ISSUES AND REMEDIES RELATED TO LEARNING ENVIRONMENT OF STUDENTS DURING MATERNAL, NEONATAL AND CHILD HEALTH CLERKSHIP

Learning Environment of Students During Clerkship

Abstract

Objective: To gain insight into learning-environment of Maternal Neonatal and Child Health community clerkship, using Dundee Ready Educational Environment Measure questionnaire and focus group discussion to improve students’ quality of learning.
Study Design: Sequential Mixed Method Study.
Place and Duration of Study: Primary Centers (Aga Khan Health Services, Pakistan) and Secondary Center (Aga Khan University), from Nov 2014 to Oct 2015.
Material and Methods: All consenting third-year MBBS students after completing maternal neonatal and childhealth (MNCH) rotation anonymously filled the Dundee Ready Educational Environment Measure (DREEM) questionnaire. Data was entered in MS Excel 2013 and SPSS version 21. Descriptive statistics were calculated such as frequencies, mean and standard deviation of the total/subscale scores. Independent samples t test was used to identify gender-related differences among DREEM scores with p-value of < 0.05 as statistically significant. Focus Group Discussion (FGD) was conducted with all consenting facilitators (Faculty/Lady Health Visitors). Thematic analysis of qualitative data was done using constant iterative approach.
Results: From a total of 99 students, 78 (78.8%) consented, of which 36 (46.2%) were males and 42 (53.8%) females. Mean total DREEM score was 126.26/200 (63.13%) indicating a more positive learning environment. Total means with percentages and interpretation of subscale scores showed ‘Students Perception of Learning (SPOL)’, 28.92/ 48 (60.25%) indicating more positive approach; ‘Students Perception of Teachers (SPOT)’, 28.58/ 44 (64.95%) indicating teachers are moving in right direction; ‘Students Academic Self-Perception (SASP)’, 20.64/32 (64.5%) indicating students felt positive academically; ‘Students’ Perception of Atmosphere (SPOA)’ 31.17/48 (64.93%) indicating positive learning-atmosphere and Students’ Social Self-Perception (SSSP), 16.93/28 (60.46%) showing not-too-bad social-environment. Thus, DREEM results showed, students perceived their learning environment to be overall positive. As a composite score in the five domains of educational environment no statistically significant difference was found between males and females. (SPOL: p value 0.655; SPOT: p value 0.760; SASP: p value 0.685; SPOA: p value 0.245; SSSP: p value 0.280).Common issues identified through DREEM and student-facilitators through FGD were grouped into threethemes; ‘Challenges faced’, ‘Student-learning facilitation’ and ‘Way-forward’. Triangulation of data from DREEMquestionnaire and FGD indicated validation of outcomes.
Conclusion: MNCH clerkship is a rotation, in a low/middle income country, in early years of inception. Students are satisfied but there is scope for improvement. This evaluation helped identify problem areas to enable improvement of program and inspire other institutions to arrange community clerkships.