General practice: the DREEM attachment? Comparing the educational environment of hospital and general practice placements.
The clinical learning environment is changing. General practice placements are now a fundamental part of undergraduate medical education. There is growing recognition that changes in hospital work practices are altering the breadth of exposure available to students. Surprisingly little work has been done comparing the quality of clinical placements between the hospital and community using validated tools. Such comparisons inform curriculum planning and resource allocation. The aim of this study was to compare the quality of the educational environment experienced by junior medical students during hospital and general practice placements using a widely used tool. Following the introduction of a new integrated curriculum, all Year 3 students (n=108) completed a standardised evaluation instrument, the Dundee Ready Education Environment Measure (DREEM) at the end of each of their clinical attachments (two different hospital sites and one in general practice), giving a total of 324 questionnaires. All forms were analysed and input into Graphpad INSTAT version 3. Total DREEM scores as well as subscale scores were calculated for each site. These were compared across sites using a Mann-Whitney U non-parametric test. By comparison with international standards, clinical attachments in our new integrated curriculum were rated highly. In particular, attachments in general practice scored highly with a mean score of 156.6 and perform significantly better (P < 0.01) when compared with the mean score for hospital rotations of 149.0. Significant differences between general practice and hospital rotations exist in the domains of students' perceptions of atmosphere and students' social self-perceptions. Finally, significant differences also emerged in students' perceptions of teachers in general practice when compared to those in the hospital setting. These findings provide evidence of the high-quality educational environment afforded students in primary care. They challenge the traditional emphasis on hospital-based teaching and preempt the question - Is the community a better place for junior students to learn?
Medical Education Unit, University College, Cork, Ireland. M.Kelly@ucc.ie
Martina
M
Kelly
Deirdre
D
Bennett
Siun
S
O'Flynn
D002982:Clinical Clerkship; D003153:Community Health Services; D003258:Consumer Behavior / Q000706:statistics & numerical data; D004504:Education, Medical, Undergraduate / Q000379:methods*; D058006:General Practice / Q000193:education*; D006784:Hospitals, Teaching; D006801:Humans; D007494:Ireland; D010465:Perception; D011361:Professional Competence / Q000592:standards; D012647:Self-Assessment; D012931:Social Environment; D013337:Students, Medical / Q000523:psychology*