Changing the learning environment: the medical student voice.

Background: Students' perceptions of their learning environment influence both how they learn and the quality of their learning outcomes. The clinical component of undergraduate medical courses takes place in an environment designed for clinical service and not teaching. Tension results when these two activities compete for resources. An impending increase in medical student numbers led us to assess the learning environment with a view to planning for the future.

Methods: An open ended question 'If you could change three things about medical school, what would they be?' was added to the Dundee Ready Educational Environment Measure (DREEM). This was used to assess the learning environment of students in years 4 and 5. Allowing students to actively voice their views about changes in the curriculum was considered a useful extension to the DREEM questionnaire.

Results: The findings indicated commonalities over the two years of clinical teaching. The areas of commonality included the need for: more clinical exposure early in the curriculum; fewer lectures; greater consistency in terms of assessment; and more constructive relationships. Fourth-year students tended to voice more concerns around resourcing, and sought more clarification about roles and learning outcomes.

Discussion: There is a need to address concerns raised by students in the areas of curricula, assessments and access to earlier clinical training. Concerns that can be addressed are increasing resource access, implementation of clearer objectives, consistency of teaching and assessments across sites, more formative assessments, and engaging feedback. Students would also benefit from substantive mentoring and role-modelling.