title: International study of medical school learning environments and their relationship with student well-being and empathy.
abstract: OBJECTIVE
  To assess whether favourable perceptions of the learning environment (LE) were associated with better quality of life, less burnout and more empathy across three undergraduate medical education programmes in Israel, Malaysia and China.
  
  
  METHODS
  Cross-sectional surveys were administered at the end of the 2013-2014 academic year at three medical schools: Technion American Medical Students Program (TAMS) in Israel, Perdana University-Royal College of Surgeons in Ireland School of Medicine (PURCSI) in Malaysia and Peking Union Medical College (PUMC) in China. LE perceptions were assessed using the Johns Hopkins Learning Environment Scale (JHLES). Well-being was assessed using validated items for quality of life and the depersonalisation and emotional exhaustion domains of burnout. The 20-item Jefferson Empathy Scale assessed empathy. Statistical analyses included bivariate regressions and multivariate regressions that adjusted for gender, school, class year and perceived academic rank.
  
  
  RESULTS
  Overall, 400/622 (64.3%) students responded, with the following rates by site: TAMS 92/121 (76.0%), PURCSI 160/198 (80.1%) and PUMC 148/303 (48.8%). In multivariate models, favourable overall LE perceptions were associated with higher odds of good quality of life (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.8-5.8; p < 0.001) and lower odds of emotional exhaustion (OR, 0.34; 95% CI, 0.24-0.50; p < 0.001) and depersonaliation (OR, 0.30; 95% CI, 0.24-0.37; p = 0.001). 'Community of Peers', one of seven factors in the JHLES, was the only one to be independently associated with better quality of life and less emotional exhaustion and depersonalisation. After adjusting for covariates, there was not a statistically significant association between overall LE and empathy (OR, 1.4; 95% CI, 0.91-2.2; p = 0.12).
  
  
  CONCLUSIONS
  Students' LE perceptions are closely associated with their well-being, and fostering peer community may hold promise for enhancing quality of life and protecting against burnout. Across these three settings, LE and empathy were not closely related, suggesting that any influence of learning environment on empathy would be modest.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Tackett
authors.affiliation: Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Wright
authors.affiliation: Department of Student Services, Technion American Medical Students Program, Haifa, Israel.
authors.forename: Robert
authors.initials: R
authors.lastname: Lubin
authors.affiliation: Department of Endocrinology, Peking Union Medical College, Beijing, China.
authors.forename: Jianing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Endocrinology, Peking Union Medical College, Beijing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Pan
mesh_terms: D000328:Adult; D002681:China; D003430:Cross-Sectional Studies; D004504:Education, Medical, Undergraduate; D004645:Empathy; D005260:Female; D006801:Humans; D007557:Israel; D007858:Learning; D008296:Malaysia; D008297:Male; D011788:Quality of Life / Q000523:psychology; D012577:Schools, Medical / Q000458:organization & administration* / Q000592:standards; D012931:Social Environment; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires