Validation of the Polish version of the DREEM questionnaire - a confirmatory factor analysis.

AIM: The aim of our study was to translate and adapt the Dundee Ready Education Environment Measure (DREEM) questionnaire developed by Roff et al. to the cultural conditions in Poland and also to validate it. Studying the learning environment is beneficial because it can identify students' perceptions of their environment and support the staff in reflecting on, planning for and combining proper teaching approaches to improve it. METHODS: The DREEM questionnaire was completed by students of all years (first-fifth) in the faculties of dental medicine at the Medical University of Lublin and the Medical University of Gdansk. The total surveyed population consisted of 650 students. Validity was separated into four phases: (1) translation validity, (2) confirmatory factor analysis, (3) concurrent validity and (4) criterion-related validity. RESULTS: Our study confirmed the original structure of the DREEM tool (GFI = 0.955, AGFI = 0.951, NFI = 0.931, TLI = 0.962, CFI = 0.964, RNI = 0.964, IFI = 0.964, RFI = 0.928, PNFI = 0.885, SRMR = 0.062, RMSEA = 0.043, 90% CI = 0.041-0.046) and obtained very good reliability rates, with Cronbach's alpha > 0.7 for all scales. Only Subscale V achieved a lower Cronbach's alpha of > 0.5. The study was conducted using the test-retest method, which is why the intraclass correlation coefficients for reliability were also calculated; individual items showed both medium and good correspondence. CONCLUSIONS: Our study provided good evidence for the reliability and validity of the Polish version of the DREEM. In conclusion, the Polish-language version of the DREEM questionnaire is a reliable and valid instrument for analysing the learning environment for dental students and its factor structure is supported by the data.

Standing out with Professionalism: How do Students and Faculty of two different Medical Schools perceive it?

BACKGROUND AND OBJECTIVES: Medical professionalism is an essential aspect of medical education and practice worldwide. Our objective was to explore and compare the perception as recommended sanctions about professionalism lapses, using the "Dundee Polyprofessionalism Inventory I: Academic Integrity", among the faculty and the students' of two different medical schools in Saudi Arabia. METHODS: Respondents from the two medical schools in Saudi Arabia, recommended sanctions for the first time, absolute lapses in academic professionalism were determined by using the "Dundee Polyprofessionalism Inventory 1: Academic Integrity". RESULTS: On comparing the faculty and students' responses (from College of Medicine, King Saud University) with the published data (from another, unidentified medical school in Saudi Arabia) we found alignments in recommending sanctions for 14 (46.66%) behaviours among faculty and again concerning the11(36.66%) behaviours among the students of both cohorts. CONCLUSION: The results can be used to emphasise on the improved teaching and learning strategies in undergraduate medical students' understanding of professionalism.

Comparison of recommended sanctions for lapses in professionalism of undergraduate medical students in a Saudi Arabian and a Scottish medical school.

BACKGROUND: Medical Professionalism is recognized as a cultural construct. We explore perceptions of the severity of lapses in professionalism of undergraduate medical students at two medical schools with different cultural contexts. METHODS: Respondents from two medical schools (Saudi Arabia & UK) recommended sanctions for the first time, unmitigated lapses in academic professionalism, using the Dundee Polyprofessionalism Inventory 1: Academic Integrity. RESULTS: While more than two-thirds of the recommended sanctions for the 30 items of poor professionalism were fully or nearly congruent among the 1125 respondents, there were substantial differences in recommended response for one-third of the items, with a strong tendency for the Saudi students to recommend more lenient sanctions than the Scottish students. CONCLUSION: The strategy of using recommended sanctions as a proxy for the perception of the severity of different lapses in professionalism may be a useful tool in learning and teaching academic professionalism among medical students in different cultural contexts.

Exploring the climates of undergraduate professionalism in a Saudi and a UK medical school.

AIM: To explore the usefulness of an online inventory for tracking medical students' understanding of the importance of lapses in academic integrity. METHOD: Respondents were asked to recommend sanctions for lapses as a proxy of their understanding of the importance of the 34 types of poor professionalism. RESULTS: The data suggest that while there is congruence, there are also substantial differences between ratings of the importance of poor professionalism, particularly in relation to data integrity, between a cohort in Saudi Arabia and one in the UK. CONCLUSION: This resource may be useful both for teaching and learning in individual schools, and particularly for the induction of doctors into organisational environments different from the one they were trained in.

Your professionalism is not my professionalism: congruence and variance in the views of medical students and faculty about professionalism.

BACKGROUND: Medical professionalism is an essential aspect of medical education and practice worldwide and it must be adopted according to different social and cultural contexts. We examined the current congruence and variance in the perception of professionalism in undergraduate medical students and faculty members in one medical school in Saudi Arabia. METHODS: The target population was first year to final year medical students of College of Medicine, King Saud University. Out of a total of 1431 students at College of Medicine 750 students (52 %) participated in the study. Fifty faculty members from clinical and non-clinical departments of the College of Medicine were randomly selected for this study and all participated in the study. The respondents recorded their responses through the Bristol online survey system, using a bilingual (English and Arabic) version of the Dundee Polyprofessionalism Inventory I: Academic integrity, which has 34 items. RESULTS: There are 17 lapses (50 % of the total) in professional behaviour where none of the faculty recommend the ignore sanction while students recommended a variable ignore sanction in a range of 6-29 % for different behaviours. Students and faculty recommended similar sanctions for 5 lapses (14.7 % of the total) in professional behaviours. Furthermore, there is statistically significant two level difference between the sanctions approved by faculty and students in the recommended sanctions for 12 lapses (35 % of the total (p < 0.050). CONCLUSIONS: These results raised concerns in relation to the students' understanding of professionalism. It is therefore, important to enhance their learning around the attributes of medical professionalism.

Similarities and variances in perception of professionalism among Saudi and Egyptian Medical Students.

BACKGROUND & OBJECTIVE: Professionalism has a number of culturally specific elements, therefore, it is imperative to identify areas of congruence and variations in the behaviors in which professionalism is understood in different countries. This study aimed to explore and compare the recommendation of sanctions by medical students of College of Medicine, King Saud University (KSU), Riyadh, Saudi Arabia and students from three medical colleges in Egypt. METHODS: The responses were recorded using an anonymous, self-administered survey " Dundee Polyprofessionalism Inventory I: Academic Integrity". In the study 750 medical students of College of Medicine, KSU, Riyadh were invited and a questionnaire was electronically sent. They rated the importance of professionalism lapses by choosing from a hierarchical menu of sanctions for first time lapses with no justifying circumstances. These responses were compared with published data from 219 students from three medical schools in Egypt. RESULTS: We found variance for 23 (76.66%) behaviors such as "physically assaulting a university employee or student" and "plagiarizing work from a fellow student or publications/internet". We also found similarities for 7 (23.33%) behaviors including "lack of punctuality for classes" and drinking alcohol over lunch and interviewing a patient in the afternoon", when comparing the median recommended sanctions from medical students in Saudi Arabia and Egypt. CONCLUSION: There are more variances than congruence regarding perceptions of professionalism between the two cohorts. The students at KSU were also found to recommend the sanction of "ignore" for a behavior, a response, which otherwise was absent from Egyptian cohort.

Reconsidering the "decline" of medical student empathy as reported in studies using the Jefferson Scale of Physician Empathy-Student version (JSPE-S).

INTRODUCTION: The suggestion that empathy "declines" or "erodes" as students progress through medical school has largely rested on observations reported from Jefferson Medical College in the United States using the Jefferson Scale of Physician Empathy (JSPE) developed by Hojat and colleagues. Now that the student version of JSPE has been administered to medical students in more than a dozen countries, it is timely to consider whether or not the Jefferson "case study" and the conclusions drawn from it are generalisable. METHODS: A literature research was conducted on MEDLINE in mid-2014 to identify studies reporting administrations of the Student version of JPSE (JSPE-S) to cohorts of medical students and the means for studies and their sub-parts conducted in Japan, South Korea, China, Kuwait, India, Iran, UK, USA, Australia, Brazil, Colombia, the Dominican Republic and Portugal. RESULTS: The means of these studies from a dozen countries outside the USA consistently cluster round 75% out of the possible maximum of 140 unlike the early Jefferson studies (although the later Jefferson means are also <120). CONCLUSIONS: These observations may support Costa et al.'s contention that "a latent growth model suggests that empathy of medical students does not decline over time" (p. 509) - or at least not significantly. But in order to understand the maturation process of medical students and trainees we need to develop more sophisticated, integrated models that combine culturally-sensitive concepts of emotional intelligence and moral reasoning with far more refined understandings of the nature of empathy required for the safe practice of patient-centred medicine.

Prevalence of lapses in academic integrity in two Pakistani medical colleges.

OBJECTIVE: To determine prevalence of professionalism lapses related to academic integrity by students Pakistani medical colleges. SUBJECTS: 520 students. STUDY DESIGN: Cross sectional. DATA COLLECTION: A validated and customized version of Dundee Polyprofessional Inventory-1 for use in Pakistani medical schools was used. The students' perceptions on 47 behaviors were explored. RESULT: The response rate of students was 92%. Ninety percent or more than 90% of student agreed that 30 of the 47 listed behaviors were wrong. Different percentages of the students admitted doing 44 (94%), out of 47 behaviors. Students thought that fellow students were doing dishonest behaviors far more frequently than they themselves were. The commonest dishonest behaviors admitted were proxy attendance (308, 64%), receiving information about the paper from a student who has already sat in the exam, or themselves providing information about a paper who have yet to sit in it (297, 62%), completing work for another student 291 (61%). CONCLUSION: There are significant issues related to academic integrity in Pakistani medical schools that require remedy. The Dundee Polyprofessional Inventory-1 as customized for use in Pakistan is a useful tool to measure professionalism lapses related to academic integrity.

Recommended sanctions for lapses in professionalism by student and faculty respondents to Dundee Polyprofessionalism inventory I: academic integrity in one medical school in Saudi Arabia.

BACKGROUND: At a time when the Committee of Deans of the Medical Schools in the Kingdom of Saudi Arabia is entering the second phase of developing Learning Outcomes for Bachelor Degree Programs in Medicine, we investigated the current level of understanding of the importance of academic probity in one Saudi medical school. METHODS: We administered the Dundee Polyprofessionalism Inventory I: Academic Integrity to students and faculty at one Saudi medical school. RESULTS: While there was considerable concordance between the 103 Saudi students and 64 Saudi faculty, there were also some aspects of lapses in professionalism relating to academic integrity where enhanced teaching is indicated to help the students prepare for their responsibilities as doctors. CONCLUSION: These data may begin to help focus teaching about professionalism in the Saudi medical school and inform the refinement of Learning Outcomes for Bachelor Degree Programs in Medicine in the Kingdom of Saudi Arabia. The generalizability of the findings needs to be further tested to see if mapping of Professionalism learning in relatively homogenous populations such as a medical school can be robustly conducted with well-constructed stratified, representative reference groups.

Egyptian medical students' recommended responses to the Dundee Polyprofessionalism Inventory I: Academic Integrity.

The Dundee Polyprofessionalism Inventory I: Academic Integrity was administered to 219 medical students from three Egyptian medical schools. The results indicate a high level of congruence between the genders in Recommended Sanctions on a scale of 1-10 ranging from Ignore through Reprimand to Expulsion/Report to Regulatory Body. Some variations in Recommended Sanctions occurred among the age groups 17-19 years; 20-24 years, and 25 years and older. The Egyptian responses were more lenient than a Scottish medical school cohort on four lapses of professionalism and stricter on 5. The Dundee Polyprofessionalism Inventory I: Academic Integrity can be used as a 'diagnostic tool' to profile a cohort's recommended responses to 30 lapses of professionalism at undergraduate level in health professions education. That profile can be compared with another cohort to indicate parallels and differences in the importance with which different respondents (perhaps in different countries and cultures) place on generic elements of academic professionalism. This information in turn can be used to target further education in expected standards of professionalism. The process can be used as an e-learning programme as well as for needs analysis, including that for International Medical Graduates moving from one culture to work in another.

An instrument for evaluating clinical teaching in Japan: content validity and cultural sensitivity.

BACKGROUND: Many instruments for evaluating clinical teaching have been developed but almost all in Western countries. None of these instruments have been validated for the Asian culture, and a literature search yielded no instruments that were developed specifically for that culture. A key element that influences content validity in developing instruments for evaluating the quality of teaching is culture. The aim of this study was to develop a culture-specific instrument with strong content validity for evaluating clinical teaching in initial medical postgraduate training in Japan. METHODS: Based on data from a literature search and an earlier study we prepared a draft evaluation instrument. To ensure a good cultural fit of the instrument with the Asian context we conducted a modified Delphi procedure among three groups of stakeholders (five education experts, twelve clinical teachers and ten residents) to establish content validity, as this factor is particularly susceptible to cultural factors. RESULTS: Two rounds of Delphi were conducted. Through the procedure, 52 prospective items were reworded, combined or eliminated, resulting in a 25-item instrument validated for the Japanese setting. CONCLUSIONS: This is the first study describing the development and content validation of an instrument for evaluating clinical teaching specifically tailored to an East Asian setting. The instrument has similarities and differences compared with instruments of Western origin. Our findings suggest that designers of evaluation instruments should consider the probability that the content validity of instruments for evaluating clinical teachers can be influenced by cultural aspects.

Development of ACLEEM questionnaire, an instrument measuring residents' educational environment in postgraduate ambulatory setting.

BACKGROUND: Students' perceptions of their educational environment (EE) have been studied in undergraduate and postgraduate curricula. Postgraduate EE has been measured in hospital settings. However, there are no instruments available to measure the EE in postgraduate ambulatory settings. AIM: The aim of this study was to develop the "ambulatory care learning education environment measure" (ACLEEM). METHODS: A mixed methodology was used including three stages: (1) Grounded theory (focus groups); (2) Delphi technique to identify consensus; and (3) Pilot study. RESULTS: Three quota samples of approximately 60 stakeholders were formed, one as focus groups and two as Delphi panels. Eight focus groups were carried out including 58 residents (Latin-American Spanish speakers). The results were analysed and 173 items were offered to a National Delphi panel (61 residents and teachers). They reduced in two rounds the number of important items to 54. The 54-item questionnaire was then piloted with 63 residents and refined to the final version of the ACLEEM with 50 items and three domains. CONCLUSIONS: The 50-item inventory is a valid instrument to measure the EE in postgraduate ambulatory setting in Chile. Large-scale administration of the ACLEEM questionnaire to evaluate its construct validity and reliability are the next steps to test the psychometric properties of the instrument.

Development of inventory for polyprofessionalism lapses at the proto-professional stage of health professions education together with recommended responses.

AIM: To identify behaviours and attitudes that exhibit poor professionalism at the proto-professional stage of undergraduate health professions education, and investigate the extent and nature of agreement by faculty on appropriate responses by undergraduate students in the UK. METHODS: A preliminary inventory of 69 items of behaviour and attitude was derived from literature review and 1-month observation at a UK teaching site. Reference Groups were formed by e-mail solicitation of senior medical educators in the UK and the Dundee Medical School to identify consensus on the relevant items and the appropriate responses. RESULTS: The multi-stage study generated a preliminary inventory with 42 items and identified clear areas of consensus among faculty on appropriate responses by students to lapses in professionalism. CONCLUSIONS: There is a broad range of consensus on the relevance of more than 40 forms of poor professionalism at the proto-professional undergraduate level and the appropriate responses that students should feel empowered to make to observed lapses. These data will give guidance in the development of e-learning programmes for UK students and to undergraduate Fitness to Practise Committees as they seek consistency in responding to lapses in professionalism by students and teachers at the undergraduate level.

Preliminary benchmarking of appropriate sanctions for lapses in undergraduate professionalism in the health professions.

OBJECTIVE: To investigate the extent of consensus between faculty and students in order to benchmark appropriate sanctions for first-time offences with no mitigating factors in the area of Academic Probity by quota sampling in one cohort of medical, nursing and dental students in a Scottish university. METHODS: This study reports administration of a web-based preliminary inventory derived from the international research literature to a target population of health professions staff and students. This study was conducted at Scottish University College of Medicine, Dentistry, Nursing and Midwifery. SUBJECTS: 57 faculty and 689 students in the College in first quarter of 2009 participated in this study. RESULTS: 50% of medical students, 26% of dental students, 22% of nursing students and 27% of midwifery students responded; 22% of faculty responded. Administration of a preliminary 41-item inventory to 57 faculty and 689 students from a Scottish College of Medicine, Dentistry, Nursing and Midwifery has allowed us to preliminarily rank the sanctions that are broadly agreed between the two cohorts as well as to identify a small cluster of behaviours which are viewed less severely by students than by faculty. CONCLUSIONS: These data will give guidance to undergraduate Fitness to Practice committees but also guidance to curriculum planners about the areas in which students may need more teaching. The results informed the reduction of the inventory and its refinement in to a 30-item e-learning tool that is being field tested for generalisability within and beyond the UK. The researchers have also been invited to adapt the proposed teaching and learning tools beyond the health professions.

Medical professionalism: what does the public think?

In the context of professionalism being viewed increasingly as a social contract, a survey was conducted to investigate the importance placed by the general public on doctors' professional attributes. A quota sample of 953 responded to a 55-item online inventory of professional attributes. The quotas closely represented the national census. The majority of the highly important attributes focused on the relationship with patients. Statistically, the responses emerged as a three-facet model (clinicianship, workmanship and citizenship) of medical professionalism. The general public did not equate professionalism with social standing, wealth production, physique or appearance. They recognised doctors as professionals by their good behaviour, high values and positive attitudes as clinicians, workmen and citizens. Although, their preference of professional attributes varied with the setting, eg patient consultation, working with others and behaving in society, they expected doctors to be confident, reliable, dependable, composed, accountable and dedicated across all settings.

Is PHEEM a multi-dimensional instrument? An international perspective.

AIM: To look at the characteristics of Postgraduate Hospital Educational Environment Measure (PHEEM) using data from the UK, Brazil, Chile and the Netherlands, and to examine the reliability and characteristics of PHEEM, especially how the three PHEEM subscales fitted with factors derived statistically from the data sets. METHODS: Statistical analysis of PHEEM scores from 1563 sets of data, using reliability analysis, exploratory factor analysis and correlations of factors derived with the three defined PHEEM subscales. RESULTS: PHEEM was very reliable with an overall Cronbach's alpha of 0.928. Three factors were derived by exploratory factor analysis. Factor One correlated most strongly with the teaching subscale (R = 0.802), Factor Two correlated most strongly with the role autonomy subscale (R = 0.623) and Factor Three correlated most strongly with the social support subscale (R = 0.538). CONCLUSIONS: PHEEM is a multi-dimensional instrument. Overall, it is very reliable. There is a good fit of the three defined subscales, derived by qualitative methods, with the three principal factors derived from the data by exploratory factor analysis.

Students' perceptions of the learning environment in two Nigerian medical schools offering different curricula.

OBJECTIVE: Compare the results of administering the DREEM questionnaire in two Nigerian medical schools offering traditional and student-centred curricular respectively, to identify any differences in the learning environment and appreciate advantages of the more modern curriculum. METHODS: A survey design was used. Data was analysed using the DREEM scoring rubric. The independent t-test was used to compare results. SETTING: The DREEM questionnaire was administered to final year medical students at two participating centres. PARTICIPANTS: Final year students of a teacher-centred and a student-centred medical school. RESULTS: There were 138 respondents - 50 (96.2% of the final year students) from the teacher centred school and 88 (59.1% of the final year students) from the student-centred school. The mean total DREEM score was 117+22.3 in the former and 119 +23.6 in the latter (p = 0.798). Mean age of students in the teacher centred school was 28 ± 5.28 years, while that of the student-centred school was 23 ± 1.83 years (p < 0.05). CONCLUSION: The mean total DREEM score proximity between the schools suggests that the younger students using a more student-centred curriculum have less of an appreciation of their improved learning environment than is expected. Thus, the hidden curriculum could be lagging behind the written one. The older students in the teacher centred environment have a more mature appreciation of their learning climate. FUNDING: Personal sources.

Setting priorities for teaching and learning: an innovative needs assessment for a new family medicine program in Lao PDR.

Lao People's Democratic Republic (Lao PDR) is a small, tropical, landlocked country in southeast Asia. It is one of the least developed countries in the region, and its socioeconomic indicators are among the lowest 25% in the world. The World Health Organization has long called for increased equity in primary health care access around the world. To meet this need in Lao PDR, the Family Medicine Specialist Program was developed, a Lao-generated postgraduate training program designed to produce community-oriented primary care practitioners to serve the rural, remote areas of Lao PDR, where 80% of the population lives. An innovative method of needs assessment was required to determine the health care priorities to be met by this new program. Through the use of a modified Delphi technique, local key leaders in medical education, clinical specialists, and teachers were consulted to develop prioritized objectives for the hospital-based curriculum of the program. By setting priorities for teaching and learning in the unique and needy circumstances of Lao PDR, a novel approach to curriculum planning in a low-income country was explored and ultimately formed the foundation of the new curriculum. This process served to direct the allocation of scarce resources during implementation of this groundbreaking program. More importantly, this model of needs assessment could potentially be used to customize medical curricula in other low-income countries facing challenges similar to those in Lao PDR.