RESUMO
BACKGROUND: A well-functioning education system for family nurses is a priority of the primary health care reform in Tajikistan. In 2015/2016, a baseline study was carried out to measure the educational environment at two nursing colleges, in Kulob and Dushanbe. Building on the study's recommendations, the educational reform has addressed several key issues to improve the educational environment among nursing students with a focus on strengthening competency-based learning and clinical skills. A follow-up study was carried out in late 2018 to comparatively analyse progress in the educational environment against the baseline and assess potential impacts of tailored interventions. METHOD: A repeated cross-sectional survey involving 1239 students was applied to measure changes in the educational environment between 2015/2016 (baseline) and 2018 (endline) using the Dundee Ready Education Environment Measure (DREEM). We compared mean scores over time using Welch's two sample t-test and the Wilcoxon-Mann-Whitney test. Single items have additionally been analysed using critical threshold (flags) for mean scores, and the percentage of answers falling above or below predefined values. A multivariate non-parametric regression was applied to control for confounding factors. Internal consistency was examined using Cronbach's α. RESULTS: Cronbach's α for overall scores ranged between 0.87 and 0.89. Between 2015/2016 and 2018 the perceived educational environment improved with an increase of the mean total DREEM score from 131.8 to 146.9 in Dushanbe and from 134.9 to 151.2 in Kulob. Mean comparisons and multivariate regression revealed a significant increase of all sub-scores between 2015/2016 and 2018 with students' social self-perception exhibiting the smallest progress. Despite the general improvements observed, analysis at the level of single items revealed persistent weaknesses including a lack of competency-based learning and stress. CONCLUSIONS: The education environment has improved in several important ways between 2015/2016 and 2018 which points to a likely positive contribution of the nursing education reform. This progress notwithstanding, there is still notable room for further improvement. Targeted efforts aimed at a better organization of practical trainings, improved didactical competences of teachers, and support structures for lonely and stressed students still seem to be lacking for the achievement of a good nursing education system in Tajikistan.
RESUMO
BACKGROUND: The Tajik medical education system is undergoing a complex reform to enhance the transition of the healthcare system from its soviet legacy of emphasizing secondary level care/specialisation to become more family medicine and primary health care oriented. The current study presents the first empirical evaluation of the educational environment for nursing students in Tajikistan using the Dundee Ready Educational Environment Measure (DREEM). The study results contribute to the benchmarking efforts of monitoring and positively steering the educational environment over time. METHOD: The study was based on a cross-sectional survey involving 630 nursing students at two nursing colleges in Tajikistan. Students' perception of the learning environment was measured using the DREEM. Internal consistency was examined using Cronbach's alpha. General scores were calculated and measured against international benchmarks. Data was further interpreted by comparing DREEM scores between students of different sex, at different colleges and different study years using T tests. RESULTS: Cronbach's alpha ranged from 0.30 to 0.75 with an overall alpha of 0.89. General DREEM scores were slightly above average compared to similar studies with nursing students in other countries. In particular, results showed that students' academic self-perception and teachers' technical competences were generally favourably rated. Teachers' pedagogical skills were critically perceived by the study participants and teaching was generally viewed as too teacher-centred with an over-emphasis on factual learning. CONCLUSIONS: Statistical results indicated acceptable levels of reliability of the DREEM tool when applied to the Tajik nursing educational context. Students rated the learning environment as generally satisfactory with average scores similar or slightly higher than comparable scores from similar studies involving nursing students. However, the on-going educational reform could have placed more emphasis on developing faculty pedagogical skills in nursing schools. Teaching approaches would benefit from being more competency based rather than so heavily focused on factual knowledge.