compare educational environments in different medical schools around the world. DREEM considers international differences in culture, moral issues and languages. DREEM has strong psychometric properties which enable the tool to be used to evaluate medical schools for international comparison in a valid and reliable way .
In the current study, students perceived their teachers positively. However, student perception of learning indicates a negative perception. A positive perception of teachers is an outcome of a faculty continuous development plan implemented by the Educational Development Centre and aimed at enhancing the faculty’s capacities in preparation and delivery of teaching materials, setup of blue-printing, standard settings and student assessment. Moreover, the college follows a specific and rigorous recruitment procedure that ensures selection of staff with the highest academic grades and strong academic teaching experience. This finding is in line with other universities in Sudan and outside of it [13, 24].
Student academic self-perception was positive in our study with a score of 21.5/32. Academic self-perception is defined by Kohli and Dhaliwal as being “related to ability of the students to cope with the academic workload” . Although many studies report low scores and negative perceptions in this domain, indicating a global challenge [26, 27], our result is similar to that reported by other studies from Sudan (21/32) and Malaysia (20.6/32) [11,14]. Well-designed and prepared timetables – with more time allocated to self-directed learning – are a leading cause for this positive perception. However, delivery of many teaching activities in a very restricted time is considered a challenge in medical education. Whether the teaching curriculum is traditional or innovative [26, 27], students often feel overloaded by academic duties and this overwhelming sensation may result in frustration and sometimes depression . Female students had academic self-perception that was significantly more positive than that of their male counterparts. Australian DREEM supports our findings .
Student perception of the atmosphere in our study scored 32.7/48 and showed a more positive perception than other DREEM reports from Sudan (26/48) and Saudi Arabia (30.2/48) [11, 16]. Educational atmosphere refers to the teaching class and clinical setup, and teachers’ behaviour during the teaching sessions and clinical rounds. It also includes curriculum design and academic regulation. Some reports indicate that a teacher-centred curriculum focused on lecturing is boring [30, 31]. Here students are subjected to a less motivating environment in contrast to problem-based learning . There were neither gender nor academic ranking differences in the perception of this domain.
In this study, students perceived their social life as more positive (19.2/28) than in many institutes in Sudan (17/28), Pakistan (15.4/28) and Malaysia (16.7/28) [13, 17, 33]. These findings regarding social life in this study are not surprising and may be partially attributed to the out-of-class activities, journeys and open cultural days regularly organized by the students’ deanship. These journeys and open days create a robust social environment and relationships between students and with the academic and administrative staff. Moreover, the student mentoring program is one of the important determinants of the social life which ensures a strong psychological support and feedback system . Although the mentoring program is not well known, an advisory program for students was implemented in the last two years with aims very close to those of a mentoring program. Female students perceived the social life significantly more positively than male students, as was seen at the College of Medicine at Taibah University .
Students’ perceptions of learning indicated a negative educational environment. This is a major concern for many international universities [26, 34–36]. To obtain a good learning perception, researchers recommend structured learning for clinical and theoretical teaching. Moreover, more time should be allocated for tutorial sessions, and the adoption of small teaching group techniques and other innovative approaches . Although there was no item that scored below 2 in this subscale, items that scored lowest were: “I am clear about the learning objectives of the course” and “I am encouraged to participate during teaching sessions”. Clarity of learning objectives is a cornerstone of adult learning principles, and participation in discussions reflects students’ cognitive activity . This subscale suggests need for urgent intervention that includes: explaining of the learning objectives to the students for each teaching session or at least for every module. Small group discussions should be held more frequently and with encouragement for each student to participate in the session. This domain should be considered at the time of curriculum appraisal and in all long-term planning.
In this study we observed that females perceive the overall educational environment, their teachers, their academic and social self-perception significantly more positively than male counterparts. There is no clear reason for this, however, it may be attributed to the way of thinking, learning style, concern and interest of the female gender over the male gender . Possibly, gender bias favouring female teaching and assessment is the case here . From another point of view, Makhdoom and his colleagues observed that high academic achievers specifically perceived their teachers far more positively than non-academic achievers. Perhaps female students constitute a high proportion of the higher academic achievers. However, we did not enquire about academic achievement in this study. More than three decades ago Carol Gilligan and Susan Pollak (1988) noted:
The increasing number of women entering the medical profession prompts a rethinking of medical education. Like the canaries taken into mines to reveal the presence of unseen dangers, women medical students in their heightened sensitivity to detachment and isolation often reveal the places in medical training and practice where human connection has become dangerously thin .
Perhaps, this high female sensitivity has led to the differences noted in the perception of the majority of the domains.
In this study, students’ ranking (clinical or pre-clinical) failed to show any significant difference in the overall DREEM score or any of the subscale domains. This may be attributed to the motivation and excitation associated with the admission to the school of medicine and a feeling of determination in the pre-clinical phase. Students in the clinical phase may be fully aware of the complexity of the clinical phase and the efforts needed for bedside teaching so they may be more realistic. However, they are still optimistic about their future as they are about to leave student life behind and become a doctor. Findings in the literature are conflicting [13, 39, 42].
This is the first study that documents the educational environment in Al-Nahda College and it has many limitations. First, although the DREEM inventory is well structured, valid and reliable, it is long and students may have become bored when responding to the items, which may then have affected the responses obtained. Second, educational environment is a complicated issue that the predetermined options in DREEM may be too limited to address. Further study is needed to reassess the educational environment in Al-Nahda College after considering all the domains that need intervention and including the variables that are missing in this version, like students’ grade point average (GPA), admission scores and secondary certificate type.