Assessing the Learning Environment for Medical Students: An Evaluation of a Novel Survey Instrument in Four Medical Schools.
OBJECTIVE
A practical, reliable, and valid instrument is needed to measure the impact of the learning environment on medical students' well-being and educational experience and to meet medical school accreditation requirements.


METHODS
From 2012 to 2015, medical students were surveyed at the end of their first, second, and third year of studies at four medical schools. The survey assessed students' perceptions of the following nine dimensions of the school culture: vitality, self-efficacy, institutional support, relationships/inclusion, values alignment, ethical/moral distress, work-life integration, gender equity, and ethnic minority equity. The internal reliability of each of the nine dimensions was measured. Construct validity was evaluated by assessing relationships predicted by our conceptual model and prior research. Assessment was made of whether the measurements were sensitive to differences over time and across institutions.


RESULTS
Six hundred and eighty-six students completed the survey (49 % women; 9 % underrepresented minorities), with a response rate of 89 % (range over the student cohorts 72-100 %). Internal consistency of each dimension was high (Cronbach's α 0.71-0.86). The instrument was able to detect significant differences in the learning environment across institutions and over time. Construct validity was supported by demonstrating several relationships predicted by our conceptual model.


CONCLUSIONS
The C-Change Medical Student Survey is a practical, reliable, and valid instrument for assessing the learning environment of medical students. Because it is sensitive to changes over time and differences across institution, results could potentially be used to facilitate and monitor improvements in the learning environment of medical students.
Brandeis University, Waltham, MA, USA. lpololi@brandeis.edu.
Linda H
LH
Pololi
Weill Cornell Medical College, New York, NY, USA.
Arthur T
AT
Evans
University of Toronto Faculty of Medicine, Toronto, Canada.
Leslie
L
Nickell
Cooper Medical School of Rowan University, Camden, NJ, USA.
Annette C
AC
Reboli
Frank H. Netter MD School of Medicine, Bridgeport, CT, USA.
Lisa D
LD
Coplit
David Geffen School of Medicine, Los Angeles, CA, USA.
Margaret L
ML
Stuber
Bentley University, Waltham, MA, USA.
Vasilia
V
Vasiliou
Brandeis University, Waltham, MA, USA.
Janet T
JT
Civian
Harvard University, Boston, MA, USA.
Robert T
RT
Brennan
D000328:Adult; D004777:Environment; D005260:Female; D006801:Humans; D007858:Learning; D008297:Male; D015279:Organizational Culture; D011594:Psychometrics / Q000295:instrumentation*; D015203:Reproducibility of Results; D012577:Schools, Medical / Q000706:statistics & numerical data*; D013337:Students, Medical / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires / Q000592:standards*; D055815:Young Adult
Culture of medicine; Learning environment; Medical students; Survey