Psychological safety in students’ clinical learning environment – thematic analysis of open-ended questions and DREEM questionnaire assessment

Constantine  Ezeme; Ebere Ugwu; Oluwafunmilayo Soneye; Nurudeen Akinbami; Naomi Olagunju; Olanrewaju  Amusat; Jesse Tanko; Habeeb  Ogundipe; Olukayode Abayomi; Keneth  Onah; Hyginus Ekwuazi; Hari Akachuku; Olumide Farinre; Moshood Adeyemo; Adebanji Adeyoju; Eme Owoaje; Olufunso Adebola Adedeji

doi:10.51496/jogm.v4.241

Authors

Constatine Ezeme Department of Surgery, University College Hospital, Ibadan, Nigeria; and Department of Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Shefield, United Kingdom
Ebere Ugwu Department of Surgery, University College Hospital, Ibadan, Nigeria
Oluwafunmilayo Soneye Department of Surgery, University College Hospital, Ibadan, Nigeria
Nurudeen Akinbami Department of Surgery, University College Hospital, Ibadan, Nigeria
Naomi Olagunju Department of Surgery, University College Hospital, Ibadan, Nigeria
Olanrewaju Amusat Department of Surgery, University College Hospital, Ibadan, Nigeria; and Department of Urology, Luton and Dunstable University Hospital, Luton, United Kingdom
Jesse Tanko Department of Surgery, University College Hospital, Ibadan, Nigeria
Habeeb Ogundipe Department of Surgery, University College Hospital, Ibadan, Nigeria
Olukayode Abayomi Department of Surgery, University College Hospital, Ibadan, Nigeria; and Department of Urology, Victoria Hospital, Kirkcaldy, Scotland, United Kingdom
Kenneth Onah Department of Surgery, University College Hospital, Ibadan, Nigeria
Hyginus Ekwuazi Department of Surgery, University College Hospital, Ibadan, Nigeria
Hari Akachuku Department of Surgery, University College Hospital, Ibadan, Nigeria
Olumide Farinre Department of Surgery, University College Hospital, Ibadan, Nigeria
Moshood Adeyemo Department of Surgery, University College Hospital, Ibadan, Nigeria
Adebanji Adeyoju Department of Urology, Stockport Hospital, Stockport, United Kingdom https://orcid.org/0000-0003-4010-5985
Eme Owoaje Department of Community Medicine College of Medicine University of Ibadan, Ibadan, Nigeria https://orcid.org/0000-0002-0491-6732
Olufunso Adebola Adedeji Department of Colorectal Surgery, University Hospital of North Durham, Durham, United Kingdom https://orcid.org/0000-0003-2571-3413

DOI:

https://doi.org/10.51496/jogm.v4.241

Keywords:

Clinical Learning Environment, Psychological Safety, Thematic analysis, DREEM, Mixed-method study

Abstract

Introduction: 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. This study assessed the perception of clinical learning environments of medical and nursing students (NSs) using the Dundee Ready Education Measure (DREEM) and with two open-ended questions (OEQs): their memorable learning experience and the effect of being in medical school on their lives.

Methods: This was a cross-sectional study using validated DREEM questionnaires and two OEQs: ‘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 fourth- to sixth-year clinical medical, and first- to third-year NSs. Questionnaire data were analysed using the Statistical Package for Social Sciences. For the OEQs, an inductive approach was used for coding and thematic analysis. Coding was both semantic and interpretive.

Results: One hundred and ninety-three students completed the validated questionnaires. Fifty-seven (29%) and 59 (30%) answered the OEQs MLE and Impact IoL, respectively. Thirty-four per cent of medical and 7% of NSs had a negative response to one of the two OEQs. Six themes emerged from the memorable learning experience question, three of which centred around student-centred teachings and two around emotional responses and psychological safety. ‘I reviewed my materials over and over, ate well, put on my best clothes and went to present. It was beautiful’, a third-year medical student. ‘The tutor was a great teacher who, when he teaches, students learn’, an NS. There were four themes on the impact on life questions, and these centred around personal development, social awareness, aspirations and psychological safety. ‘It has made me see that broken people break others’, a third-year medical student.

The mean total DREEM score was 111 ± 10.2, interpreted as more positive than negative. In only two of the five DREEM domains, perception of the atmosphere and social self-perception were more negative than positive findings. Whilst there was near unanimity about their teachers being knowledgeable, and most students felt teachers were well-prepared for their teaching sessions, complaints about behaviours that adversely affected learning because of their negative impact on psychological safety in the clinical learning environment were very common.

Conclusion: Despite the overall positive picture of clinical learning environments, there are significant areas of students’ welfare that need addressing to ensure psychologically safe clinical learning environment. Students’ feedback feeding into annual appraisals, and pedagogic courses are means to achieving students-centred learning environments.

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