Memorable learning experience, impact of school on life, and perception of clinical learning environment amongst nursing and medical students

Abstract

Background: The learning environment impacts students’ motivation,
success, and fulfilment, and central to this is the psychological safety of
students. Psychologically safe environments lead to collaboration, positive
learning experiences, and effective practitioners.

Objectives: The study aimed to assess the perception of the clinical
learning environments of medical and nursing students at the College
of Medicine, University of Ibadan, Ibadan, Nigeria.

Methods: This was a cross-sectional study carried out in November, 2021
using the validated questionnaires – Dundee Ready Education Measure
(DREEM) and the John Hopkins Learning Environment Scale (JHLES)
as well as two open-ended questions (OEQs). The OEQs were ‘tell us
about a memorable learning experience in medical/nursing school’ (MLE)
and ‘what impact has your time in medical/nursing school had on your
life’ (IoL). Data were collected from third to sixth-year clinical medical,
and first to third-year nursing students and analysed using SPSS v23. For
the OEQs, an inductive approach was used for manual coding and thematic
analysis. Coding and themes were both semantic and interpretive
and data were managed using NVIVO v14 software. The responses to the
OEQs were graded on a Likert scale from 1 (very negative) to 5 (very
positive).

Results: A total of 193 students completed the validated questionnaires
with a mean age of 22 (±2.58) years. The mean total DREEM score was
111/200 (±10.2), interpreted as more positive than negative. However, the
perceptions were more negative than positive in two of the five DREEM
domains – perception of the atmosphere and social self-perception. The
mean overall JHLES score was 91/140 (±14.8), also more positive than
negative, and this was so for all its seven domains. Nursing students had
better academic self-perception than medical students (P = 0.002) while
medical students had better perception of their learning atmosphere
(P = 0.021).
Seventy-five students (39%) answered one or both OEQs, with 57
(29%) answering the memorable learning experience (MLE) and 59
(30%), the impact of medical/nursing school on life (IoL) question.
Sixteen and twenty-two percent of answers to MLE and IoL
questions were negative. No students gave negative answers to both
OEQs. Overall, 29% of students gave a negative response to one
question.

The overall themes for memorable learning experience questions were:
1. Novelty
2. Enhancing experiences – ‘That teaching method made me feel seen as
a student and got me excited to solve problems’, by a 4th year medical
student
3. Learning environment atmosphere – ‘I was impressed by the way he
was able to change the atmosphere from a very tense one to a funny
and calm one’
4. Psychological effects.

For the impact on life questions, the overall themes were as follows:
1. Personal development – this included appreciation of hard work,
motivation to be better people, purpose and direction in life, social and
intellectual development.
2. Aspirational
3. Psychological – ‘it made me see that broken people break people’

Conclusion: Whatever the positive benefits of being a student are, psychologically
unsafe environments, even for the very few, lead to negative psychological
sequelae, poor overall learning process and health practitioners
ill-prepared for the future. Despite the overall positive picture of the clinical
learning environment in this study, there are significant areas of students’
welfare that need to be addressed. It has been shown that a formal
pedagogic programme for clinicians to improve the quality of their student
centred teaching (1).

Reference
1. Poon H, Ahmad MF, Lowry D, et al. Two-year longitudinal observation
study of junior doctors as clinical teachers: the Associated Clinical
Teaching Fellow Program. J Glob Med 2021; 1(2): e43. doi: 10.51496/
jogm.v1.43