The adaptation process of the DREEM scale was conducted according to the research methodology. Alpha Cronbach’s coefficient indicates good internal reliability (α = 0,95). The reliability for the QuESST scale is α = 0,91 after deletion of 4 items. The correlations of QuESST and DREEM general scores as well as the scores of individual subscales are at the level of significance equal to p ≤ 0.001.
Organization of the educational environment is an important factor influencing the level of realization of particular educational goals. Medical simulation is a special kind of educational environment. Due to legislative changes imposing implementation of educational standards in medical degrees, it has become a popular and necessary method used in program curricula. Medical simulation, defined as simulated clinical conditions, when optimally used, brings a great educational potential. The full use of its resources relies, among others, on the attitude of students to use simulation methods. In this study, therefore, an attempt has been made to present specific tools which may be helpful in investigating the perspectives of students with reference to conditions associated with implementation of a medical program curriculum using simulated environment (24).
Medical simulation is certainly a specific educational environment, which should meet specific requirements in order for educational activities to produce expected results. A few researchers have already attempted to define the role of simulation in medical education (25, 26). For example, Reynolds et al. (2008) presented a research aimed at assessing the impact of medical simulation-based teaching on students' knowledge and satisfaction with the teaching process. Their research was based on the course of Obstetrics and Gynaecology and provided results indicating that classes using medical simulation increase students' satisfaction with the teaching process (27).
Undoubtedly, one of the biggest assets of setting the learning process in simulation environment is the possibility to avoid risking patient’s safety during simulated training. Students have the ability to undertake activities and procedures in a repetitive manner, being able to make and learn from mistakes, without any serious consequences. At the same time, simulation environment is a reflection of the conditions that are most likely found at any contemporary healthcare institution. Healthcare professionals are required not only to possess specific knowledge about medical procedures and related technical skills but also develop non-technical skills, decision-making skills, be able to work in a team, or communicate with patients of different ages and needs (28). Students are provided with an opportunity to practice and acquire these skills attending the courses organized in medical simulation environment, which makes them better prepared for their future work.
Very interesting correlations were obtained by using a correlation analysis between the overall result of the QuESST questionnaire and the overall result and the individual subscales of the DREEM questionnaire. Both the overall results of the QuESST and DREEM tools, as well as the overall result of QuESST and the results of individual DREEM subscales significantly correlated statistically. These correlations mean that the increase in the overall score of the QuESST questionnaire was linked to the increase in the overall score and the results of the individual subscales of the DREEM questionnaire. The assessment of the educational environment was therefore related to the assessment of simulation conditions made by students, in particular, their satisfaction with the simulation experience. The QuESST method seemed to confirm this relationship in a good way. High correlations between the proprietary QuESST tool and the existing DREEM tool may suggest a high psychometric value of the QuESST questionnaire.
Possibility to describe educational environment seems to be very important. Information about the aspects making educational environment a well-organized teaching and learning place can be further used in planning an effective educational environment based on simulated conditions. Simulation environment requires appropriate preparation of teaching conditions, appropriate embedding in the curriculum and organization from the administrative point of view, high level of content, appropriate attitude of persons presenting the teaching content, ability to interact with students, ability to design scenarios and course of classes (29). Even a small inconvenience on the part of technical equipment may disturb the course of simulation classes and their realism.
Proper design and construction of the educational environment seems to be important from the perspective of optimization of the learning and teaching process. It is a kind of basis for the development of conditions in which learning will be organized using simulation methods (1, 30, 31) especially in medical faculties, where students often have to face real-life situations in a hospital or clinic. Using the DREEM tool seems to be essential for proper assessment of the educational environment. Additionally, it was necessary to construct another appropriate tool in order to capture specific conditions of simulation environment as an educational environment. The QuESST questionnaire proved to effectively identify distinct aspects related to educational process using medical simulation. Only a proper design of this process allows realization of the teaching content and successful achievement of the assumed educational goals.
Notwithstanding the effects of the QuESST tool designed in our study, it is recommended that further work on strengthening its construction and psychometric values is undertaken.