title: Student centered curricular elements are associated with a healthier educational environment and lower depressive symptoms in medical students.
abstract: BACKGROUND
  Any curriculum change is essentially an environmental change; therefore there is a need to assess the impact of any change in the curriculum on the students' perception of the Educational Environment (EE) and psychological well-being. The objectives of the current study are to (i) compare the EE perceptions of medical students studying in a System Based Curriculum (SBC) with those studying in a traditional curriculum (ii) compare the rate of depressive symptoms among the same students studying in both types of curricula (iii) determine whether there is a difference in the EE perception and depressive symptoms based on gender and year of study.
  
  
  METHODS
  A cross sectional survey was conducted in a Saudi Medical School from 2007-2011, a period in which the school transitioned from a traditional to a SBC. A bilingual version of the Dundee Ready Educational Environment Measure (DREEM) inventory was used for measuring the EE; the Beck Depression Inventory (BDI II) was used for screening of depressive symptoms. A separate demographic questionnaire was also used. Mean scores and percentages were calculated. Continuous variables were summarized as means and standard deviation. For comparison of means, the effect size and student t test (with significance level of <0.05) were used. The percentages of the categorical data were compared using chi square test.
  
  
  RESULTS
  The mean total DREEM score of positive perception of the EE in the SBC students was significantly higher (better) than the traditional curriculum students (p < 0.01) with an effect size of 0.472. The mean total score on the BDI-II inventory for depressive symptoms was higher (sicker) 21.3 among the female traditional curriculum students than 16.7 among the male traditional curriculum students and the difference was statistically significant (p = 0.001). The BDI score of the female SBC students (14.7) was significantly lower (healthier) than the female traditional curriculum students (21.3). No similar change was noted for the male students.
  
  
  CONCLUSIONS
  The current study adds to the advantages of the SBC indicating not only healthier EE for both genders but also healthier emotional well-being for female students only.
authors.forename: Eiad Abdelmohsen
authors.initials: EA
authors.lastname: AlFaris
authors.affiliation: King Saud University Chair for Medical Education Research and Development, King Saud University, Riyadh, Kingdom of Saudi Arabia. naghma.naeem@gmail.com.
authors.forename: Naghma
authors.initials: N
authors.lastname: Naeem
authors.forename: Farhana
authors.initials: F
authors.lastname: Irfan
authors.forename: Riaz
authors.initials: R
authors.lastname: Qureshi
authors.forename: Cees
authors.initials: C
authors.lastname: van der Vleuten
mesh_terms: D003430:Cross-Sectional Studies; D003479:Curriculum; D003863:Depression / Q000453:epidemiology*; D004501:Education, Medical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012529:Saudi Arabia; D013337:Students, Medical / Q000523:psychology*