Journal of Medical Imaging and Radiation Sciences

Journal of Medical Imaging and Radiation Sciences 42 (2011) 124-129

Journal de l’imagerie médicaleet des sciences de la radiation

www.elsevier.com/locate/jmir

Perceptions of Educational Climate in a Canadian MedicalRadiation Science Programme

Renata Lumsden, MRT(R), RTR, BSc, MMEda* and Susie Schofield, BSc, PGCE, MScb

aMedical Radiation Sciences, Mohawk-McMaster Institute for Applied Health Sciences, Hamilton, Ontario, CanadabCentre for Medical Education, Dundee, Scotland

ABSTRACT

Background: The medical radiation science (MEDRADSC) collab-orative program at Mohawk-McMaster (MoMac) Institute for Ap-

plied Health Sciences in Hamilton, Ontario, Canada, has used360� feedback about the program since its inception in 2004, whichis still ongoing.

Aim: To measure students’ perception of the educational environ-ment in MEDRADSC using the Dundee Ready Education Environ-

ment Measure (DREEM), and investigate perception of theeducational environment overall, by specialization, and by gender.

Method: The DREEM instrument was distributed electronically inJune 2009 to 105 third-year students from three medical radiationspecializations: ultrasound, therapy, and radiography.

Results: With an 83% response rate, students rated their educationalclimate overall as positive. No significant difference was found be-

tween gender or specialization at MoMac.

Conclusion: The DREEM inventory can be used effectively withinthe medical radiation sciences to measure students’ perceptions of ed-ucational environment and verify very specific issues relating to eachof the five subscales.

* Corresponding author: Renata Lumsden, MRT(R), RTR, BSc, MMEd,

Professor,Medical Radiation Sciences,Mohawk-McMaster Institute for Applied

Health Sciences, 1400Main StreetWest, Hamilton, Ontario, Canada L8S 1C7.

E-mail address: renata.lumsden@mohawkcollege.ca (R. Lumsden).

1939-8654/$ - see front matter � 2011 Published by Elsevier Inc.

doi: 10.1016/j.jmir.2011.06.002

R�ESUM�E

Contexte: Le programme de collaboration en science de la radiationm�edicale (MEDRADSC) du Mohawk-McMaster (MoMac) Institute

for Applied Health Sciences de Hamilton (Ontario) au Canada a uti-lis�e une r�etroaction de 360� sur le programme depuis son lancementen 2004, qui se poursuit d’ailleurs.

Objet: Mesurer la perception des �etudiants du milieu �educatif duMEDRADSC au moyen du Dundee Ready Education Environment

Measure (DREEM), et examiner la perception de l’environnement�educatif dans son ensemble, par sp�ecialisation et par genre.

M�ethode: LeDREEMa�et�e diffus�e par voie�electronique en juin 2009,�a 105 �etudiants de 3e ann�ee du secteur de la radiation m�edicale :ultrason, th�erapie et radiographie.

R�esultats: Par un taux de r�eponse de 83 %, les �etudiants ont �evalu�eleur climat d’apprentissage comme positif dans l’ensemble. On n’a

pas d�ecel�e d’�ecart important par genre ou par sp�ecialisation auMoMac.

Conclusion: Le DREEM peut etre utilis�e efficacement dans les sci-ences de la radiation m�edicale pour mesure les perceptions des�etudiants de leur milieu �educatif et pour v�erifier des questions partic-uli�eres des 5 sous-�echelles.

Introduction

The Mohawk-McMaster (MoMac) Institute for AppliedHealth Sciences is located on campus at McMaster Universityin Hamilton, Ontario, Canada. In 2004, the medical radia-tion science (MEDRADSC) collaborative 4-year degree/di-ploma program accepted its first cohort of students. Intakeper annum is approximately 150 students, with a 1 to 4 ratioof males to females.

From its recent inception, the MEDRADSC program hasfollowed an outcome-based curriculum. Split over 10 termswith one summer off between years 1 and 2, the program con-sists of three 13- to 15-week clinical phases occurring betweenyears 1 and 2 (phase 1) and in year 4 (phases 2 and 3). Thefirst year of study covers the basic sciences, taught by theMcMaster group, as well as introductory courses in ME-DRADSC, taught by the Mohawk group. Years 2 and 3courses are conducted primarily by the Mohawk group andinclude courses specific to radiography, ultrasound, and radi-ation therapy.

The curriculum is reviewed annually as part of a quality as-surance process. Also, internal key performance indicator

surveys are performed annually at all levels of the program. Anexternal audit related to quality, which is part of the accredi-tation process, is conducted by the Canadian Medical Associ-ation. Multisource feedback, also referred to as 360� feedback,can be a very powerful instrument to access key competenciesin medical education [1].

The lack of quantitative evidence in the applied healthsciences became evident as a researchable problem during theliterature search for this study. The primary objective of part1 of this master’s thesis was to use a psychometric questionnaire(Appendix 1) to measure the educational environment in allthree disciplines of the applied health sciences at MoMac.The intent was to learn from the survey and share the informa-tion with the wider research community, because there is pau-city in the literature of questionnaires in the applied healthsciences programs. Measuring the environment and climateof the newly formed collaborative MEDRADSC program asa barometer of student perception would be beneficial at thispoint of maturity of the program. The Dundee Ready Educa-tion Environment Measure (DREEM) is a well-validated toolto evaluate the MEDRADSC program across all three disci-plines, as well as by gender.

The DREEM survey contains 50 items trialed across mul-tiple cultures and countries, and is found to be valid [2–4]. Ithas been used in many settings and for several purposes (e.g.,to get a baseline before curricular reform [5], to look at expec-tations of climate [6], and as an instrument for improvement[7]). Given its robustness as an assessment and diagnostictool, DREEM has been proven in the literature to be a usefuldiagnostic and assessment tool in evaluating undergraduates’perception of their educational climate [8]. It has been usedthroughout the world for medical students, nurses, dentists,chiropractors, and other accredited programs allied tomedicine [9–13].

Survey questions were answered on a 5-point Likert scalewith five ordered response levels: strongly agree, agree, unsure,disagree, and strongly disagree. The scale was scored from 4 to0dthe higher the score, the better the performance. In termsof scoring, survey questions 4, 8, 9, 17, 25, 35, 39, 48, and 50are negative statements and would be scored in an oppositefashion [3]. Five subscales or domains about the dimensionsof the learning environment are identified [2]:

1. Students’ perception of learning2. Students’ perception of teachers3. Students’ academic self-perceptions4. Students’ perception of atmosphere5. Students’ social self-perceptions.

A global 200-point final score results from the addition ofsubscale scores, with negative scoring for questions: 4, 8, 9,17, 25, 35, 39, 48, and 50 [3]. Scores from the global calcu-lation are interpreted according to the existing approximateguide [3]:

1. 0–50: very poor2. 51–100: plenty of problems

R. Lumsden and S. Schofield/Journal of Medical Imag

3. 101–150: more positive than negative4. 151–200: excellent

Methods

A total of 105 year 3 MEDRADSC students in all threespecializations were recruited using an electronic-basedDREEM survey. The tool was applied in June 2009, as atthis point the students were in their final academic term, pos-sessed a global perception of the program academically, andhad experienced one clinical placement. For all threespecializations, students were due to start their final clinicalplacement for year 4 in September 2009.

The survey contained a total of 51 items, including 50DREEM items and 1 open-ended question relating to otherfactors that had an influence on the learning environment.Wording was modified in the following questions to reflectmore appropriately the use of patients in the in-house labora-tory setting during practical skills classes, because year 3MEDRADSC students were in an academic term using theimaging laboratory at MoMac, not a hospital setting:

� #6 and #18: replacing ‘‘patients’’ with ‘‘simulatedpatients’’

� #11: replacing ‘‘ward teaching’’ with ‘‘practical classes’’

At the request of the McMaster Ethics Board, a disinter-ested third party was obtained to collect and pass on data inraw form and summarize responses to the open-ended ques-tion #51. The Program and Clinical Support staff memberwas considered an acceptable candidate because of her famil-iarity with the MEDRADSC program in an independent role.It is this researcher’s opinion that involvement as a radiogra-phy professor had little if any effect on response rate and doesnot represent a limitation to this study because of the anony-mous nature of the electronic survey and role of the disinter-ested third party. The code list of topics generated for theopen-ended question demonstrated concerns including: logis-tics, financial, class size, family issues, audiovisual, and teacheraccess.

Results

Of the students who responded, 18 (20%) were males and70 (80%) were females. Chi-square test results compared maleand female versus those that did and did not respond, andshowed no significant difference (c2 ¼ P > .05) indicatingthat the respondents were representative of the year by gender.

Response rate by specialization was largest from radiogra-phy with 43/88 ¼ 49%, followed by ultrasound with 26/88¼ 29%, and finally therapy with 19/88 ¼ 22%. Chi-squaretest results compared each specialization versus those thatdid and did not respond, and showed no significant statisticaldifference (c2 ¼ P > .05).

The overall DREEM maximum score for MEDRADSCwas 138.8, with 137 for males and 140.2 for females. Byspecialization, the global maximum score was 138.9 for

ing and Radiation Sciences 42 (2011) 124-129 125

Figure 1. Dundee Ready Educational Environment Measure score results per

specialization for five subscales.

Table 2

Scores and Percentages of the Five Subscales for Males

Subscale Scores Percent

1. Perception of Learning 33/48 70

2. Perception of Teachers 31/44 71

3. Academic Self-Perceptions 22/32 69

4. Perception of Atmosphere 33/48 69

5. Social Self-Perception 18/28 64

radiography, 135.7 for ultrasound, and 141.3 for radiationtherapy. Scores in the range of 101–150 are considered as‘‘more positive than negative’’ [2–3, 11]. Figure 1 showsDREEM score results per specialization for the five subscales.

On the five subscales, Table 1 shows the global mean scores.Social self-perception results were lower than the other fourdomains, but still in the positive range. The five subscales bygender as a percentage weremeasured; Table 2 shows the resultsfor males and Table 3 shows the results for females. The averagescore for males relating to the five domains was 68.5% and theaverage score for females was 69.6%.

Discussion

The results of this inventory indicate that the overall edu-cational climate in the MEDRADSC program is more posi-tive than negative in all three specializations. According tothe literature [14], participation in psychometric question-naires by more than one group or section of respondents ina single survey can mean that discrepancies exist amongeach section, as not all sections respond equally.

Respondents reacted favorably to the electronic-basedDREEM survey, as evidenced by the high response rate of83%. Salience of an issue to the sample population hasbeen found to have a strong positive correlation with responserate for postal, e-mail, and Internet-based surveys [15]. Thesample population, by their high response rate, may appearto be aware of the infancy of the collaborative program andpossess a desire to enhance the program where necessaryand maintain its strengths.

Of the 12 items that make up perception of learning, 10were positive and 2 were negative [3]. The scores for each

Table 1

Global Mean Scores (Scale of 1–4) of the Five Subscales

Subscale Mean Scores

1. Perception of Learning 2.8

2. Perception of Teachers 2.9

3. Academic Self-Perceptions 2.8

4. Perception of Atmosphere 2.9

5. Social Self-Perception 2.5

126 R. Lumsden and S. Schofield/Journal of Medical Imag

item identified many positive features of learning perception,including encouragement to participate, clear learning objec-tives, student centered teaching, and concern to develop com-petence. A few negative features were also identified, such asoveremphasis of factual learning and lack of stimulatingteaching. Emphasis on factual learning was noted, perhaps be-cause of the radiological technology competency profile [16]that lists topics such as radiation safety legislation as ‘‘high’’priority.

Students’ perception of teachers was the second of five sub-scales in the questionnaire. Many positive features wereidentified, including knowledgeable teachers with good com-munication skills and class preparation. Of the 11 items,question 9 was the lowest mean score rated at 2.1/4.0,‘‘teachers are viewed as authoritarian.’’

Sonography students scored highest in academic self-perception, followed by therapy and radiography. Memoriza-tion of material achieved the lowest mean score of the group(2.1/4.0). Emphasis on factual learning and memorization canbe attributed to specifics such as radiation safety legislation,which is listed in the competency profile as noted above [16].

All items in perception of atmosphere were positive, withhigh scores for problem-solving skills well developed; oppor-tunities for development of interpersonal skills; and studentsfelt comfortable socially in class and were able to ask questionsfreely. A low mean score of 2.1/4.0 was noted surroundingtimetabling. In 10 terms over 4 years, MEDRADSC studentsonly have one summer off between first and second year. Thisleaves many with financial concerns, as well as causing stressand fatigue.

Of the seven items in social self-perception, six were posi-tive and one negative [3]. Positive features identified weregood friends in the school, pleasant accommodation, andgood social life. Some negative features were also identified,such as a sense of boredom and tiredness. Sonography scoredlowest, 15.9/28 ¼ 57%, over radiography, 18.2/28 ¼ 65%,and therapy, 19.2/28 ¼ 69%.

Table 3

Scores and Percentages of the Five Subscales for Females

Subscale Scores Percent

1. Perception of Learning 33/48 70

2. Perception of Teachers 32/44 73

3. Academic Self-Perceptions 23/32 71

4. Perception of Atmosphere 34/48 71

5. Social Self-Perception 18/28 64

ing and Radiation Sciences 42 (2011) 124-129

Conclusion

Part 1 of this master’s thesis included the use of a psycho-metric tool to determine the educational climate in the ap-plied health sciences, of which there was paucity in theliterature. A cross-sectional study using the nonculturallyspecific, already validated DREEM questionnaire was usedto assess the applied health sciences educational environmentof all three specializations, overall and by gender. In the col-laborative program with McMaster University and MohawkCollege, 88 of 105 students (83%) completed the question-naire. The mean total score was 139 out of a maximum of200 (70%), indicating relative satisfaction with the environ-ment but with room for improvement. Female students’overall score (70%) was higher than males (69%), but justmarginally. Comparing each specialization in terms of totalscore, therapy respondents were most positive with 71%, ra-diography 69.5%, and sonography 68%. There were individ-ual areas of excellence identified: (a) teachers are sufficientlyconcerned to develop my competence; (b) teachers are knowl-edgeable; (c) feeling of being well prepared for my profession;(d) comfortable in class socially; (e) problem-solving skills arebeing well developed; and (f) good friends in this school.The following four specific aspects of the educational envi-ronment were identified as being problematic: (1) teachingoveremphasizes factual learning; (2) teachers are viewed asauthoritarian; (3) overemphasis on memorization; and (4)timetabling.

The present study revealed that, given its robustness asa valid assessment and universal diagnostic tool, DREEMhas proven to be useful in evaluating MEDRADSC stu-dents’ perceptions of their educational environment. Percep-tions can vary from student to student, and are importantin motivating or demotivating students in the learningenvironment [3].

The DREEM self-evaluative survey overall results, resultsby gender, and results by specialization revealed a positiveperception of the learning environment with more room forimprovement. Global readings in accredited programs suchas the applied health sciences can use these results to measurematurity and self evaluation of the newly established (2004)collaborative degree/diploma program at MoMac. TheDREEM provides useful diagnostic information about theapplied health sciences, whether in a collaborative programsuch as this study or at a diploma level.

Further studies are needed to analyze the educational envi-ronment of the other year levels, and also to compare percep-tion of educational environment in collaborative programsversus accredited college diploma programs in Ontario. Thisresearcher also recommends using a Postgraduate HospitalEducation Environment (PHEEM) in MEDRADSC. The40-question survey would assess the level of autonomy, qual-ity of teaching, and social support during the hospital-basedtraining period undertaken by all MEDRADSC students[2]. PHEEM can identify specific strengths and weaknesseswithin a hospital-based educational environment. Also, the

R. Lumsden and S. Schofield/Journal of Medical Imag

researcher could not find anything in the literature relatingto physics content to support high physics content or refutethe conjecture in MEDRADSC, suggesting further study.

The quantitative aspect of this study (part 1 of this master’sthesis) was accompanied by a reflective practice lecture tool(part 2) used to enhance teaching and learning in the appliedhealth sciences. MEDRADSC, part of McMaster University’sfaculty of science, follows an outcome-based curriculum usinga mix of lecture, lab, and tutorial. The professors on theMohawk College side of the collaborative degree/diplomaprogram (part of the faculty of Medical Radiation and Reha-bilitation Science) represent skilled imaging technologistsfrom each specialization. Faculty teacher training reflectsa secondary component to their hire and becomes a primarycomponent in their new role [17].

In the hands of the most effective instructors, the lecture, forexample, becomes a way to clarify and simplify complex mate-rial while engaging important and challenging questions, or toinspire attention to important matters; to provoke, to focus.The medical radiation technologist fulfills a minimum of 25hours/year of continuous learning activities. The reflective prac-tice approach to learning and professional development encour-ages use of day-to-day experience, a look beyond the superficial.By using the reflective practice lecture self-evaluation tool in thisstudy, the teacher can review the lecture experience in a system-atic way. The day-to-day experience of lecturing was reviewedby making notes that consider the timing, opening, body,summary, student questions, or comments, thereby enhancinglectures. The simple self-administered tool was used by eightprofessors in MEDRADSC, representing a 100% responserate and each specialization.

Acknowledgments

The authors wish to acknowledge the participants in year 3at MoMac and Susan Garr for survey distribution as a disinter-ested third party.

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Appendix 1

Question 1I am encouraged to participate in class.B a. Strongly agree B b. AgreeB c.Unsure B d.Disagree B e. Stronglydisagree

Question 2The teachers are knowledgeable.

Question 3There is a good support system for students who get

stressed.

Question 4I am too tired to enjoy this course.

Question 5Learning strategies that worked for me before continue to

work for me now.

Question 6The teachers are patient with simulated patients.

Question 7The teaching is often stimulating.

Question 8The teachers ridicule the students.

Question 9The teachers are authoritarian.

128 R. Lumsden and S. Schofield/Journal of Medical Imag

Question 10I am confident about my passing this year.

Question 11The atmosphere is relaxed during practical classes (Skills

and Treatment Planning).

Question 12This school is well timetabled.

Question 13The teaching is student centered.

Question 14I am rarely bored in this school.

Question 15I have good friends in this school.

Question 16The teachers are sufficiently concerned to develop my

competence.

Question 17Cheating is a problem in this school.

Question 18The teachers have good communication skills with simu-

lated patients.

Question 19My social life is good.

Question 20The teaching is well focused.

Question 21I feel I am being well prepared for my profession.

Question 22The teaching is sufficiently concerned to develop my

confidence.

Question 23The atmosphere is relaxed during lectures.

Question 24The teaching time is put to good use.

Question 25The teaching overemphasizes factual learning.

Question 26Last year’s work has been a good preparation for this year’s

work.

Question 27I am able to memorize all I need.

Question 28I seldom feel lonely.

Question 29The teachers are good at providing feedback to students.

Question 30There are opportunities forme to develop interpersonal skills.

ing and Radiation Sciences 42 (2011) 124-129

Question 31I have learned a lot about empathy in my profession.

Question 32The teachers provide constructive criticism here.

Question 33I feel comfortable in class socially.

Question 34The atmosphere is relaxed during seminars/tutorials.

Question 35I find the experience disappointing.

Question 36I am able to concentrate well.

Question 37The teachers give clear examples.

Question 38I am clear about the learning objectives of the course.

Question 39The teachers get angry in class.

Question 40The teachers are well prepared for their classes.

Question 41My problem-solving skills are being well developed

here.

R. Lumsden and S. Schofield/Journal of Medical Imag

Question 42The enjoyment outweighs the stress of studying Medical

Radiation Science.

Question 43The atmosphere motivates me as a learner.

Question 44The teaching encourages me to be an active learner.

Question 45Much of what I have to learn seems relevant.

Question 46My accommodation is pleasant.

Question 47Long term learning is emphasized over the short term.

Question 48The teaching is too teacher-centered.

Question 49I feel able to ask the question I want.

Question 50The students irritate the teachers.

Question 51Could you please list any other factors that you feel have

an influence on the learning environment.Answer:

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