Evaluation of Educational Environment for Medical Students of a Tertiary Pediatric Hospital in Tehran, Using DREEM Questionnaire

Background: Tertiary pediatric hospitals usually provide excellent clinical services, but such centers have a lot to do for educational perfection. Objectives: This study was performed to address under-graduate educational deficits and find feasible solutions. Patients and Methods: This cross-sectional study was done in a target population of 77 sixth year undergraduate medical students (response rate = 78%) who spent their 3-month pediatric rotation in the Children’s Medical Center, the Pediatrics Center of Excellence in Tehran, Iran. The Dundee ready educational environment measure (DREEM) instrument was used for assessing educational environment of this subspecialized pediatric hospital. Results: Among 60 students who answered the questionnaires, 24 were male (40%). Participants’ age ranged from 23 to 24 years. The mean total score was 95.8 (48%). Comparison of scores based on students’ knowledge showed no significant difference. Problematic areas were learning, academic self-perception, and social self-perception. Conclusions: Having an accurate schedule to train general practitioner, using new teaching methods, and providing a non-stressful atmosphere were suggested solutions.

Violent adolescents and their educational environment : a multilevel analysis ; et, Youths carrying a weapon or using a weapon in a fight : what makes the difference ?

Rapport de synthèse : Cette recherche s'intéresse (1) au port et à l'utilisation d'armes chez les adolescents ainsi que (2) aux rôles des facteurs environnementaux et individuels dans la violence juvénile. Les données étaient tirés de SMASH 2002 (Swiss multicenter adolescent survey on health 2002), étude dans laquelle un échantillon représentatif de 7548 étudiants et apprentis âgés entre 16 et 20 ans vivant en Suisse ont été interrogés Dans une première étude, les adolescents ayant porté une arme (couteau, masse, coup de poing américain, pistolet/autre arme à feu, spray) durant l'année précédant l'enquête étaient comparés avec ceux n'ayant pas porté d'arme. Ensuite, dans le sous-échantillon de porteurs d'armes, ceux ayant uniquement porté l'arme étaient comparés avec ceux ayant utilisé une arme dans une bagarre. Des facteurs individuels, familiaux, scolaires et sociaux ont été étudiés à l'aide d'analyses bivariées et multivariées. 13.7% des jeunes vivant en Suisse ont porté une arme dans l'année précédant l'enquête. 6.2% des filles porteuses d'armes et 19.9% des garçons porteurs d'armes ont fait usage de l'arme dans une bagarre. Chez les garçons et chez les filles, les porteurs d'armes étaient plus souvent délinquants et victimes de violence physique. Les garçons porteurs d'armes étaient plus souvent des apprentis, à la recherche de sensations fortes, porteurs de tatouages, avaient une mauvaise relation avec leurs parents, étaient dans des bagarres sous l'influence de substances, et avaient des relations sexuelles à risque. En comparaison avec les porteuses d'armes, les filles utilisatrices d'armes étaient plus souvent fumeuses quotidiennes. Les garçons ayant utilisé leur arme étaient plus souvent nés à l'étranger, vivaient dans un milieu urbain, étaient des apprentis, avaient un mauvais contexte scolaire, avaient des relations sexuelles à risque et étaient impliqués dans des bagarres sous l'influence de substances. Nos résultats montrent que porter une arme est un comportement relativement fréquent chez les adolescents vivant en Suisse et qu'une proportion non négligeable de ces porteurs d'armes ont utilisé l'arme dans une bagarre. De ce fait, une discussion sur le port d'arme devrait être incluse dans l'entretien clinique ainsi que dans les programmes de prévention visant les adolescents. Dans une deuxième étude, la violence juvénile était définie comme présente si l'adolescent avait commis au moins un des quatre délits suivants durant l'année précédant l'enquête: attaquer un adulte, arracher ou voler quelque chose, porter une arme ou utiliser une arme dans une bagarre. Des niveaux écologiques étaient testés et résultaient en un modèle à trois niveaux pour les garçons (niveau individuel, niveau classe et niveau école) et, à cause d'une faible prévalence de la violence chez les filles, en un modèle à un niveau (individuel) pour les filles. Des variables dépendantes étaient attribuées à chaque niveau, en se basant sur la littérature. Le modèle multiniveaux des garçons montrait que le niveau école (10%) et le niveau classe (24%) comptaient pour plus d'un tiers de la variance inter-individuelle dans le comportement violent. Les facteurs associés à ce comportement chez les filles étaient être victime de violence physique et la recherche de sensations fortes. Pour les garçons, les facteurs explicatifs de la violence étaient pratiquer des relations sexuelles à risque, être à la recherche de sensations fortes, être victime de violence physique, avoir une mauvaise relation avec les parents, être déprimé et vivre dans une famille monoparentale au niveau individuel, la violence et les actes antisociaux au niveau de la classe et être apprenti au niveau de l'école. Des interventions au niveau de la classe ainsi qu'un règlement explicit en ce qui concerne la violence et d'autres comportements à risque dans des écoles devraient être prioritaires pour la prévention de la violence chez les adolescents. En outre, la prévention devrait tenir compte des différences entre les sexes.

Violent adolescents and their educational environment: a multilevel analysis.

OBJECTIVE: This study examined the respective roles of personal and environmental factors in youth violence in a nationally representative sample of 7548 postmandatory school students and apprentices ages 16-20 years in Switzerland. METHODS: Youth violence was defined as having committed at least one of the following in the previous 12 months: attacking an adult, snatching something, carrying a weapon, or using a weapon in a fight. Different ecological levels were tested, resulting in a three-level model only in males (individual, classroom, and school) as the low prevalence of female violence did not allow for a multilevel analysis. Dependent variables were attributed to each level. For males, the classroom level (10%) and the school level (24%) accounted for more than one third in interindividual variance. RESULTS: Factors associated with violence perpetration in females were being a victim of physical violence and sensation seeking at the individual level. In males, practicing unsafe sex, sensation seeking, being a victim of physical violence, having a poor relationship with parents, being depressed, and living in a single-parent household at the individual level; violence and antisocial acts at the classroom level; and being in a vocational school at the school level showed a correlation with violence perpetration. CONCLUSION: Interventions at the classroom level as well as an explicit school policy on violence and other risk behaviors should be considered a priority when dealing with the problem of youth violence. Furthermore, prevention should take into account gender differences.

Survey on student motivation and approval of educational environment at Universidad Politécnica de Madrid within the European Higher Education area implementation

A recent study elaborated by Vicerrectorado de Ordenación Académica y Planificación Estratégica of Technical University of Madrid (UPM) defines the satisfaction of the university student body as "the response that the University offers to the expectations and demands of service of the students, considered in a general way ". Besides an indicator of academic and institutional insertion of the student, the assessment of student engagement allows us to adapt the academic offer and the extension services of the University to the real needs of the students. The process of convergence towards the European Higher Education Area (EHEA) raises the need to form in competitions, that is to say, of developing in our students capacities and knowledge beyond the purely theoretical-practical thing. Therefore, the perception and experience of the educational process and environment by the students is an important issue to be addressed to accomplish their expectations and achieve a curriculum accordingly to EHEA expectations. The present study aims to explore the student motivation and approval of the educational environment at the UPM. To this end a total of 97 students enrolled in the undergraduate program of Civil Engineering, Computer Engineering and Agronomic Engineering at UPM were surveyed. The survey consisted of 40 questions divided in three blocks. The first one of 20 questions of personal character in that they were gathering, besides the sex and the age, the degree of fulfilment, implication and dedication with the institution and the academic tasks. In the second block we identify 10 questions related to the perception of the student on the teaching quality, and finally a block of 10 questions regarding the Bologna Process. The students personal motivation was moderately high, with a score of 3.6 (all scores are provided on a 5-point scale), being the most valuable items obtaining a university degree (4,3) and the friendship between students (4,2). Any significant difference was shown between sexes (P=0.23) since the averages for this block of questions were of 3.7±0.3 and 3.5±0.4 for women and men respectively. The students are moderately satisfied with their graduate studies with an average score of 3,2, being the questions that reflect a minor satisfaction the research profile of the teachers (2,8) and the organization of the Schools (2,9). The best valued questions are related to the usefulness and quality of the degrees, with 3,5 and 3,4 respectively, and to the interest of the courses within the degree (3,4). For sexes, the results of this block of questions are similar (3.1±0.3 and 3.2±0.3 for men and women respectively=0.79). Also, there were no differences (P=0.39) between the students who arrange work and studies or do not work (3.1±0.2 and 3.2±0.3 respectively). In conclusion, students at UPM present an acceptable degree of motivation and satisfaction with regard to the studies and services that offer their respective Schools. Both characteristics receive the same value both for men and for women and so much for students who arrange work and studies as for those who devote themselves only to studying. In a significant way, students who are more engaged and are in-class attendants present the major degree of satisfaction.Overall, there is a great lack of information regarding the Bologna Process. In fact to the majority, they would like to know more on what it is, what it means and what changes will involve its implementation.

Talking to children: The within-classroom nature of everyday adult language in the early childhood educational environment

Group-size effects, as changes in the adult language when speaking to individual or multiple children in two- and three-year-olds' Australian childcare centre classrooms were investigated. The language addressed to children by 21 staff members was coded for social (e.g., non-verbal, inferential and pragmatic), and linguistic (e.g., morphological, lexical, syntactic and referential) features. In the two-year-olds' classrooms, minimal differences were found between the language used in dyads (addressed to a single child) and polyads (addressed to more than one child). More extensive group-size effects, particularly in syntactic complexity, were found in the three-year-olds' classrooms. Explanations for the constancy of the adult language input in the younger classrooms, and the changes noted in the older rooms will be discussed in terms of plurality (i.e., more than one listener), methodology, and group-size effects that may be specific to the early childhood educational setting.

The role of the school library: resource center in the current educational environment

Principle 7 of the Declaration of the Rights of the Child (UN General Assembly, 1959) states in part: "The child has the right to receive education which will be free and compulsory ... You will be given an education that promotes their general education and training on an equal opportunity to develop their individual judgment skills and sense of moral and social responsibility, and to become a useful member of society. " I will expose to you that the school library resource center is the general instrument essential to fulfill this right of the child. Within the comprehensive range of materials and acquisition objective of their materials, school library complements and supports all aspects of the educational program.

Adult language input in the early childhood educational setting

Age-related changes in the adult language addressed to children aged 2;0-4;0 years in polyadic conditions were investigated in Australian childcare centres. The language that 21 staff members addressed to these children was coded for multiple variables in the broad social categories of prosody, context, speech act and gesture. The linguistic components were coded within the categories of phonology, lexicon, morphology, syntax and referential deixis. Minimal age-related differences were found. Explanations for the similarity of the adult language input across the age groups within the early childhood educational environment, will be discussed

Learning environment, preparedness and satisfaction in osteopathy in Europe: The PreSS study

Objective: 1) to assess the preparedness to practice and satisfaction in learning environment amongst new graduates from European osteopathic institutions; 2) to compare the results of preparedness to practice and satisfaction in learning environment between and within countries where osteopathy is regulated and where regulation is still to be achieved; 3) to identify possible correlations between learning environment and preparedness to practice. Method: Osteopathic education providers of full-time education located in Europe were enrolled, and their final year students were contacted to complete a survey. Measures used were: Dundee Ready Educational Environment Measure (DREEM), the Association of American Medical Colleges (AAMC) and a demographic questionnaire. Scores were compared across institutions using one-way ANOVA and generalised linear model. Results: Nine European osteopathic education institutions participated in the study (4 located in Italy, 2 in the UK, 1 in France, 1 in Belgium and 1 in the Netherlands) and 243 (77%) of their final-year students completed the survey. The DREEM total score mean was 121.4 (SEM: 1.66) whilst the AAMC was 17.58 (SEM:0.35). A generalised linear model found a significant association between not-regulated countries and total score as well as subscales DREEM scores (p<0.001). Learning environment and preparedness to practice were significantly positively correlated (r=0.76; p<0.01). Discussion: A perceived higher level of preparedness and satisfaction was found amongst students from osteopathic institutions located in countries without regulation compared to those located in countries where osteopathy is regulated; however, all institutions obtained a 'more positive than negative' result. Moreover, in general, cohorts with fewer than 20 students scored significantly higher compared to larger student cohorts. Finally, an overall positive correlation between students' preparedness and satisfaction were found across all institutions recruited.

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.

Reversibility of ventricular dysfunction: clinical experience in a medical office

OBJECTIVE - To describe clinical observations of marked improvement in ventricular dysfunction in a medical office environment under circumstances differing from those in study protocols and multicenter studies performed in hospital or with outpatient cohorts. METHODS - Eleven cardiac failure patients with marked ventricular dysfunction receiving treatment at a doctors office between 1994 and 1999 were studied. Their ages ranged from 20 and 66 years (mean 39.42±14.05 years); 7 patients were men, 4 were women. Cardiopathic etiologies were arterial hypertension in 5 patients, peripartum cardiomyopathy in 2, nondefined myocarditis in 2, and alcoholic cardiomyopathy in 4. Initial echocardiograms revealed left ventricular dilatation (average diastolic diameter, 69.45±8.15mm), reduced left ventricular ejection fraction (0.38±0.08) and left atrial dilatation (43.36±5.16mm). The therapeutic approach followed consisted of patient orientation, elimination of etiological or causal factors of cardiac failure, and prescription of digitalis, diuretics, and angiotensinconverting enzyme inhibitors. RESULTS - Following treatment, left ventricular ejection fraction changed to 0.63±0.09; left ventricular diameters changed to 57.18±8.13mm, and left atrium diameters changed to 37.27±8.05mm. Maximum improvement was noted after 16.9±8.63 (6 to 36) months. CONCLUSION - Patients with serious cardiac failure and ventricular dysfunction caused by hypertension, alcoholism, or myocarditis can experience marked improvement in ventricular dysfunction after undergoing appropriate therapy within the venue of the doctor's office.

Decent work?

Pastoralism and ranching are two different rangeland-based livestock systems in dryland areas of East Africa. Both usually operate under low and irregular rainfall and consequently low overall primary biomass production of high spatial and temporal heterogeneity. Both are usually located far from town centres, market outlets and communication, medical, educational, banking, insurance and other infrastructure. Whereas pastoralists can be regarded as self-employed, gaining their livelihood from managing their individually owned livestock on communal land, ranches mostly employ herders as wage labourers to manage the livestock owned by the ranch on the ranches’ own land property. Both production systems can be similarly labour intensive and – with regard to the livestock management – require the same type of work, whether carried out as self-employed pastoralist or as employed herder on a work contract. Given this similarity, the aim of this study was to comparatively assess how pastoralists and employed herders in northern Kenya view their working conditions, and which criteria they use to assess hardship and rewards in their daily work and their working life. Their own perception is compared with the concept of Decent Work developed by the International Labour Organisation (ILO). Samburu pastoralists in Marsabit and Samburu Districts as well as herders on ranches in Laikipia District were interviewed. A qualitative analysis of 47 semi-structured interviews yielded information about daily activities, income, free time, education and social security. Five out of 22 open interviews with pastoralists and seven out of 13 open interviews with employed herders fully transcribed and subjected to qualitative content analysis to yield life stories of 12 informants. Pastoralists consider it important to have healthy and satisfied animals. The ability to provide food for their family especially for the children has a high priority. Hardships for the pastoralists are, if activities are exhausting, and challenging, and dangerous. For employed herders, decent conditions are if their wages are high enough to be able to provide food for their family and formal education for their children. It is further most important for them to do work they are experienced and skilled in. Most employed herders were former pastoralists, who had lost their animals due to drought or raids. There are parallels between the ILO ‘Decent Work’ concept and the perception of working conditions of pastoralists and employed herders. These are, for example, that remuneration is of importance and the appreciation by either the employer or the community is desired. Some aspects that are seen as important by the ILO such as safety at work and healthy working conditions only play a secondary role to the pastoralists, who see risky and dangerous tasks as inherent characteristics of their efforts to gain a livelihood in their living environment.

Percepción de residentes de medicina de urgencias en Colombia del ambiente educativo en los servicios de urgencias

Introducción: La atención de calidad en urgencias sólo es posible si los médicos han recibido una enseñanza de alta calidad. La escala PHEEM (Postgraduate Hospital Educational Environment Measure) es un instrumento válido y fiable, utilizado internacionalmente para medir el entorno educativo, en la formación médica de posgrado. Materiales y métodos: Estudio de corte trasversal que utilizó la escala PHEEM versión en español para conocer el entorno educativo de los programas de urgencias. El coeficiente alfa de Cronbach se calculó para determinar la consistencia interna. Se aplicó estadística descriptiva a nivel global, por categorías e ítems de la escala PHEEM y se compararon resultados por sexo, año de residencia y programa. Resultados: 94 (94%) residentes llenaron el cuestionario. La puntuación media de la escala PHEEM fue 93,91 ± 23,71 (58,1% de la puntuación máxima) que se considera un ambiente educativo más positivo que negativo, pero con margen de mejora. Hubo una diferencia estadísticamente significativa en la percepción del ambiente educativo entre los programas de residencia (p =0,01). El instrumento es altamente confiable (alfa de Cronbach = 0,952). La barrera más frecuente en la enseñanza fue el hacinamiento y la evaluación fue percibida con el propósito de cumplir normas. Discusión: Los resultados de este estudio aportaron evidencia sobre la validez interna de la escala PHEEM en el contexto colombiano. Este estudio demostró cómo la medición del ambiente educativo en una especialidad médico-quirúrgica, con el uso de una herramienta cuantitativa, puede proporcionar información en relación a las fortalezas y debilidades de los programas.

Participatory design in the project of virtual learning environment of histology

This present article describes a research on the development, under the approach of participatory design, a virtual teaching-learning of Histology in which students and teachers participated actively in all stages of development of the educational environment. We postulates that the development of virtual learning environment of Histology, through the Participatory Design approach, contributes to greater acceptance and use by students and that the adoption of virtual environment for teaching and learning by teachers is a determining factor of use by students