Medical Teacher

ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20

Assessing the learning environment of a faculty:

Psychometric validation of the German version
of the Dundee Ready Education Environment
Measure with students and teachers

Thomas Rotthoff, Martin S. Ostapczuk, Judith De Bruin, Ulrich Decking,

Matthias Schneider & Stefanie Ritz-Timme

To cite this article: Thomas Rotthoff, Martin S. Ostapczuk, Judith De Bruin, Ulrich Decking,
Matthias Schneider & Stefanie Ritz-Timme (2011) Assessing the learning environment of
a faculty: Psychometric validation of the German version of the Dundee Ready Education
Environment Measure with students and teachers, Medical Teacher, 33:11, e624-e636, DOI:
10.3109/0142159X.2011.610841

To link to this article: http://dx.doi.org/10.3109/0142159X.2011.610841

Published online: 24 Oct 2011.

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 2011; 33: e624e636

WEB PAPER

Assessing the learning environment of a faculty:

Psychometric validation of the German version
of the Dundee Ready Education Environment
Measure with students and teachers
THOMAS ROTTHOFF1,2, MARTIN S. OSTAPCZUK1, JUDITH DE BRUIN1, ULRICH DECKING1,
MATTHIAS SCHNEIDER1,2 & STEFANIE RITZ-TIMME1,2
1
Heinrich-Heine-University of Duesseldorf, Germany, 2University Hospital Duesseldorf, Germany

Abstract
Aims: The teachers perspectives of the educational environment have as yet only been sparsely considered. This study aimed at
validating the first German version of the Dundee Ready Education Environment Measure (DREEM) from the points of view of
both students and teachers.
Methods: Data from 1119 students and 258 teachers were available for analysis. Psychometric validation included the analysis of
homogeneity and discrimination at item level as well as reliability (Cronbachs ), criterion and construct validity at test level. Effect
sizes were calculated and the independent samples t-test was used for statistical inference testing of mean differences between two
groups.
Results: Item characteristics were satisfactory in both samples. Reliability was high with  0.92 (students) and 0.94 (teachers),
respectively. Factor analyses revealed five dimensions which slightly diverged from the five subscales postulated by the DREEM
authors though. The environment was evaluated significantly ( p 5 0.001) more positively by teachers (M 117.63) than by
students (M 109.75). Further significant differences were observed with regard to gender, mother language, stage of studies and
previous professional training among others.
Conclusions: With convincing psychometric properties at item and test levels, the suitability of DREEM not only for students but
also for teachers to assess the educational environment has been demonstrated.

Introduction Practice points

Knowledge about the teaching and learning environment is an
important prerequisite for the successful conception and
implementation of a new curriculum (Bouhaimed et al. 2009)
and should become a part of educational institutions good
practices (Soemantri et al. 2010). Although the educational
environment is rather a fuzzy construct which makes a binding
definition difficult (Genn & Harden 1986), it can be deduced
from the numerous attempts at definition that here not only
external parts in the sense of an objective environment but
also internal parts in the sense of a personality trait are
important. The individual perception of one and the same
objective fact is known to vary widely (Dornic & Ekehammar
1990). Furthermore, the individual perception of the learning
environment by the student has a significant impact on the
educational results realised in this learning climate: Desirable
learning outcomes and gains are positively associated with
favourable aspects of socio-psychological learning environ-
ments, i.e. the better the environment, the better the results
(Haertel et al. 1981). Besides the performance behaviour, the
students gender also correlates with his/her perception of the
. The suitability of DREEM not only for students but also
for teachers to assess the educational environment has
been demonstrated.
. The exploration and communication of discrepancies on
group immanent self- and other-perception for students
and teachers create chances for the improvement of the
learning environment, in particular, the studentteacher
relationship.
. More investigation of the factorial structure of DREEM,
the relationship between the perception of climate by
means of DREEM and academic performance and its
retest reliability with use of an adequate retest interval
would be of interest.
environment (Chaput de Santonge & Dunn 2001): Some
authors found female students to assess their learning
environment more negatively than male students (Mayya &
Roff 2004), others, however, found the opposite results, i.e.
female students evaluating the climate more positively

Correspondence: T. Rotthoff, Deanery of Study, Medical Faculty and Department for Endocrinology, Diabetes and Rheumatology, Heinrich-Heine-
University and University Hospital Duesseldorf, Moorenstr. 5, 40225 Dusseldorf, Germany. Tel: 0049 211 8118771; fax: 0049 211 8101518771;
email: rotthoff@med.uni-duesseldorf.de

e624 ISSN 0142159X print/ISSN 1466187X online/11/11062413 2011 Informa UK Ltd.

DOI: 10.3109/0142159X.2011.610841

than their male counterparts (Bassaw et al. 2003). Apparently,
female and male students often experience their learning
environments differently (Roff et al. 2001) which is, in light of
an increasing proportion of female students not only in
Germany but also worldwide, of interest for the traditionally
male-dominated medical teaching facilities (Genn 2001b).
The teachers perspectives of the educational environment
have as yet only been sparsely considered in spite of the many
curriculum reforms that have been initiated worldwide (Fraser
1986; Genn 2001a, 2001b; Miles & Leinster 2009). This is even
more remarkable since curriculum changes represent a chal-
lenge for the teachers and, just for this group of people, an
evaluation appears to be particularly important (Till 2005).
In German (medical) educational research, the educational
environment has received only little attention and there is a
lack of suitable measurement tools in the German language.
An international, widely used and validated measurement tool
that has been translated into several other languages is the
Dundee Ready Education Environment Measure (DREEM;
Roff et al. 1997; cf. Soemantri et al. 2010). The test construction
included a Delphi panel of almost 100 international health-care
educators and the combination of quantitative with qualitative
test construction techniques. The questionnaire was thus
conceived as a non-culturally specific instrument for assessing
the teaching and learning environment in the perception of
students of the health-care professions (Roff 2005). Up to now,
it has been used only once to compare staff and student
perceptions of the learning environment at a given medical
school. To explore potential perceptional discrepancies
between these two groups, Miles and Leinster (2009) admin-
istered DREEM to students and in a reworded version to
teachers who were thereby able to complete the questionnaire
with their opinion about the student experience. Although the
overall results were closely aligned, there were significant
differences at subscale level, i.e. teachers perceived them-
selves and learning more positively than students did, whereas
students social perception of themselves was more positive
than in the teachers view. In addition, the results demon-
strated staffs unfamiliarity with student aspects of the learning
environment. In its present form, DREEM consists of 50 items
that must be answered using a scale of 0 (strongly disagree)
to 4 (strongly agree); thus, a maximum of 200 points can be
achieved. A high number of points is indicative of a good
environment. The items are divided into the five subscales:
perception of teaching, perception of teachers, academic
self-perception, perception of the atmosphere and social
self-perception.
The aim of this study is to psychometrically validate DREEM
for the first time in the German-speaking area as a standardised
questionnaire for assessing the learning environment from the
points of view of both students and teachers.
Methods
A German version of DREEM was completed online by 1119
medical students and 258 teachers of the Medical Faculty of the
Heinrich-Heine-University (HHU) Duesseldorf. In addition, the
students and teachers were asked extensive questions about
their demographic background.
Assessing the learning environment of a faculty
First, a German translation of DREEM was prepared using
the back-translation method of Brislin (1970) as modified by
Jones et al. (2001). This was then translated back by two
independent, bilingual experts, discrepancies were discussed
and a final version agreed upon. For the preparation of the
teachers version of the questionnaire, items formulated in the
original in the I form (e.g. I am encouraged to participate
actively in the classes) were adapted for teachers according to
the procedure of Miles and Leinster (2009; e.g. The students
are encouraged to participate in class; see Appendix 1).
Medical education in Duesseldorf currently follows a
traditional curriculum that is divided into a 2-year, preclinical
period (science and basic subjects) and a 4-year clinical
period. The first state examination is held at the end of the
preclinical period while the second and final state examination
is held at the end of the clinical period.
Data collection was carried out as an online procedure at
the end of the summer semester 2010 for all students and
teachers. Participation was voluntary and the data were stored
in anonymous form. Details of demographic variables were
collected prior to the questionnaire. Hereby the students were,
among others, asked to provide information about their school
leaving certificates and their grades in the first state
examination.
Altogether, questionnaires from 1119 students (55.0%)
and 258 teachers were analysed. As it was not known who in
the faculty was actually really involved in teaching, the
questionnaires were first sent to all scientific personnel in the
faculty (N 1294). Staff members who could be safely ignored
as not being involved in teaching, such as clerks, technicians
or nurses, were omitted from the very beginning. The
accompanying letter was addressed specifically to teachers
and demographic questions on the topic teaching activity
were posed. Even if staff members, such as scientific personnel
solely involved in research, had begun to complete the
questionnaire, they would not have been able to provide
pertinent answers to most questions because of their lacking
teaching experience and would have therefore been rather
likely to cancel the survey. This is why we only evaluated
completed surveys and additionally run post hoc plausibility
data checks to identify respondents both students and staff
who had not answered the questions in a meaningful way.
Thanks to these precautions, it can thus be safely assumed that
the questionnaires we analysed were only completed by
personnel actually involved in teaching. Because of these
circumstances, however, no statements about the proportion
of all teaching staff who participated are possible. Table 1
contains demographic information on both samples.
Within the framework of item and test analysis, besides the
mean values and the discrimination indices of the items, also
item homogeneity as well as the reliability and validity of the
entire test were to be examined.
A control of the administration and scoring objectivity was
not necessary because the whole questionnaire contained
standardised instructions and answering possibilities. Thanks
to the interpretation guidelines for this questionnaire by Lai
et al. (2009) as well as McAleer and Roff (2001), the
interpretation objectivity of DREEM was also high and thus
did not need to be examined. Content validity did not require
e625
T. Rotthoff et al.

Table 1. Demographic data of the student and the teacher sample

Students (N 1119) Teachers (N 258)

Gender Female 739 (66.0%) 72 (27.9%)
Male 380 (34.0%) 186 (72.1%)
Age M (SD) 24.1 years (3.8) 41.7 years (9.5)
Mother tongue German 985 (88.0%) 249 (96.5%)
Other 134 (12.0%) 9 (3.5%)
Mark in school leaving examinationa M (SD) 1.8 (0.6)
Stage of course: studying (students)/teaching (teachers) Pre-clinicalb 509 (45.8%)c 30 (13.4%)
Clinical 602 (54.2%) 152 (67.9%)
Both 42 (18.7%)
If clinical, mark first state examination* M (SD) 2.7 (0.7)
Have you completed a professional occupational training (e.g. as a nurse)? Yes 241 (23.2%)
No 796 (76.8%)
Do you live in Duesseldorf? Yes 836 (75.0%) 144 (56.9%)
No 278 (25.0%) 109 (43.1%)
How far away from school do you live? M (SD) 10.2 km (17.1) 13.2 km (17.2)

Notes: M (SD) mean value (standard deviation).

a
The marks in the school leaving examination and in the first state examination range from 1 (excellent) to 5 (failed).
b
Preclinical semesters 14; Clinical semester 512.
c
The frequencies do not always add up to 1119 and 258, respectively, as some participants have not replied to all demographic questions. Thus, due to these missing
values the percentages are not always based on the total sample size of N 1119 and N 258, respectively.

any examination either because DREEM was developed by 1997) but as yet hardly ever tested (de Oliveira Filho et al.
experts in a Delphi process. 2005; Wang et al. 2009).

. Homogeneity: Explorative factor analyses were performed
to analyse the homogeneity of the items and the factorial
validity of DREEM.
. Discrimination: Item discrimination was assessed by means
of part-whole-corrected discrimination indices.1
. Reliability: Examination of the reliability was limited to
an analysis of the internal consistency by means of
Cronbachs .
. Criterion validity: With regard to criterion validity, we
investigated both predictively (on the basis of the school
leaving grades) and concurrently (on the basis of the grades
in the first state examination) whether good students
evaluated the environment better than did their weaker
counterparts (Pimparyon et al. 2000; Sun 2003; Mayya &
Roff 2004; Carmody et al. 2009) and whether the perception
of the environment became more negative with increasing
number of semesters, even when age was held constant
(Hutchins 1964; Till 2004; Zaini 2005; Bouhaimed et al.
2009; Riquelme et al. 2009). Furthermore, possible relation-
ships with mother language and place of residence were
studied. Also, an answer to the question of the discrepancy
between the evaluation of the environment by the students
in comparison to the evaluation by the teachers was sought
in an undirected manner, since the few available results on
this subject are inconsistent (Sheehan 1970; Fraser 1986;
Miles & Leinster 2009) and allow the assumption of a series
of difficultly predictable factors. Finally, an evaluation of
possible gender differences was undertaken.
. Construct validity: With regard to construct validity, we
wanted to examine whether DREEM, also in its German
version, exhibits the five-factorial structure (perception
of teaching, perception of teachers, academic
self-perception, perception of atmosphere, and social
self-perception) as postulated by the authors (Roff et al.
e626
All data were analysed with the help of the programme
Statistical Package for the Social Sciences 17.0 for Windows
(2008). Effect sizes were calculated with the freely available
programme G*Power 3 (Faul et al. 2007). For inference testing
of mean differences between two groups (e.g. students vs.
teachers), the independent samples t-test was used. Pearsons
correlations were calculated to examine relationships. Cohens
(1988) guidelines were used for the interpretation of effect
sizes. For the effect size measure d in the t-test, it holds that
d  0.20 small effect, d  0.50 medium effect, d  0.80
large effect. The productmoment correlation coefficient r,
on the other hand, is already a measure of effect size, it holds
that r  0.10 small effect, r  0.30 medium effect,
r  0.50 large effect.
Explorative factor analyses were conducted to analyse the
homogeneity of the items and the factorial validity of the
employed questionnaire. Besides theoretical expectations,
the KaiserGuttman criterion (Gorsuch 1983) and the scree
test (Cattell 1966) were used as criteria for the extraction of
factors.
Results
Item analysis
DREEM item means dispersed sufficiently in both the student
and teacher samples. In the student group, the total item mean
amounted to M 2.19 (SD 0.50), only just above the limit of
2, which in DREEM indicates a region worthy of improvement
at item level (Vieira et al. 2003; Whittle et al. 2007). Altogether,
the means for 20 items were less than 2. For the teachers, the
mean values were somewhat less dispersed and on the whole
somewhat higher with a total mean of M 2.35 (SD 0.35).
 Assessing the learning environment of a faculty

Table 2. Mean values, standard deviations and part-whole-corrected discrimination indices of DREEM items in the student and the
teacher sample.

Students (N 1119) Teachers (N 258)

Subscale Item M (SD) DI M (SD) DI

Perception of teaching 1 I am encouraged to participate in class 1.98 (0.95) 0.50 2.73 (0.94) 0.48
2 The teaching is sufficiently concerned to develop my confidence 1.95 (1.05) 0.62 2.13 (0.91) 0.68
3 The teaching encourages me to be an active learner 1.90 (1.01) 0.58 2.21 (0.95) 0.71
4 The teaching is well focused 2.05 (0.93) 0.63 2.15 (0.84) 0.58
5 The teaching is sufficiently concerned to develop my competence 2.39 (0.92) 0.61 2.61 (0.79) 0.59
6 I am clear about the learning objectives of the course 2.72 (0.89) 0.50 2.31 (0.90) 0.62
7 The teaching is often stimulating 1.82 (0.93) 0.60 2.52 (0.88) 0.54
8 The teaching time is put to good use 1.90 (0.97) 0.49 2.45 (0.82) 0.62
9 The teaching is student centred 1.71 (0.96) 0.57 2.10 (0.94) 0.55
10 Long-term learning is emphasized over short term 1.33 (1.06) 0.45 1.87 (0.94) 0.61
11 The teaching is too teacher-centred 1.73 (0.88) 0.26 2.05 (0.98) 0.37
12 The teaching over-emphasizes factual learning 1.43 (1.05) 0.25 1.91 (1.07) 0.35
Perception of teachers 13 The teachers are good at providing feedback to students 1.45 (0.91) 0.49 2.04 (0.93) 0.57
14 The teachers have good communications skills with patients 2.06 (0.73) 0.45 2.57 (0.78) 0.54
15 The teachers are knowledgeable 2.87 (0.70) 0.35 2.70 (0.87) 0.29
16 The teachers give clear examples 2.41 (0.81) 0.52 2.63 (0.72) 0.58
17 The teachers are well prepared for their classes 2.39 (0.92) 0.36 2.57 (0.86) 0.52
18 The teachers provide constructive criticism here 1.88 (0.91) 0.55 2.36 (0.82) 0.54
19 The teachers ridicule the students 2.56 (0.95) 0.41 3.47 (0.72) 0.47
20 The teachers get angry in class 2.71 (0.90) 0.32 3.10 (0.88) 0.39
21 The teachers are authoritarian 1.64 (0.94) 0.21 2.41 (0.95) 0.41
22 The teachers are patient with patients 2.19 (0.77) 0.42 2.52 (0.74) 0.40
23 The students irritate the teachers 2.16 (0.95) 0.30 2.73 (0.93) 0.43
Academic self-perception 24 I am able to memorise all I need 2.17 (1.10) 0.25 2.21 (0.93) 0.01
25 Much of what I have to learn seems relevant to a career in medicine 2.28 (1.03) 0.50 2.41 (1.00) 0.44
26 I feel I am being well prepared for my profession 1.97 (1.04) 0.63 1.76 (0.89) 0.66
27 Last years work has been a good preparation for this years work 2.08 (1.00) 0.45 2.12 (0.73) 0.43
28 My problem-solving skills are being well developed here 1.70 (0.90) 0.56 2.21 (0.83) 0.66
29 I am confident about passing this year 2.71 (0.90) 0.27 2.59 (0.66) 0.35
30 I have learned a lot about empathy in my profession 1.86 (1.10) 0.45 1.83 (0.91) 0.51
31 Learning strategies which worked for me before continue to work for me now 2.60 (0.93) 0.33 2.39 (0.87) 0.34
Perception of atmosphere 32 The atmosphere is relaxed during lectures 2.66 (0.83) 0.47 2.75 (0.73) 0.58
33 I feel able to ask the questions I want 2.48 (0.95) 0.40 2.85 (0.73) 0.50
34 I feel comfortable in class socially 2.70 (0.85) 0.50 2.52 (0.68) 0.59
35 There are opportunities for me to develop interpersonal skills 2.20 (1.07) 0.48 2.41 (0.83) 0.35
36 The enjoyment outweighs the stress of studying medicine 2.05 (1.10) 0.52 2.22 (0.78) 0.57
37 The atmosphere motivates me as a learner 1.84 (0.99) 0.63 2.25 (0.76) 0.73
38 I am able to concentrate well 2.65 (0.90) 0.30 2.22 (0.83) 0.31
39 The atmosphere is relaxed during ward teaching 2.29 (0.72) 0.37 2.66 (0.76) 0.35
40 This school is well timetabled 1.49 (1.08) 0.43 1.70 (0.92) 0.57
41 I find the experience disappointing 1.83 (1.18) 0.41 2.04 (0.91) 0.53
42 Cheating is a problem in this school 2.73 (1.04) 0.08 2.51 (0.84) 0.19
43 The atmosphere is relaxed during seminars/tutorials 2.45 (0.98) 0.50 2.87 (0.73) 0.53
Social self-perception 44 I have good friends in this school 3.19 (0.91) 0.25 2.24 (0.79) 0.47
45 There is a good support system for students who get stressed 1.02 (0.88) 0.44 1.89 (0.78) 0.51
46 I am too tired to enjoy this course 1.78 (1.17) 0.39 2.17 (0.97) 0.35
47 I am rarely bored on this course 2.78 (1.12) 0.19 2.05 (0.95) 0.38
48 My accommodation is pleasant 3.30 (0.83) 0.23 2.11 (0.53) 0.09
49 My social life is good 3.01 (0.96) 0.35 2.44 (0.67) 0.14
50 I seldom feel lonely 2.60 (1.07) 0.33 2.08 (0.61) 0.14

Notes: M (SD) mean value (standard deviation); DI part-whole-corrected discrimination index.

Items in italics are keyed negatively. After reversing the polarity for analysis, a low value now corresponds to prior consent and therefore a poor teaching and learning
environment.
The validated German version of the DREEM can be obtained from the authors on request.

In this group, only six items had a mean value of less than the
limit of 2. In both samples, there were no ceiling or floor
effects at item level.
With regard to homogeneity, for students all, and for
teachers most, of the items loaded highly (40.30) on the
dimensions identified by us by means of factor analyses
(Appendix 2). Exceptions in the teachers questionnaire were
items 24 (The students are able to memorise all that is
needed), 38 (The students are able to concentrate well) and
42 (Cheating in exams is a problem at this university), which
did not exhibit satisfactory loadings (i.e. 40.30) on any of the
identified dimensions.2 The part-whole-corrected discrimina-
tion indices for the students were all positive and amounted on
average to M 0.42 (SD 0.13); in the teacher sample, the
discrimination indices were on average M 0.46 (SD 0.16;
see Table 2).
e627
T. Rotthoff et al.

Table 3. DREEM total and subscale scores in the student and the teacher sample.

Students (N 1119) Teachers (N 258)

Maximal Internal Internal

Questionnaire score consistency () M (SD) MinMax Consistency () M (SD) MinMax t(1375) p d

DREEM Total score (50 items) 200 0.92 109.75 (21.71) 28182 0.94 117.63 (20.80) 52182 5.30 50.001 0.37
Perception of teaching (12 items) 48 0.84 22.92 (6.91) 247 0.86 27.05 (6.85) 547 8.66 50.001 0.60
Perception of teachers (11 items) 44 0.75 24.33 (5.08) 544 0.80 29.10 (5.32) 1244 13.46 50.001 0.92
Academic self-perception (8 items) 32 0.68 17.39 (4.47) 031 0.67 17.50 (3.78) 526 0.37 0.71 0.03
Perception of atmosphere (12 items) 48 0.75 27.39 (6.04) 548 0.80 29.01 (5.40) 1345 3.96 50.001 0.28
Social self-perception (7 items) 28 0.57 17.71 (3.68) 226 0.53 14.97 (2.76) 623 11.26 50.001 0.84

Note:  Cronbachs ; M (SD) mean value (standard deviation); MinMax minimal and maximal scores achieved; p empirical -level of two-tailed testing;
t(1375) t-value with 1375 degrees of freedom; d effect size for independent sample t-test with d  0.20 small effect, d  0.50 medium effect and d  0.80
large effect.

Table 4. DREEM total and subscale scores in the student sample depending on students marks in the school leaving examination and
the first state examination.

Students with school leaving examination Students with first state examination

51.60 (N 518) 41.60 (N 557) 52.50 (N 308) 42.50 (N 275)

Questionnaire M (SD) M (SD) t(1073) p d M (SD) M (SD) t(581) p d

DREEM total score 111.26 (21.06) 108.74 (22.01) 1.92 50.05 0.16 109.81 (21.82) 109.46 (22.43) 0.19 0.43 0.02
Perception of teaching 23.24 (6.78) 22.76 (6.89) 1.15 0.13 0.07 21.69 (7.11) 22.41 (7.08) 1.22 0.11 0.10
Perception of teachers 24.56 (4.93) 24.19 (5.13) 1.18 0.12 0.07 24.32 (5.24) 24.13 (5.49) 0.42 0.38 0.04
Academic self-perception 17.68 (4.34) 17.18 (4.51) 1.87 50.05 0.11 17.48 (4.51) 17.20 (4.39) 0.78 0.22 0.06
Perception of atmosphere 27.86 (5.90) 27.06 (6.12) 2.15 50.05 0.13 28.28 (5.87) 27.93 (6.24) 0.70 0.24 0.06
Social self-perception 17.93 (3.50) 17.54 (3.85) 1.72 50.05 0.11 18.04 (3.59) 17.80 (3.89) 0.77 0.22 0.06

Note: The marks in the school leaving examination and in the first state examination range from 1 (excellent) to 5 (failed).
p empirical -level of one-tailed testing; t(1073) and t(581) t-value with 1073 and 581 degrees of freedom, respectively; d effect size for independent samples t-
test with d  0.20 small effect, d  0.50 medium effect and d  80 large effect.

Reliability
At the level of the entire test, the results of the reliability
analyses using Cronbachs  were similar in both groups, and
DREEM proved highly reliable with  0.92 (students) and
 0.94 (teachers), respectively. At subscale level, the coef-
ficients ranged between 0.53 and 0.86 (Table 3). In accordance
with the interpretation guidelines recommended by Lai et al.
(2009) as well as McAleer and Roff (2001), the educational
environments as measured by means of DREEM exhibited
both for the students (M 109.75, SD 21.71) and for the
teachers (M 117.63, SD 20.80) albeit only marginally
more positive than negative aspects (100  149 points).
However, this is far removed from an excellent climate
(more than 150 points) and lies in the typical region for
traditional curricula (5120; Roff 2005).
Criterion validity
For the total DREEM score, the analyses showed significant
mean differences between students with a school leaving
grade below the median of 1.60 (M 111.26, SD 21.06) and
those with a school leaving grade above the median of 1.60
(M 108.74, SD 22.01), t(1073) 1.92, p 5 0.05 and
e628
d 0.16. With regard to the grade in the first state examination,
there were no longer any significant differences between the
good and less good students (Table 4).
Students in later semesters (clinical part of course) evalu-
ated the environment as being significantly poorer than did
their colleagues in earlier semesters ( preclinical part of course)
on the DREEM subscale perception of teaching ( preclinical:
M 23.91, SD 6.52 vs. clinical: M 22.08, SD 7.14;
t(1109) 4.42; p 5 0.001; d 0.27). In contrast, the atmo-
sphere in the clinical stage was considered to be significantly
better ( preclinical: M 26.56, SD 5.89 vs. clinical: M 28.12,
SD 6.07; t(1109) 4.32; p 5 0.001; d 0.26]. The signifi-
cant negative correlations between number of semesters and
evaluation of the environment (e.g. perception of teaching:
r 0.18, p 5 0.001) remained significant even after partial-
ling out the factor age which, as expected, correlated positively
with the number of semesters (r 0.47, p 5 0.001), but,
however, did become weaker (perception of teaching:
r* 0.13, p 5 0.001; see Table 5).
In the student sample, native speakers tended to evaluate the
environment (e.g. DREEM total score: M 109.04, SD 21.68)
more negatively than non-native speakers (M 114.95,
SD 21.24), t(1117) 2.97, p 5 0.01 and d 0.28.
 Assessing the learning environment of a faculty

Table 5. Association between DREEM total and subscale scores and stage of course in the student sample.

Students

Correlation with Preclinical Clinical

Questionnaire number of semester (r) (Partial correlation) (N 509) M (SD) (N 602) M (SD) t(1109) p d

DREEM Total score 0.07* (0.01) 109.82 (21.07) 109.71 (22.28) 0.08 0.47 0.01
Perception of teaching 0.18** (0.13***) 23.91 (6.52) 22.08 (7.14) 4.42 50.001 0.27
Perception of teachers 0.09** (0.07**) 24.48 (4.59) 24.20 (5.40) 0.91 0.18 0.06
Academic self-perception 0.04 (0.02) 17.40 (4.46) 17.38 (4.48) 0.07 0.47 0.00
Perception of atmosphere 0.05 (0.11***) 26.56 (5.89) 28.12 (6.07) 4.32 50.001 0.26
Social self-perception 0.03 (0.10***) 17.46 (3.64) 17.93 (3.71) 2.10 0.05 0.13

Note: Partial correlation correlation between respective DREEM score and number of semesters after partialling out the factor age; M (SD) mean value (standard
deviation); p empirical -level of one-tailed testing; t(1109) t-value with 1109 degrees of freedom; d effect size for independent samples t-test with d  0.20
small effect, d  0.50 medium effect and d  0.80 large effect; *p 5 0.05; **p 5 0.01; ***p 5 0.001 in the respective t-test for ( partial) correlations (one-tailed).

Table 6. DREEM total and subscale scores in the student sample depending on students mother tongue.

Students

Questionnaire Native speakers (N 985) M (SD) Non-native speakers (N 134) M (SD) t(1117) p d

DREEM Total score 109.04 (21.68) 114.95 (21.24) 2.97 50.01 0.28
Perception of teaching 22.54 (6.86) 25.77 (6.60) 5.14 50.001 0.48
Perception of teachers 24.10 (5.02) 25.98 (5.25) 4.03 50.001 0.36
Academic self-perception 17.15 (4.49) 19.19 (3.83) 5.01 50.001 0.49
Perception of atmosphere 27.34 (6.08) 27.75 (5.70) 0.74 0.46 0.07
Social self-perception 17.91 (3.60) 16.26 (3.99) 4.92 50.001 0.43

Note: M (SD) mean value (standard deviation); p empirical -level of two-tailed testing; t(1117) t-value with 1117 degrees of freedom; d effect size for
independent samples t-test with d  0.20 small effect, d  0.50 medium effect and d  0.80 large effect.

The non-native speakers also considered themselves to be

significantly more positive in academic self-perception in Table 7. Association between DREEM total and subscale
scores and distance between respondents residence and
DREEM (M 19.19, SD 3.83) than the native speakers university (in km) in the student and teacher sample.
(M 17.15, SD 4.49), t(1117) 5.01, p 5 0.001, d 0.49,
and this even though in the subgroup of students who had
Students (N 1119)Teachers (N 258)
already completed the first state examination the non-native
Correlation with
speakers (M 2.92, SD 0.71) achieved significantly poorer
distance between
results than the German native speakers (M 2.66, SD 0.74), Questionnaire residence and university (r)
t(581) 2.77, p 5 0.01, d 0.36 (Table 6).
Students who did not live in Duesseldorf (M 25.05, DREEM Total score 0.02 0.13*
Perception of teaching 0.05 0.12
SD 4.94) evaluated the teachers in DREEM significantly
Perception of teachers 0.07* 0.06
better than those students who lived in Duesseldorf Academic self-perception 0.01 0.09
(M 24.11, SD 5.11), t(1112) 2.68, p 5 0.01, d 0.18. Perception of atmosphere 0.01 0.14*
Social self-perception 0.03 0.19**
The further the teachers lived away from the university, the
lower was their total score in DREEM (r 0.13, p 5 0.05) and Note: *p 5 0.05; **p 5 0.01 in respective t-test for correlations (two-tailed).
the poorer did they evaluate the atmosphere in DREEM
(r 0.14, p 5 0.05) as well as the social self-perception of
the students (r 0.19, p 5 0.01; see Table 7).
Students who had completed a professional training
Comparison of student perspectives versus teacher
programme, e.g. in nursing or geriatric care (DREEM total
perspectives
score: M 104.67, SD 22.48), evaluated the environment in
all dimensions of DREEM as being significantly poorer than did On comparison between teachers and students, the overall
their fellow students without a completed profession training environment was evaluated significantly more positively by
(M 111.14, SD 21.04), t(1098) 4.11, p 5 0.001, d 0.30 our teachers (DREEM total score: M 117.63, SD 20.80) than
(Table 8). by our students (M 109.75, SD 21.71), t(1375) 5.30,
e629
T. Rotthoff et al.

Table 8. DREEM total and subscale scores depending on students previous occupational training.

Students without completed

Students with completed previous previous occupational training
occupational training (N 241) (N 972)
Questionnaire M (SD) M (SD) t(1035) p d

DREEM Total score 104.67 (22.48) 111.14 (21.04) 4.11 50.001 0.30
Perception of teaching 21.66 (7.24) 23.32 (6.72) 3.31 50.001 0.24
Perception of teachers 23.76 (5.47) 24.51 (4.88) 2.02 50.05 0.15
Academic self-perception 16.47 (4.75) 17.63 (4.32) 3.55 50.001 0.26
Perception of atmosphere 25.79 (5.87) 27.83 (5.95) 4.67 50.001 0.35
Social self-perception 16.99 (3.89) 17.86 (3.62) 3.20 50.01 0.23

Note: M (SD) mean value (standard deviation); p empirical -level of two-tailed testing; t(1035) t-value with 1035 degrees of freedom; d effect size for
independent samples t-test with d  0.20 small effect, d  0.50 medium effect and d  0.80 large effect.

Table 9. Gender differences in the assessment of teaching and learning environment in the student sample.

Male students (N 380) Female students (N 739)

Questionnaire M (SD) M (SD) t(1117) p d

DREEM Total score 107.41 (23.35) 110.96 (20.72) 2.60 50.01 0.16
Perception of teaching 21.73 (7.44) 23.54 (6.54) 4.17 50.001 0.26
Perception of teachers 23.97 (5.36) 24.51 (4.93) 1.69 50.09 0.10
Academic self-perception 17.29 (4.55) 17.44 (4.42) 0.54 50.59 0.03
Perception of atmosphere 27.13 (6.30) 27.53 (5.90) 1.06 50.29 0.07
Social self-perception 17.29 (4.03) 17.93 (3.48) 2.79 50.01 0.15

Note: M (SD) mean value (standard deviation); p empirical -level of two-tailed testing; t(1117) t-value with 1117 degrees of freedom; d effect size for
independent samples t-test with d  0.20 small effect, d  0.50 medium effect and d  0.80 large effect.

p 5 0.001, d 0.37. In both groups, however, the DREEM total
score was significantly poorer than the average score
(weighted according to sample size) of the available interna-
tional studies with medical students (DREEM total score:
M 121.04) in which DREEM has been used so far (see
Ostapczuk et al. (2011) for an overview of all studies);
students: t(1118) 17.40, p 5 0.001, d 0.52, and, respec-
tively, teachers: t(257) 2.63, p 5 0.01, d 0.16.
Examining the different DREEM subscales in this study,
teachers assessments were more positive than students
assessments with regard to the subscales perception of
teaching, perception of teachers and perception of atmo-
sphere, i.e. our teachers were more satisfied with themselves
as teachers, their teaching and the atmosphere in comparison
with their students. Students evaluated only their social self-
perception more positively than teachers did. On the DREEM
subscale academic self-perception, there was no significant
difference between student and teacher perceptions (Table 3).
Gender differences
In the student sample, female students evaluated the educa-
tional environment as being significantly more positive in
practically all dimensions than did their male counterparts;
however, the effects were small (Table 9). In contrast, there
were absolutely no over-coincidental gender differences
among the teachers. In order to clarify whether or not the
e630
gender difference among the students was due to a better
academic performance of the female students, male and
female students were analysed with regard to their school
leaving grades and grades in the first state examination. It was
found that female students (M 1.81, SD 0.55) on average
achieved a significantly better school leaving grade than the
male students (M 1.92, SD 0.59), t(1073) 2.97, p 5 0.01,
d 0.20, but then performed on average significantly more
poorly in the first state examination (M 2.76, SD 0.50) than
their male counterparts (M 2.54, SD 0.80), t(581) 3.44,
p 5 0.001, d 0.33.
Construct validity
In order to examine the factorial validity of DREEM, we
investigated in both groups whether the five DREEM dimen-
sions postulated by Roff et al. (1997) could be identified by
means of an explorative principal components analysis. Since
the KaiserMeyerOlkin (KMO) value (Kaiser 1970, 1974) was
0.93 and Bartletts (1954) test of sphericity significant,
2(1225) 18,561.63, p 5 0.001, in the student sample, the
factor analysis was carried out.3 After successful factorisation
of the 50 DREEM items, there were 10 factors with an
eigenvalue 4 1; after the analysis of the scree plot and
according to expectations, five factors were extracted and
subjected to an orthogonal rotation. In total, the five factors
explained 41.3% of the variance and exhibited a satisfactory

simple structure. However, the five dimensions did not
correspond exactly to the five DREEM subscales
(Appendix 2): we interpreted them as teaching and learning,
self-perception, interpersonal relations, prevailing social
conditions, and a method factor, on which mainly items that
were keyed negatively had high loadings. A factor analysis
could also be carried out in the teacher sample, KMO 0.91,
Bartletts test: 2(1225) 5066.23, p 5 0.001. In analogy to the
situation with students, of the original 13 factors with an
eigenvalue 41, five components were extracted (variance
explanation: 41.4%) and rotated orthogonally. As with the
students, the five factors did not fully correspond with the
expected subscales: we interpreted them as teaching and
academic perception, teachers and atmosphere, social
perception and communication with patients and, as
already the case with the students, a method factor.
Altogether, some of the extracted factors (e.g. self-percep-
tion for the students) represented mixed factors of the original
scales, whereas others (e.g. communication with patients for
the teachers) could not be assigned to any of the original
DREEM subscales.2
Discussion
In this present investigation, a German version of DREEM (Roff
et al. 1997) was subjected to a psychometric validation at item
and test levels in a sample of students and teachers of human
medicine, respectively. We were able to demonstrate con-
vincing psychometric properties at both item and test levels, so
that DREEM is now available in German and can be used to
assess the teaching and learning environments for both
students and teachers. With regard to other published studies
on DREEM, ours involves the as-yet largest investigated
samples.
The item means of DREEM were in a similar range as those
in international studies in which DREEM had previously been
employed (1.503.40; Whittle et al. 2007), whereby the
dispersion among the teachers was somewhat lower than
among the students. Items with a mean 52 indicate regions in
need of improvement (Vieira et al. 2003; Whittle et al. 2007). In
our samples, 20 items for the students and 6 items for the
teachers were in this region.
The low discrimination of the DREEM items 24 (I am able
to memorise all I need) and 48 (My accommodation is
pleasant) for the teachers is most probably related to the fact
that the teachers did not have the necessary information to
answer these questions, so that their responses to these items
were less predictive in regard to the DREEM total score. Item
42 (Cheating is a problem at this university), on the other
hand, had already demonstrated a low discrimination in
another study employing DREEM (Wang et al. 2009).
Analyses of item discrimination have only been reported in
two studies to date. In the above-mentioned work, the item
discrimination indices of 49 items were in an acceptable range
0.270.77, solely the mentioned item 42 exhibited a discrim-
ination index of 50.20 (Wang et al. 2009). Unfortunately, the
authors do not clearly state whether or not they had performed
the necessary part-whole corrections of the discrimination
index; de Oliveira Filho et al. (2005), on the other hand,
Assessing the learning environment of a faculty
reported that the discrimination had been examined, but did
not provide any results of these analyses. The homogeneity of
our items was, above all, in the student sample very good.
The reliability of DREEM was as yet most frequently tested
in the sense of internal consistency by means of Cronbachs .
In the previously published studies, it varied from
 0.900.95 for the entire test and from  0.510.90 for
the five subscales (Mayya & Roff 2004; de Oliveira Filho et al.
2005; OBrien et al. 2008; Lai et al. 2009; Riquelme et al. 2009;
Wang et al. 2009). The retest reliability amounted to rtt 0.43
for the entire test at a retest interval of 6 months for the original
50-item version. In our study, the reliability indices (internal
consistency) in both samples were comparable and very good.
Criterion validation revealed weak relationships between
the evaluation of the teaching and learning climates and the
school leaving grades: students with higher grades assessed
the climate to be somewhat better than did students with lower
grades. In contrast, there were practically no significant
associations between perception of the climate and perfor-
mance in the first state examination. These results are in
contradiction to those of other studies in which students with
good examination results assessed the climate as being better
than did students with poorer examination results (Pimparyon
et al. 2000; Sun 2003; Mayya & Roff 2004). One reason for our
results could be that the learning environment was on the
whole rather negatively evaluated in the present sample and
that the expected relationship between a good learning
environment and good performance would rather develop in
a positive atmosphere. Another reason could be the assess-
ment of performance by means of objective and, above all,
written theoretical measures (first state examination), for
which Carmody et al. (2009) had previously found no
relationship with DREEM in contrast to clinical practical
performance. However, this was not confirmed by other
authors (Pimparyon et al. 2000; Sun 2003; Mayya & Roff 2004).
Further clarification of this situation may be provided by
planned investigation with a further German-speaking sample
in which the environment will be assessed on the whole as
better and/or the grades achieved in the final state examina-
tion will be available, as in this examination, also clinical
practical performance is being tested.
In our study as well, the perceived learning environment is
found to be poorer on average with increasing duration of
studies. Students in the clinical phase of their education,
however, assessed the atmosphere as being better than did
their counterparts in the preclinical stage. Above all, teaching
in the clinic received a poorer assessment. The differences
remained weakened but still significant when age was
partialled out of the correlation between number of semesters
and perception of the learning environment; this has been
investigated for the first time in our analysis of DREEM. Thus, it
can be deduced that the perception of an increasing deteri-
oration of the educational environment is not solely due to the
circumstances of education but also to personal factors such
as, possibly, becoming older and more critical. The initial
enthusiasm in medical education seems for many students to
decrease in the course of studies, also independent of any
concrete bad experiences (Miles & Leinster 2007). These
results agree with those of other investigations in which
e631
T. Rotthoff et al.
DREEM was employed. These have shown both in cross-
section and longitudinally that the perception of the educa-
tional environment becomes poorer in the course of (medical)
education (Till 2004, 2005; Zaini 2005; Bouhaimed et al. 2009;
Riquelme et al. 2009) or at best remains the same (Jiffry et al.
2005; McKendree 2009), and improves only in isolated cases
(Pimparyon et al. 2000).
In agreement with Miles and Leinster (2007), another
interesting result is that students who had already completed
training in another area had a more negative perception of
climate than their counterparts without such experience. The
possibility of drawing (negative or positive) comparisons with
external experiences may possibly affect the impression of the
educational climate in medical studies, leading to higher (or
lower) expectations. These findings might be taken into
account in choosing applicants for medical studies or in
curriculum development, for example by designing areas of
the curriculum suited to the needs of particular groups.
Similar to the experience of Miles and Leinster (2009), our
students perceived themselves to be socially more positive
than they were perceived by their teachers, whereas in
contrast, the teachers evaluated themselves and their teaching
more positively than did the students which could be due to a
mutual self-serving bias (Lewicki 1983). In consequence of the
transformation of the questionnaire in a teachers version, the
question regarding content validity arises, as some of the items
may not be really relevant to teachers or the teachers might not
be in a position to give pertinent responses (e.g., The students
are encouraged to participate in class or The students
seldom feel lonely). In fact, some of our teachers reported
difficulties in answering some of these items which might be
indicative of lacking content validity. On the other hand, items
relating to students self-perception can provide us with
valuable feedback about how well teachers know the reality
of students lives, feelings and sorrows (cf. Miles & Leinster
2009). The fact that in contrast to the study of Miles and
Leinster (2009) our teachers assessed both the atmosphere
and the entire environment significantly more positively than
students did can be interpreted along these lines. Divergent
assessments are indicative of the intensity of exchange and
communication between these two groups. Thus, the explo-
ration and communication of discrepancies allow both groups
to reflect on group immanent self- and other-perception and
thereby create chances for the improvement of the learning
environment, in particular the studentteacher relationship.
The promotion of mentoring programmes (Kalen et al. 2010)
and the implementation of effective feedback (Archer 2010),
for example, could contribute to the formation of a true
community of teachers and students.
In agreement with other studies (Roff et al. 1997; Bassaw
et al. 2003; de Oliveira Filho et al. 2005; Bouhaimed et al.
2009), our data confirm that the educational environment is
assessed more positively by females in comparison to males,
even though the effect is small. Roff (2005) reported in
summary that gender differences in the perception of the
teaching and learning environment depend on numerous
cultural factors and are on the whole smaller when the total
satisfaction is high. In contrast, we have detected significant
but less relevant differences in spite of a rather lower total
e632
satisfaction. Other authors have reported exactly opposing
results (Mayya & Roff 2004), i.e. female students were
significantly less satisfied with the educational environment
than male students in Argentina (Roff et al. 1997, 2001), or no
or only minor gender differences were found (Till 2005; Miles
& Leinster 2007; Carmody et al. 2009). Cultural differences
could be playing a role here. Besides, socio-cultural factors
seem to play a role since students whose mother tongue was
not German perceived the educational climate more positively
according to DREEM. In view of increasing internationalisation
of courses, such findings might also be useful in developing a
curriculum suited to the individual needs of particular groups.
In view of the large number of international studies in
which DREEM was employed, its factorial validity as one facet
of construct validity has previously only been rarely investi-
gated. The five subscales described above are based on an
explorative factor analysis by Roff et al. (1997) of an
Argentinean precursor of DREEM with 58 items. Replications
of the five-factorial structure were only partially successful: not
only de Oliveira Filho et al. (2005) but also Wang et al. (2009)
reported that, although they also found five factors by means
of explorative analysis of the 50 DREEM items, these were not
absolutely identical with the original five factors. Finally,
OBrien et al. (2008) also found five DREEM factors, although
their results cannot be directly compared with the above-
mentioned results since the shortened 32-item version of
DREEM was used.
In this study, we also could not unambiguously identify the
five subscales postulated by the authors. In our investigation,
both in the student and the teacher samples, there was one
factor that is to be considered as a methodological artefact on
which mainly negatively keyed items loaded highly. Such
effects occur frequently when a questionnaire contains both
positively and negatively keyed items (Paulhus 1984; Paulhus
& Reid 1991) and often can only be avoided by one of the
following means: (1) exclusive use of positively keyed items
and (2) balanced use of equal numbers of positively and
negatively keyed items per scale/factor. The first solution
option can be criticised in that it makes a questionnaire
susceptible to acquiescence effects, i.e. when for all items, a
yes or I agree answer is associated with a high manifes-
tation of the characteristic in question or general agreement,
after a certain time, the participants answer more and more
frequently and automatically with yes or I agree (Hinz
et al. 2007). On the other hand, the second solution can only
be realised when one constructs the questionnaire oneself and
not  as is the case in this investigation with DREEM  when
one translates the original into another language.
Because a direct comparison with the two other studies
(de Oliveira Filho et al. 2005; Wang et al. 2009) in which the
five factors could also not be replicated is not possible due to
insufficient details, it is not at present reasonable or it would be
premature to discard the five original scales. Instead, future
research efforts should be directed at verifying the factor
structure in various languages and cultural environments.
With convincing psychometric properties at item and test
levels, the suitability of DREEM not only for students but also
for teachers to assess the educational environment has been
demonstrated and it is now available in German for

both groups. Both questionnaires provide the foundation for
defining future improvements for faculty development.
Repeated measurements will enable the assessment of prog-
ress in improving the learning environment. In future German
and international investigations, a further-reaching psycho-
metric validation of the questionnaire such as, e.g. an
investigation of the factorial structure of DREEM, the relation-
ship between the perception of climate by means of DREEM
and academic performance and its retest reliability with use of
an adequate retest interval would be of interest.
Declaration of interest: The authors have no conflicts of
interests with respect to their authorship or the potential
publication of this article. We did not receive financial support
for the research and/or the authorship of this article.
Notes on contributors
THOMAS ROTTHOFF, Dr. med., MME, is a senior physician for internal
medicine. He is head of the clinical skills centre and speaker of the
curriculum development group.
MARTIN S. OSTAPCZUK, Dr. rer. nat., is a psychologist and researcher at
the Institute of Experimental Psychology. He is also a medical student.
JUDITH DE BRUIN, Dr. phil. is a psychologist and head of the evaluation
programme at the Medical Faculty.
ULRICH DECKING, Prof. Dr. med., is a associate professor in physiology
and deputy dean of study for the preclinical part.
MATTHIAS SCHNEIDER, Prof. Dr. med, is head of the rheumatology
sector. He is the deputy dean of study for the clinical part.
STEFANIE RITZ-TIMME, Prof. Dr. med, is head of the institute for forensic
medicine. She is the dean of study at medical faculty.
Notes
1. Item discrimination is determined by correlating the sum of
the respective item score (i) with the total score consisting of
the sum of all item scores (t). The resulting correlation
coefficient (rit ), however, is spuriously high, because the item
whose discrimination is to be determined is also part of the
total sum. The fewer items a test contains, the larger the
resulting bias when calculating item discrimination. To obtain
an unbiased item discrimination coefficient, one therefore
must correlate the respective item score (e.g. item 30) with the
total score minus the contribution of the item in question (i.e.
total score based on the sum of items 129, without item 30).
The resulting coefficient is called a part-whole-corrected item
discrimination coefficient (cf. Davis 1958).
2. The loading matrix for the factor analysis of the DREEM
items in the teacher sample is available on request from the
authors.
3. A KMO value 40.60 or even better 40.75 (Kaiser 1970,
1974) as well as a significant Bartletts (1954) test show that the
variables correlate highly enough with each other to be able to
perform a meaningful factor analysis.
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 Assessing the learning environment of a faculty

Appendices

Appendix 1. Teachers version of the questionnaire.

Subscale Item
Perception of teaching 1 The students are encouraged to participate in class
2 The teaching is sufficiently concerned to develop the students confidence
3 The teaching encourages the students to be an active learner
4 The teaching is well focused
5 The teaching is sufficiently concerned to develop the students competence
6 The students are clear about the learning objectives of the course
7 The teaching is often stimulating
8 The teaching time is put to good use
9 The teaching is student centred
10 Long-term learning is emphasised over short term
11 The teaching is too teacher-centred
12 The teaching over-emphasises factual learning
Perception of teachers 13 The teachers are good at providing feedback to students
14 The teachers have good communications skills with patients
15 The teachers are knowledgeable
16 The teachers give clear examples
17 The teachers are well prepared for their classes
18 The teachers provide constructive criticism here
19 The teachers ridicule the students
20 The teachers get angry in class
21 The teachers are authoritarian
22 The teachers are patient with patients
23 The students irritate the teachers
Academic self-perception 24 The students are able to memorise all they need
25 Much of what the students have to learn seems relevant to a career in medicine
26 The students feel being well prepared for their future profession
27 For the students, last years work has been a good preparation for this years work
28 The students problem-solving skills are being well developed here
29 The students are confident about passing this year
30 The students have learned a lot about empathy in their future profession
31 Learning strategies which worked for the students before continue to work for them now
Perception of atmosphere 32 The atmosphere is relaxed during lectures
33 The students feel able to ask the questions they want
34 The students feel comfortable in class socially
35 There are opportunities for the students to develop interpersonal skills
36 The enjoyment outweighs the stress of studying medicine
37 The atmosphere motivates the students as a learner
38 The students are able to concentrate well
39 The atmosphere is relaxed during ward teaching
40 This school is well timetabled
41 The students find the experience disappointing
42 Cheating is a problem in this school
43 The atmosphere is relaxed during seminars/tutorials
Social self-perception 44 The students have good friends in this school
45 There is a good support system for students who get stressed
46 The students are too tired to enjoy this course
47 The students are rarely bored on this course
48 The students accommodations are pleasant
49 The students social life is good
50 The students seldom feel lonely

Note: For the preparation of the teachers version of the questionnaire, items formulated in the I form in the original DREEM, were adapted for the teachers
according to the procedure of Miles and Leinster (2009).

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Appendix 2. Factor analytic loadings of DREEM items in the student sample.

V Prevailing
I Teaching II III Inter-personal IV Method social
Item and learning Self-perception relations factor conditions
26 I feel I am being well prepared for my profession 0.72
4 The teaching is well focused 0.67
9 The teaching is student centred 0.65
3 The teaching encourages me to be an active learner 0.65
7 The teaching is often stimulating 0.64
8 The teaching time is put to good use 0.61
37 The atmosphere motivates me as a learner 0.61 0.35
17 The teachers are well prepared for their classes 0.61 0.37
40 This school is well timetabled 0.60
27 Last years work has been a good preparation for this years 0.60
work
5 The teaching is sufficiently concerned to develop my 0.59
competence
2 The teaching is sufficiently concerned to develop my 0.52 0.37
confidence.
6 I am clear about the learning objectives of the course 0.52
28 My problem-solving skills are being well developed here 0.51 0.45
13 The teachers are good at providing feedback to students 0.46 0.46
10 Long-term learning is emphasized over short term 0.46
16 The teachers give clear examples 0.45
25 Much of what I have to learn seems relevant to a career in 0.44
medicine
47 I am rarely bored on this course 0.43 0.35
45 There is a good support system for students who get 0.39
stressed
1 I am encouraged to participate in class 0.39 0.37
38 I am able to concentrate well 0.64
50 I seldom feel lonely 0.63
49 My social life is good 0.60
36 The enjoyment outweighs the stress of studying medicine 0.57 0.33
29 I am confident about passing this year 0.56
31 Learning strategies which worked for me before continue to 0.51
work for me now
24 I am able to memorise all I need 0.48
46 I am too tired to enjoy this course 0.48 0.47
44 I have good friends in this school 0.47 0.39
34 I feel comfortable in class socially 0.46 0.32
48 My accomodation is pleasant 0.43 0.39
30 I have learned a lot about empathy in my profession 0.62
39 The atmosphere is relaxed during ward teaching 0.55
22 The teachers are patient with patients 0.54
35 There are opportunities for me to develop interpersonal skills 0.53
18 The teachers provide constructive criticism here 0.39 0.50
14 The teachers have good communications skills with patients 0.30 0.47
43 The atmosphere is relaxed during seminars/tutorials 0.35 0.42 0.35
33 I feel able to ask the questions I want 0.40
19 The teachers ridicule the students 0.65
20 The teachers get angry in class 0.59 0.36
21 The teachers are authoritarian 0.59
11 The teaching is too teacher-centred 0.51
12 The teaching over-emphasizes factual learning 0.49
41 I find the experience disappointing 0.33 0.46
23 The students irritate the teachers 0.35
15 The teachers are knowledgeable 0.37 0.49
32 The atmosphere is relaxed during lectures 0.37 0.39
42 Cheating is a problem in this school 0.31

Note: Loadings 5 0.30 are suppressed for reasons of clarity. The items in italics are keyed negatively.

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