Chapter 48 Surely we would hope that life as an undergraduate medical student would not be viewed as a colourless, boring experience. It should be a major aim of every medical school to have a vibrant, effective ‘learning site’. Genn (2001) has stated, ‘Students experience or perceive the educational environment of the overall medical school as the climate. It is the climate that influences behaviour.’ The educational environment as perceived by the students becomes the climate. In many instances the terms environment and climate are viewed as synonymous. In this chapter let us view climate as the environment seen through the eyes of the undergraduate or postgraduate student. When students arrive at university, one of the first interactions they have is with their teachers. How are students being taught, and what subjects are they being taught? These two aspects will have an immediate influence on whether they have a positive view of their initial experience in medical school. If their teachers are seen as authoritarian figures and if the teaching methods are making learning difficult, then it will be likely that the climate is far from healthy. Table 48.1 provides a list of some of the variables that can have an impact on how the environment is perceived. Table 48.1 Elements of an educational environment Climate can be looked at from a macro viewpoint. For example, what do first-year students think about their first term in medical school? Their perceptions will probably be based on their evaluation of many of the items included in Table 48.1. Alternatively, a more micro approach to climate might be applied. A good example of this is described by Homana et al (2005) when they list the characteristics associated with a positive climate for citizenship education in schools: meaningful learning of civic knowledge, cooperation and collaboration in civic-related learning, mutual trust among staff and students, student input, deliberation and dialogue, engagement within the school and community and official recognition of the civic purpose of education that is conveyed to all involved in the process. These characteristics would form a different list from the one in Table 48.1. Learning environment applies to a vast range of settings, both formal and informal. Primary, secondary and tertiary education each has its own specific environment. At the postgraduate level it might be the hospital ward, the operating theatre or a general practice surgery. Each of these potential training sites should be linked to a curriculum (see Chapter 7, The hidden curriculum). The Postgraduate Medical Education and Training Board (PMETB) (2005) in the UK defined the curriculum as: • a decision of the training structure (entry requirements, length and organization of the programme including its flexibilities, and assessment system), • a description of expected methods of learning, teaching, feedback and supervision The curriculum should cover both generic professional and specialty areas. Cross et al (2006) underline the importance of the perceived environment, i.e. climate, in establishing a successful career choice. They state, ‘the pace of change demanded by central policy on medical education and healthcare delivery and the uncertainty this entails make it important that postgraduate deaneries keep the learning environment constantly under review.’ The emphasis placed on regular monitoring is a key to ensuring that the level of postgraduate and undergraduate training never dips into dangerous waters. The training environment is obviously crucial in attracting young doctors into a particular specialty, and having a ‘healthy climate’ is the first step in this process. Jefferys and Elston (1989) made a similar point in relation to undergraduate teaching and emphasize the importance of the medical school environment since it can have a significant influence on the students’ progress in becoming doctors and even determine their attitudes towards medical specialization. Genn and Harden (1986) also provided a comprehensive account of the underlying reasons for measuring the environment. It acts as the basis for the diagnosis of practices or situations within an institution. In addition, since the environment is changeable, the measurement will also act as a platform for making the necessary modifications towards better educational practices in line with the institution’s own goals.
Educational environment
Introduction
Defining educational environment
The key components of educational climate
Teachers’ skills
Assessment methods
Classroom
Accommodation
Size of class
Food
Learning materials
Personal safety
Teaching methods
Transport availability
Timetable
Library
Social life
Leisure facilities
A sense of belonging
Clinical experience
Student support
Access to computers
Clear learning outcomes
Study skills
Why is it important to gauge the educational climate?
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“Wet spring had merged imperceptibly into bleak autumn. For months the sky had remained a depthless grey. Sometimes it rained, but mostly it was dull … It was like living inside Tupperware.”
“School climate refers to the impressions, beliefs and expectations held by members of the school community about their school as a learning environment, their associated behaviour, and the symbols and institutions that represent the patterned expression of behaviour”
Aspects of the learning environment will change over time. Remember that what is important for a first-year student may be of no concern to a final-year student and vice versa.
“It has come as something of a surprise to some teachers and administrators in medical education to hear that curriculum comprises, in part, students chatting over lunch in the Medical Club, staff greeting students out of class, student union meetings, pictures on the walls, sculptures, landscaping, gardens, medical students’ reaction to the death of a patient, conversations of staff, students and patients at the Health Centre, and so on and so forth, almost ad infinitum, one could say.”
Each educational environment will have its own special characteristics. In order to establish what these are, you must look at the purpose of the training as well as the setting in which it takes place. Look at what your learning outcomes are and also the social and physical geography of the surrounds. This will help you determine the relevant aspects of the environment.
“A cloudy day or a little sunshine have as great an influence on many constitutions as the most real blessings or misfortunes.”
If you have to make changes within your medical school, then it is usually best to do so when the general atmosphere is perceived as healthy. Be proactive – to use a sporting analogy – the best time to make changes to a team is when it is successful. It is difficult to bring new faces into a ‘beaten’ team and expect a sudden change.