보건전문직 연구에서 교육환경 측정: 체계적 문헌고찰(Med Teach, 2010)

보건전문직 연구에서 교육환경 측정: 체계적 문헌고찰(Med Teach, 2010)

Measuring the educational environment in health professions studies: A systematic review

DIANTHA SOEMANTRI1, CRISTIAN HERRERA2,3 & ARNOLDO RIQUELME2,4

1Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Indonesia, 2School of Medicine, Pontificia Universidad Cato´ lica de Chile, Chile, 3Evidence Based Medicine Unit, Pontificia Universidad Cato´ lica de Chile, Chile, 4Department of Gastroenterology, Pontificia Universidad Cato´ lica de Chile, Chile

도입

Introduction

의대생들의 행동을 결정하는 요소 중 하나는 의대 학습 환경이다. 학생의 행동과 관련된 환경은 학생들에 의해 인식된다. 젠과 하덴(1986)은 그 개념이 다소 무형적이지만 교육 환경의 영향은 실질적이고, 현실적이며, 영향력이 크다고 제안했다. 이 분위기는 학생들의 성취도, 만족도, 그리고 성공의 예측에 큰 기여를 한다.

One determinant of a medical student’s behaviour is the medical school learning environment (Genn 2001a). The environment related to the student’s behaviour is as perceived by the student. Genn and Harden (1986) suggested that although the concept is rather intangible, the effects of an educational environment are substantial, real and influential. The climate makes a notable contribution to the prediction of student achievement, satisfaction and success (Genn 2001b).

세계 의학 교육 연맹(1998)은 학습 환경을 의료 교육 프로그램의 평가 대상 중 하나로 간주해 왔다. 환경에 대한 연구는 의과대학 교과과정의 불가분의 부분이 되어야 한다.

The World Federation for Medical Education (1998) has considered the learning environment as one of the targets for the evaluation of medical education programmes. a study of the environment should become an inseparable part of the study of a medical school’s curriculum.

젠(2001a)은 커리큘럼의 manifestation으로서 교육 환경에 대한 정의를 제공합니다. Rothman과 Ayoade(1970년)는 또한 학습 환경을 '교육 과정의 여러 부분에서 학생들에게 미치는 영향의 표현형manifestation'로 간주한다. Maudsley(2001)는 '학생들이 모인다면 언제든 어디서든 학습 환경은 존재한다'고 진술하며, 효과적인 교육에 기여하고, 교육과정 존재의 배경이 되는 다양한 요소를 포함하였다.

Genn (2001a) provides a definition for educational environment as the manifestation of a curriculum. Rothman and Ayoade (1970) also consider the learning environment as ‘a manifestation of the effects on students of the various parts of the curriculum’. Maudsley (2001) states that ‘a learning environment exists wherever and whenever students gather ...’ and it includes various factors, which contribute to an effective education and becomes the background in which the curriculum exists.

페이스 및 스턴(1958)은 교육 환경이 '환경적 압박'이라는 용어로 '교육환경이란 교실 또는 학교 내의 압력, 스트레스, 관행, 정책, 보상 및 가치에 의해 특징지어진다'는 것을 제안합니다.

Pace and Stern (1958) suggest that an educational environment is characterized by the pressures, stresses, practices, policies, rewards and values within the classroom or school of which they refer to as ‘environmental press’.

환경이라는 용어와 기후라는 용어는 교육용 문헌에서 서로 상호교환적으로 사용되는 경우가 많다. 

• 젠(2001b)은 교육분위기climate란 학생이 인식하는 기관의 교육환경이라고 정의한다. 

• Roff와 McAleer(2001)는 교육 환경의 동의어로 교육 분위기을 사용한다. 

• 로스만 & 아이요이드(1970년)가 실시한 연구에서, 학습 환경은 학생들이 인식하는 것으로 정의되며, 따라서 환경과 기후라는 용어의 차이는 없다.

The term environment and climate are often used interchangeably in educational literature. Genn (2001b) defines the term climate as the educational environment of an institution as perceived by students. Roff and McAleer (2001) use the term educational climate as the synonym of educational environment. In the study conducted by Rothman & Ayoade (1970), the learning environment is defined as what the students perceive and thus no differentiation is made between the term environment and climate.

하지만, 행동을 결정하는 것은 환경 그 자체가 아니라 환경에 대한 학생들의 인식이다. 학생들의 교실 환경에 대한 인식은 그들의 성과를 예측하는 데 사용되어 왔다. 교육환경 내의 '거주자'로서 학생들은 환경을 경험하는 사람들이며, 행동을 결정하는 것은 환경에 대한 그들의 인식이다.

However, it is the students’ perceptions of the environment, rather than the environment itself, that determines the behaviour (Hutchins 1961; Rothman & Ayoade 1970; Genn 2001a; Konings et al. 2005). Students’ perceptions of the classroom environment have been used to predict their outcomes (Fraser et al. 1986). Students, as the ‘inhabitants’ (Genn 2001a), are the ones who experience the environment and it is their perceptions of the environment, which then becomes one of the determinants of their behaviour.

교육 환경에 대한 양적 측정은 인벤토리 또는 도구를 사용해야 합니다. 다양한 교육 환경 간의 차이는 특정 기관의 특정 상황에 맞는 다른 교육 환경 인벤토리를 필요로 할 수 있습니다.

A quantitative measurement of the educational environment requires the use of an inventory or instrument. The differences among various educational settings may require a different educational environment inventory, which suits the specific situation of a particular institution.

어떠한 측정 과정에서도 도구나 인벤토리가 측정하고자 하는 것을 측정하는지 여부를 확인하고, 타당성 이 특정 문제를 다룬다.

In any measurement process, it is necessary to ascertain whether the instrument or inventory measures what it supposes to measure; and validity deals with this specific question.

신뢰성은 측정 또는 평가 결과의 재현성을 나타냅니다.

Reliability refers to the reproducibility of the measurement or assessment results.

방법

Methods

Search strategy

Inclusion and exclusion criteria

Data extraction

Data synthesis

79개의 연구

Following the flowchart, 79 studies from 1961 to 2008 were included (Figure 1).

31개의 도구

Thirty one instruments were identified from the 79 included studies.

도구들

Table 1 summarizes the identified instruments along with the settings in which the instruments were used.

The synthesis of data were presented in the form of table for each area of the health profession study(Tables 2–5, available at www.medicaltacher.org).

Results

고찰

Discussion

그런 다음 검색을 관련 키워드와 결합하여 특정성을 높여야 했습니다.

It was then necessary to combine the search with relevant keywords (‘education environment’, ‘education cli-mate’, ‘learning environment’ and ‘climate’) to increase the specificity.

체계적이고 포괄적인 검색을 성공적으로 수행하려면 적절한 리소스(인간 리소스, 교육 자료, 시간 및 비용)가 필요합니다. 검색의 포괄성을 높이기 위해 검색한 논문에서 인용한 참고문헌의 직집 찾아보았다.

For a systematic and comprehensive search to be successfully conducted, adequate resources (human resources, educational material, time and cost) are essential. In order to improve the comprehensiveness of the search, the hand searching of the references cited in the retrieved articles was conducted. 

교육환경 측정도구의 타당도와 신뢰도

Analysis of the validity and reliability of educational environment measurement instruments 

학부의학교육

Medicine (undergraduate).

12개 도구

There were 12 educational environment measurement instruments identified in this study.

The summary of the psychometric qualities of the instruments are presented in Table 2, available at www.medicalteacher.org. Several instruments  had considerable weaknesses in heir validity and reliability. 

The LEQ MSLES and DREEM demonstrated the robustness in terms of their psychometric qualities. 

• Their content validity was established and they also had high internal consistency. 

• The construct validity of the MSLES and DREEM were indicated by their ability to significantly differentiate the students’ perceptions of the learning environment between medical schools with the traditional curriculum and ones with the more innovative curriculum (Feletti & Clarke 1981b; Al-Qahtani1999; Zaini 2003; Al-Hazimi et al. 2004a). 

• The DREEM showed an additional strength because it could be applied in medical schools in different countries, cultures and contexts and still demonstrated consistent reliability

DREEM이 가장 좋음

According to the data presented in the related articles, the DREEM is likely to be the most suitable instrument to be applied in undergraduate medical education settings. 

졸업후의학교육

Medicine (postgraduate).

Most of the identified educational environment measurement instruments in postgraduate medical education were developed for use in specific postgraduate specialty areas. The psychometric qualities of the identified instruments are summarized in Table 3, available at www.medicalteacher.org.

4개

Four instruments: the STEEM (Cassar 2004), the OREEM(Kanashiro et al. 2006), the ATEEM (Holt & Roff 2004) and the practice-based educational environment measure (Mulrooney2005) were developed for use in the surgical/operating theatre learning setting, anaesthetic theatre learning setting and practice-based component in general practice (GP) training,respectively. The VA Learners’ Perceptions Survey was designed for residents from different specialties within the United States VA clinical training setting (Keitz et al. 2003)

The content validity of the high LEA was not established,although it showed fairly internal consistency (Roth et al. 2006). 

The PHEEM consisted of 40 items divided into three subscales (perceptions of role autonomy, perceptions of teaching and perceptions of social support)

It has also been shown that by using PHEEM, reliable results can be obtained with feasible sample size. In addition, the PHEEM had been administered to several different sample groups, such as senior house officers and specialist registrars from different specialties, and demonstrated almost similar reliability coefficients in those groups(Jayashree 2004; Roff et al. 2005; Aspegren et al. 2007; Booret al. 2007; Clapham et al. 2007). 

PHEEM이 가장 좋음

Therefore, the PHEEM is likely to be the most suitable instrument for use in postgraduate medical education because of its content validity,high reliability and also its ability to be used in different postgraduate settings. 

간호

Nursing.

Most of the identified instruments were used to Nursing. assess the clinical learning environment in nursing education setting. A summary of the psychometric qualities of the instruments’ is presented in Table 4, available at www.medicalteacher.org.

CLES가 가장 좋음

Therefore, based on the available information and analysis, the CLES is likely to be the most suitable instrument to assess nursing students’ perceptions of their clinical learning environment.

치과

Dentistry.

다섯 개 도구 

There were five instruments for dental educational environment measurement identified in this study. The validity and reliability of those instruments varied and are summarized in Table 5, available at www.medicalteacher.org.

originally 개발된 것은 하나 

There was only one instrument that was originally developed for dental educational environment (Gerzina et al. 2005).

In addition to that, two instruments (LES and DSLES) were developed from the MSLES. It was an instrument first developed in 1970s and it might not encompass current trends or changes in educational practice nowadays.

DLES가 가장 좋음

Based on the information provided in the studies and the analysis conducted, the DSLES is likely to be the most suitable instrument for measuring educational environment in dental education setting. It demonstrated good reliability and since the DSLES was more similar to MSLES than the LES, it was more likely to have better content validity.

결론

Conclusion

The DREEM, PHEEM, CLES and DSLES are likely to be the most suitable instruments for undergraduate medicine, postgraduate medicine, nursing and dental education, respectively.

These educational environment measurement instruments also demonstrated consistency throughout their applications in different contexts/settings.

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Med Teach. 2010;32(12):947-52. doi: 10.3109/01421591003686229.

Measuring the educational environment in health professions studies: a systematic review.

Soemantri D1, Herrera C, Riquelme A.

Author information

1

Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Indonesia. dianthasoemantri@yahoo.com

Abstract

BACKGROUND:

One of the determinants of the medical student's behaviour is the medical school learning environment.

AIM:

The aim of this research was to identify the instruments used to measure the educational environment in health professions education and to assess their validity and reliability.

METHODS:

We performed an electronic search in the medical literature analysis and retrieval system online (MEDLINE) and Timelit (Topics in medical education) databases through to October 2008. The non-electronic search (hand searching) was conducted through reviewing the references of the retrieved studies and identifying the relevant ones. Two independent authors read, rated and selected studies for the reviewaccording to the pre-specified criteria. The inter-rater agreement was measured with Kappa coefficient.

RESULTS:

Seventy-nine studies were included with the Kappa coefficient of 0.79, which demonstrated a reliable process, and 31 instruments were extracted. The Dundee Ready Education Environment Measure, Postgraduate Hospital Educational Environment Measure, Clinical Learning Environment and Supervision and Dental Student Learning Environment Survey are likely to be the most suitable instruments for undergraduate medicine, postgraduate medicine, nursing and dental education, respectively.

CONCLUSIONS:

As a valid and reliable instrument is available for each educational setting, a study to assess the educational environmentshould become a part of an institution's good educational practice. Further studies employing a wider range of databases with more elaborated search strategies will increase the comprehensiveness of the systematic review.

PMID:

 

21090946

 

DOI:

 

10.3109/01421591003686229