It takes two to tango : an inquiry into healthcare professional education environments

Investigations into healthcare professional education environments have been increasingly acknowledged and it is widely recognized that the environment is an important determinant of educational outcomes and educational stakeholders’ behavior and sense of well-being. However, the phenomenon of the educational environment constitutes a somewhat vague construct with a multitude of connotations, and exploring the environment can be intricate because of the various settings in healthcare professional education. Moreover, some professional groups have been investigated less than others, and there is a scarcity of perspectives from specific stakeholders.

The overall aim of this thesis was to provide a deeper understanding of the phenomenon of the educational environment in healthcare professional education. More specifically, to explore what constitutes educational environments and what it means in the context of chiropractic and physiotherapy undergraduate education from the perspective of students and teachers. A mixed methods multiple case study approach with a multi-lens focus anchored in a pragmatic stance was embraced, thus employing quantitative descriptive surveys using a well-established instrument, the Dundee Ready Educational Environment Measure (DREEM), and a psychometric investigation using a non-parametric approach of item response theory. In-depth qualitative explorations using focus groups with students and semi-structured individual interviews with teachers was also executed.

In Studies I and II, students’ perceptions of the environment were introspected. Study I revealed that physiotherapy students perceived a very good overall environment. Students in terms 1 and 2 were most positive and term 4 most negative. Two DREEM items stood out: teaching overemphasizing factual learning and authoritarian teachers. In Study II, chiropractic students perceived an excellent overall environment at two time points (2009 and 2012). Year 1 students were most positive at both time points, and years 3 and 4 students were most negative in 2009 and 2012, respectively. Students’ perceptions about teachers decreased between the two time points. Three DREEM items stood out in 2009, 2012, and also in a longitudinal sample of students: teaching overemphasizing factual learning, authoritarian teachers, and limited support for stressed students. There were tendencies of a more positive perception about different aspects of the environment among the longitudinally surveyed students.

Study III examined the DREEM’s psychometric properties. The findings could not support the a priori subscale construction of the instrument (subpar scalability coefficients), and reversely worded items proved most problematic. Study IV explored chiropractic students’ experiences of the meaning of their educational environment. The findings indicated a sense of a changing environment, with five themes emerging: Being part of a community; Scaffolding relationships; Personal growth; A place of meaningfulness, and Trust in a regulated system. Study V explored and contrasted chiropractic and physiotherapy teachers’ experiences and conceptualizations of the meaning of the educational environment. Contextual differences were uncovered between the two groups of teachers as well as five communal conceptualizations of the educational environment: Physical, Organizational, Relational, Communicational, and Pedagogical.

Conclusively, this thesis argues that the educational environment is not an all-encompassing, solitary, and static phenomenon but, rather, a more complex, less fixed and measurable phenomenon than previously thought – a multilayered and multidimensional phenomenon in a relentless state of flux and a product of the contextual climate and culture.

List of scientific papers

I. Palmgren PJ, Lindquist I, Sundberg T, Nilsson GH and Bolander Laksov K. Exploring perceptions of the educational environment among undergraduate physiotherapy students. International Journal of Medical Education. 2014;5:135-146.
https://doi.org/10.5116/ijme.53a5.7457

II. Palmgren PJ, Sundberg T and Bolander Laksov K. Reassessing the educational environment among undergraduate students in a chiropractic training institution – A study over time. Journal of Chiropractic Education. 2015;29:110-126.
https://doi.org/10.7899/JCE-14-37

III. Palmgren PJ, Brodin U, Nilsson GH, Watson R and Bolander Laksov K. The psychometric properties and dimensional structure of the Dundee Ready Educational Environment Measure – A Mokken Scale Analysis. [Submitted]

IV. Palmgren PJ and Bolander Laksov K. Exploring chiropractic students’ experiences of the educational environment in healthcare professional training: a qualitative study. BMC Medical Education. 2015;15:128.
https://doi.org/10.1186/s12909-015-0417-z

V. Palmgren PJ, Liljedahl M, Lindquist I and Bolander Laksov K. Chiropractic and physiotherapy teachers’ experiences and conceptualizations of the educational environment – a qualitative exploration. [Manuscript]