title: Medical Students' Perception of Their Educational Environment and Quality of Life: Is There a Positive Association?
abstract: OBJECTIVE
  To assess perceptions of educational environment of students from 22 Brazilian medical schools and to study the association between these perceptions and quality of life (QoL) measures.
  
  
  METHODS
  The authors performed a multicenter study (August 2011 to August 2012), examining students' views both of (1) educational environment using the Dundee Ready Education Environment Measure (DREEM) and (2) QoL using the World Health Organization Quality of Life Assessment, abbreviated version (WHOQOL-BREF). They also examined students' self-assessment of their overall QoL and medical-school-related QoL (MSQoL). The authors classified participants' perceptions into four quartiles according to DREEM total score, overall QoL, and MSQoL.
  
  
  RESULTS
  Of 1,650 randomly selected students, 1,350 (81.8%) completed the study. The mean total DREEM score was 119.4 (standard deviation = 27.1). Higher total DREEM scores were associated with higher overall QoL and MSQoL scores (P < .001 for all comparisons) and younger ages (P < .001). Mean overall QoL scores were higher than MSQoL scores (mean difference, 1.35; 95% confidence interval [CI] 1.28-1.43; P < .001). Multinomial regression models showed significant dose-response patterns: Higher DREEM quartile scores were associated with better QoL. The psychological health domain of WHOQOL-BREF was most closely associated with DREEM scores (odds ratio 4.70; 95% CI = 3.80-5.81).
  
  
  CONCLUSIONS
  The authors observed a positive association between QoL measures and DREEM scores. This association had a dose-response effect, independent of age, sex, and year of medical training, showing that educational environment appears to be an important moderator of medical student QoL.
authors.affiliation: S.C. Enns is a postdoctoral fellow, Center for Development of Medical Education, School of Medicine, University of São Paulo, São Paulo, Brazil. B. Perotta is assistant professor of embryology, Evangelical Medical School of Parana, Curitiba, Brazil. H.B. Paro is assistant professor of gynecology, School of Medicine, Federal University of Uberlandia, Uberlandia, Brazil. S. Gannam is assistant professor of pediatrics and primary care, School of Medicine, University of the City of São Paulo, São Paulo, Brazil. M. Peleias is a PhD student, Center for Development of Medical Education, School of Medicine, University of São Paulo, São Paulo, Brazil. F.B. Mayer is a PhD student, Center for Development of Medical Education, School of Medicine, University of São Paulo, São Paulo, Brazil. I.S. Santos is assistant professor of internal medicine, Department of Medicine, and staff member, Center for Development of Medical Education, School of Medicine, University of São Paulo, São Paulo, Brazil. M. Menezes is assistant professor of cardiology, Bahiana School of Medicine and Public Health, Salvador, Brazil. M.H. Senger is assistant professor of endocrinology, School of Medicine, Pontifical Catholic University of São Paulo, Sorocaba, Brazil. C. Barelli is assistant professor of public health, School of Medicine, University of Passo Fundo, Passo Fundo, Brazil. P.S.P. Silveira is assistant professor of medical informatics, Department of Pathology, and staff member, Center for Development of Medical Education, School of Medicine, University of São Paulo, São Paulo, Brazil. M.A. Martins is professor of medicine, Department of Medicine, and coordinator, Center for Development of Medical Education, School of Medicine, University of São Paulo, São Paulo, Brazil. P.Z. Tempski is chief, Down Syndrome Center, Institute of Rehabilitation, Clinics Hospital, and staff member, Center for Development of Medical Education, School of Medicine, University of São Paulo, São Paulo, Br
authors.forename: Sylvia Claassen
authors.initials: SC
authors.lastname: Enns
authors.forename: Bruno
authors.initials: B
authors.lastname: Perotta
authors.forename: Helena B
authors.initials: HB
authors.lastname: Paro
authors.forename: Silmar
authors.initials: S
authors.lastname: Gannam
authors.forename: Munique
authors.initials: M
authors.lastname: Peleias
authors.forename: Fernanda Brenneisen
authors.initials: FB
authors.lastname: Mayer
authors.forename: Itamar Souza
authors.initials: IS
authors.lastname: Santos
authors.forename: Marta
authors.initials: M
authors.lastname: Menezes
authors.forename: Maria Helena
authors.initials: MH
authors.lastname: Senger
authors.forename: Cristiane
authors.initials: C
authors.lastname: Barelli
authors.forename: Paulo S P
authors.initials: PS
authors.lastname: Silveira
authors.forename: Milton A
authors.initials: MA
authors.lastname: Martins
authors.forename: Patricia
authors.initials: P
authors.lastname: Zen Tempski
mesh_terms: D000328:Adult; D001938:Brazil; D004504:Education, Medical, Undergraduate; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D012577:Schools, Medical; D012649:Self Concept; D012931:Social Environment; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult