Implementation of the MS
Regarding the MS as a whole, both samples perceived its implementation as “moderate” (60-89 points; students: M = 77.12, SD = 16.97, faculty: M = 79.43, SD = 17.24) (Figure
). On average, students thought implementation of the MS was less successful than faculty did, but the effect was quite small (p < 0.05, d = 0.14). As a result, there are only small differences in the distribution of opinions (Figure
): slightly more students than faculty viewed the implementation as poor or slight (13.9% vs. 12.4%), while slightly fewer viewed it as good (22.3% vs. 26.7%) or excellent (0.6% vs. 0.8%). These differences were statistically not significant (p = 0.64, w = 0.04).
Distribution of responses to the Mission-statement (MS) questionnaire by students and teachers.
For both students and faculty the dispersion of item means of the MS questionnaire was adequate (Table
). The range of means was between 1.21 (item 28: “The course is family-friendly”) and 2.87 (item 32: “The course considers the equality of women and men”), M = 2.08 (SD = 0.38), in the student sample, and between 1.24 (item 6: “The teachers receive recognition for their work by the faculty”) and 2.89 (item 27: “The course encourages students at a professional level”), M = 2.15 (SD = 0.35), in the faculty sample.
Means, standard deviations and part-whole corrected discrimination indices of the mission-statement questionnaire items in the student and teacher sample
Both groups showed a similar dispersion of DREEM mean scores. The overall item mean in the student sample was M = 2.19 (SD = 0.50), slightly higher than the limit of 2, which at the item level in DREEM is deemed to indicate areas requiring improvement
]. Using this criterion in the MS questionnaire as well, 16 of 37 items pertained to areas where students and/or faculty saw deficiencies. Of these 16 items, 8 items (17, 19, 26, 28, 29, 30, 33, 34) pertained to general aspects of the course (for example free time for academic qualification, patient-orientation, family-friendliness), while the other 8 (1, 2, 4, 5, 6, 16, 23, 31) focused more on intra-/interindividual aspects. In particular, items 1, 2, 4 and 5 pertain to relations between students and faculty. While both groups perceived a similar need to improve the external conditions of studying, the relations between students and faculty were seen very differently, as testified by the large effect sizes (see Table
), which ranged from d
= 0.49 for item 1 (“The teachers are role models for the students
”) to 0.91 for item 5 (“The teachers are persons in charge and in position of trust for the students
In the student sample the discrimination index ranged from 0.24 (item: 10: “The students communicate appropriately, sensitively and respectfully with patients”) to 0.58 (item 14: “The students are well prepared for lifelong learning and to develop personally”), M = 0.46 (SD = 0.09); only 2 items fell below the reference level of 0.30, while 18 exceeded 0.50. In the faculty sample the discrimination index fell in a similar range, M = 0.50 (SD = 0.11), with the lowest value 0.19 for item 32 (“The course considers the equality of women and men”), the highest 0.67 for item 15 (“The students learn to think critically in consideration of evidence and to make decisions on that basis”). Only item 32 fell well below the reference level, while 23 of the 37 items had high discrimination values.
The reliability of the MS questionnaire (37 items) was comparable to that of the longer DREEM (50 items): α = 0.92 for both in the student sample, α = 0.93 vs. 0.94 in the faculty sample. At the subscale level the MS questionnaire showed a similarly high reliability, with values between α = 0.81 and 0.87 (Table
Scores of DREEM and Mission-statement (MS) questionnaire in the student and teacher sample
The total scores of both DREEM and the MS questionnaire showed a high and significant positive correlation in both the student and faculty sample (r = 0.79 and 0.80, respectively, both p’s < 0.001).
Educational climate in DREEM and implementation of the MS were perceived more negatively by students than by faculty, but each group gave itself a better grade. On the MS questionnaire, students’ perception of teachers was poorer (M = 15.11, SD = 4.67) than teachers’ perception of themselves (M = 17.57, SD = 4.73; p < 0.001, d = 0.52), while students’ perception of themselves was more positive (M = 33.65, SD = 7.35) than their teachers’ perception of them (M = 32.57, SD = 7.38; p < 0.05, d = 0.15). Students and faculty evinced no significant difference in their perception of the course (M = 28.36, SD = 7.06 vs. M = 29.29, SD = 7.02; p = 0.06, d = 0.13).
Independent-samples t-tests showed that students in the clinical course viewed the implementation of the MS in a significantly more negative light than their colleagues in the preclinical course. There were significant negative correlations between the MS questionnaire and year of study, although none appeared in DREEM (Table
Correlations of the Mission-statement (MS) questionnaire with DREEM total score and subscales in the student and teacher sample
To assess whether the perceptions of teachers depend on the phase in which they teach, analyses of variance were performed with phase of study as the independent variable (grouped as “preclinical only”, n = 30; “clinical only”, n = 152; “both”, n = 42) and teachers’ responses on both questionnaires as the dependent variable.
Descriptively, it is apparent on most dimensions that teachers in the preclinical course took a more negative view than their clinical colleagues, and an even more negative view than those who teach in both phases (Table
Teachers’ perceptions of the learning environment in relation to their year of teaching
When students had already completed training in another area (such as nursing or geriatric care), this affected their scores on the MS questionnaire. Students with previous training (n = 241) took a significantly dimmer view of the implementation of the MS (M = 72.17, SD = 17.55) than their peers without such training (n = 796) (M = 78.42, SD = 16.46), but effect sizes were small (p < 0.001, d = 0.37).
Students who were not native speakers (n = 134) thought the MS had been better implemented (M = 85.12, SD = 18.73) than did the native speakers (M = 76.03, SD = 16.43); (p < 0.001, d = 0.52). The number of non-native speakers in the faculty sample (n = 9) was too small for meaningful inference testing.
Comparing male and female students, it is apparent that women (n = 739, M = 78.06, SD = 16.06) perceived the implementation of the MS significantly more positively than did men (n = 380, M = 75.28, SD = 18.51), but the effect was quite small (p < 0.01, d = 0.16). No such differences were found in the faculty sample.
To examine the factorial validity of the MS questionnaire, we conducted in both groups (students and teachers) explorative principal components analyses. After successful factorization of the 37 items in the student sample (KMO = 0.94, Bartlett: p < 0.001), there were seven factors with eigenvalues > 1. After analysis of the screen plot, two factors were extracted and subjected to an orthogonal rotation. In total, these two factors explained 32.2% of the variance and exhibited a satisfactory simple structure. We interpreted them as “The teachers and the curriculum” and “The students and the curriculum”, i.e. items dealing with the curriculum were not represented by a dimension of its own, but were distributed rather equally among the two remaining subscales (Table
Factor analytic loadings of the MS questionnaire items in the student sample
In the teacher sample (KMO = 0.91, Bartlett: p < 0.001), factor analysis revealed eight dimensions with eigenvalues > 1. Following the screen plot, a 3-factor-solution was chosen and rotated orthogonally (variance explanation 41.3%). The dimensions identified were interpreted as “Medical goals of the curriculum and the teachers”, “General conditions of the curriculum” and “Students’ social skills” (Table
Factor analytic loadings of the MS questionnaire items in the teacher sample