Moderately positive educational environment with opportunities for improvement: a national study of Ethiopian medical schools using the Dundee Ready Education Environment Measure (DREEM), 2024

BACKGROUND: Medical schools play a significant role in shaping students' professional development. The environment in which students learn, both the culture and the resources, directly impacts their education and future practice. This study aimed to assess medical graduates' perceptions of their learning environment, identify areas for improvement, and determine key factors that influence these perceptions. The findings will inform educators, policymakers, and researchers. METHODS: A cross-sectional study was conducted on 12 randomly selected public and private medical schools across Ethiopia. We used a two-stage stratified systematic sampling technique to select 548 samples. The study participants were graduating medical students who were on internship during the study period. We used the 50-item validated Dundee Ready Education Environment Measure (DREEM) tool to assess perceptions of the educational environment across five domains: perception of learning, perception of teachers, academic self-perception, perception of the learning environment, and social self-perception. Data were collected using the KoboToolbox. Negatively phrased items were reverse-coded for consistent interpretation with positively worded items during analysis. We conducted descriptive and inferential statistics using R and STATA software. RESULTS: The mean total DREEM score was 112.6 ± 32.4 (out of 200), indicating a "more positive than negative" perception of the educational environment. Subscale analysis revealed relatively favorable perceptions of learning and academic self-perceptions, compared to perceptions of the learning atmosphere and social support systems. Eleven problematic items, with mean scores below 2.0, were identified regarding student support systems, teachers' behaviors, and the overall learning atmosphere. The multivariate linear regression analysis indicated that the USAID Health Workforce Improvement Program (HWIP), institution type, and students' age influenced their perceptions of the educational environment. Students from HWIP-supported schools had a more positive perception than those from non-supported schools (β = 11.0, p < 0.001). Similarly, students from third-generation public schools had a better perception of their educational environment (β = 29.26, p < 0.001) than those from first-generation schools. Additionally, older students reported a more positive environment (β = 4.4 per year, p < 0.001). CONCLUSION: The medical educational environment is generally viewed as moderately positive, though there are variations across domains and institutions. The study helped to identify specific problematic DREEM items and domains that need targeted interventions.