Doctors, professionals who are very important resources for a national healthcare system, provide a myriad of medical services to people for the public health and welfare [
Legally, Korea has two distinct and equivalent healthcare systems based on either conventional Western medicine or Korean medicine. To avoid possible confusion in mentioning them, in this paper, we will express system associated with Korean medicine as traditional Korean medicine (TKM), although the official name recognized by the Ministry of Health and Welfare in Korea is just “Korean medicine.”
Regarding TKM, the Institute of Korean Medicine Education and Evaluation (IKMEE) was established in 2004; it has taken charge of evaluating TKM colleges. However, there is no academic society specializing in TKM education but just one department specializing in TKM education at the Pusan National University School of Korean Medicine. Accordingly, the academic and institutional approaches toward TKM education have been very poor compared to those of the conventional Western medical community. Although many studies have reported the importance of the educational environment in medical schools for academic motivation, educational satisfaction, academic achievement, and so on [
DREEM is a scale for measuring perceptions regarding the education of students majoring in medical-related departments. It was developed in 1997 using a Delphi method for assessing various medical educational institutions throughout the world, based on the Medical Educational Environment Measure (MEEM), Postgraduate Hospital Educational Environment Measure (PHEEM), Surgical Theatre Educational Environment Measure (STEEM), and Anaesthetic Theatre Educational Environment Measure (ATEEM). Also, its validity and reliability were confirmed properly [
In Korea, the TKM educational curriculum requires six years to complete. During the first two years, students take general liberal arts courses and attend a few basic Western medical and TKM lectures. Over the next 4 years, they receive professional training in general biomedicine, basic science, conventional medicine, and TKM. Therefore, we conducted this study to target students during this four-year professional training period at a designated TKM college. The survey was conducted over 10 days in June, the latter part of the first semester. One author of this paper, who is also a TKM student, explained protection of anonymity of individual information to all students before the survey. Proper rewards were given to all respondents for their authentic answers.
Roff et al. [
The developers of DREEM suggested interpretation criteria for the total score, subscale scores, and individual scores for each item [
An approximate guide to interpret the DREEM scores [
| |
Total score | |
0–50 | Very poor |
51–100 | Significant problem |
101–150 | More positive than negative |
151–200 | Excellent |
Individual item | |
≤2 | Problem areas |
2-3 | Could be enhanced |
≥3.5 | Real positive points |
| |
SPL | |
0–12 | Very poor |
12–25 | Negatively viewed teaching |
25–37 | A more positive perception |
37–48 | Teaching highly regarded |
SAS | |
0–8 | Feelings of total failure |
9–16 | Many negative aspects |
17–24 | Feeling more on the positive side |
25–32 | Confident |
SSS | |
0–7 | Miserable |
8–14 | Not a nice place |
15–21 | Not too bad |
22–28 | Very good socially |
SPT | |
0–11 | Very poor |
12–22 | Negatively viewed teaching |
23–33 | A more positive perception |
34–44 | Teaching highly regarded |
SPA | |
0–12 | Very poor environment |
13–24 | Many issues need changing |
25–36 | A more positive attitude |
37–48 | A good overall feeling |
DREEM: Dundee Ready Educational Environment Measure.
SPL: students’ perceptions of learning; SPT: students’ perceptions of teachers; SAS: students’ academic self-perceptions; SPA: students’ perceptions of atmosphere; SSS: students’ social self-perceptions.
In this study, we used the Korean version of DREEM developed in 2015 [
Basic descriptive statistics were analyzed, and the
Totally, 325 (205 males, 118 females, and two respondents who did not report their gender) of all 358 students responded to the survey. Gender, mean grade score data from the previous semester, and the current school years were also acquired for subgroup analysis (Table
Basic characteristics of respondents (
Characteristics | Frequency (%) |
---|---|
Gender | |
Male | 205 (63.1) |
Female | 118 (36.3) |
No reply | 2 (0.6) |
Year in school | |
First | 74 (22.8) |
Second | 89 (27.4) |
Third | 80 (24.6) |
Fourth | 82 (25.2) |
Grade score | |
4.0≤ | 31 (9.5) |
3.0≤ and <4.0 | 172 (52.9) |
2.0≤ and <3.0 | 105 (32.3) |
No reply | 17 (5.2) |
The mean of overall scores was 94.65 out of 200. The SPL score was 20.20; SPT, 23.03; SAS, 16.16; SPA, 21.70; and SSS, 13.57. According to the interpretation criteria in Roff’s guideline, 9 out of 12 SPL items, 5 out of 11 SPT items, 4 out of 8 SAS items, 7 out of 12 SPA items, and 5 out of 7 SSS items were identified as problem areas. In total, 30 out of 50 items were identified as problematic (Table
Total results of DREEM survey (
Subscales of DREEM (number of items) | Max | Min | Mean | SD | Number of problematic items |
---|---|---|---|---|---|
SPL (12) | 44 | 4 | 20.20 | 6.51 | 9 |
SPT (11) | 38 | 9 | 23.03 | 4.67 | 5 |
SAS (8) | 32 | 3 | 16.16 | 4.54 | 4 |
SPA (12) | 38 | 4 | 21.70 | 5.30 | 7 |
SSS (7) | 23 | 3 | 13.57 | 3.27 | 5 |
| |||||
Total 50 items | 175 | 36 | 94.65 | 20.09 | 30 |
All responses were acquired using Likert scale (0–4).
DREEM: Dundee Ready Educational Environment Measure.
SD: standard deviation.
SPL: students’ perceptions of learning; SPT: students’ perceptions of teachers; SAS: students’ academic self-perceptions; SPA: students’ perceptions of atmosphere; SSS: students’ social self-perceptions.
The mean scores for the male group and female group were 95.22 and 93.69, respectively. The mean for male group was higher even though there was no significant difference. Mean scores of SAS, SPA, and SSS were slightly higher for the male group, but there were no statistically significant differences differentiating them from the mean scores for the female group (Table
DREEM score according to gender.
Subscales | Male | Female | | |
---|---|---|---|---|
SPL | 20.19 (7.16) | 20.25 (5.26) | −0.10 | 0.92 |
SPT | 22.79 (4.86) | 23.47 (4.36) | −1.25 | 0.21 |
SAS | 16.42 (4.98) | 15.64 (3.63) | 1.61 | 0.11 |
SPA | 22.06 (5.68) | 21.07 (4.57) | 1.61 | 0.11 |
SSS | 13.76 (3.44) | 13.25 (2.93) | 1.40 | 0.16 |
| ||||
Total DREEM score | 95.22 (21.98) | 93.69 (16.51) | 0.71 | 0.48 |
DREEM: Dundee Ready Educational Environment Measure.
Statistics are expressed as mean (standard deviation).
Comparisons of total and subtotal means are expressed in Table
DREEM score according to years in school.
School years | ||||
---|---|---|---|---|
Freshman | Sophomore | Junior | Senior | |
SPL | 21.54 (6.36) | 20.65 (6.99) | 21.11 (5.93) | 17.61 (6.03) |
SPT | 23.86 (4.15) | 21.46 (4.72) | 24.95 (4.41) | 22.12 (4.57) |
SAS | 16.91 (4.32) | 15.82 (4.81) | 16.42 (4.14) | 15.58 (4.76) |
SPA | 23.72 (4.88) | 20.71 (5.57) | 22.22 (4.74) | 20.44 (5.35) |
SSS | 14.36 (2.95) | 13.08 (3.55) | 13.32 (3.09) | 13.61 (3.30) |
| ||||
Total DREEM score | 100.39 (18.87) | 91.73 (21.73) | 98.02 (18.61) | 89.36 (19.07) |
DREEM: Dundee Ready Educational Environment Measure.
Statistics are expressed as mean (standard deviation).
DREEM score according to academic achievement.
Grade scores of the previous semester (academic achievement) | |||
---|---|---|---|
Low score | Middle score | High score | |
2.0≤ and <3.0 | 3.0≤ and <4.0 | 4.0≤ | |
SPL | 18.49 (6.78) | 20.73 (6.04) | 22.01 (7.25) |
SPT | 21.93 (5.18) | 23.46 (4.14) | 23.68 (5.30) |
SAS | 14.30 (4.39) | 17.05 (4.24) | 17.35 (5.29) |
SPA | 20.36 (5.28) | 22.28 (5.22) | 22.06 (5.40) |
SSS | 12.53 (3.21) | 13.98 (3.15) | 14.26 (3.78) |
| |||
Total DREEM score | 87.61 (20.50) | 97.50 (18.32) | 99.36 (23.43) |
DREEM: Dundee Ready Educational Environment Measure.
Statistics are expressed as mean (standard deviation).
We investigated students’ perceptions regarding their educational environments with a DREEM survey questionnaire. The total DREEM score of 94.65 out of 200 was quite low compared to studies reported from other countries: European studies usually showed scores from 130 to 153, and some universities in Greece and Germany showed scores from 100 to 110. Asian countries including India, Sri Lanka, Nepal, and Turkey and other mid-eastern countries usually showed scores from 100 to 110, and some other universities showed scores of 130 [
According to the interpretation criteria in Table
We examined items with mean scores of 1.5 or less on each subscale. Regarding the SPL subscale, item 13
In addition, we compared groups according to gender (Table
For total DREEM scores and subscale scores, freshmen and juniors had higher mean scores than sophomores and seniors resulting from low SPL, SPT, and SPA scores of seniors and low SPT and SPA scores of sophomores. These findings are different from the previous results of Kohli and Dhaliwal [
In comparing DREEM scores for academic achievement, our result is consistent with that of Park et al. [
The most important thing in this study interpretation is the following: what we investigated in this study was not the quality of TKM education, but the students’ perception in view of education consumers. Of course, students’ perceptions are very important in evaluating the quality of education, but in the quality evaluation one should consider other factors such as educational purposes, screening systems, teaching methods, evaluation methods, and curricula.
In this study, we used the Korean version of DREEM [
In this study, we examined students’ perceptions regarding TKM education at a TKM college using a DREEM questionnaire for which validity and reliability were verified. Using the quantitative indicators of DREEM, we could perform statistical comparisons and an objective evaluation to diagnose actual educational conditions. In comparison with conventional Western medical education in Korea and other countries, students’ perceptions regarding TKM education were relatively poor. To verify causes or trends more clearly, longitudinal studies of a cohort should be considered. We expect DREEM to be used widely in TKM or traditional medical education field throughout the world to evaluate and improve the educational conditions.
The authors declare that they have no competing interests.
Hyunho Kim and Hanyoung Jeong are co-first authors and contributed to this paper equally. Hyunho Kim and Hanyoung Jeong designed the study, performed statistical analysis, and drafted the manuscript. Pyeongjin Jeon and Seungju Kim carried out the survey research and supported data analysis. Young-Bae Park contributed to this study discussion and preparation of the paper. Yeonseok Kang contributed to study design, discussion, and preparation of the draft manuscript.
This work was supported by 2014 Research Grant of Wonkwang University.