Memorable learning experience, impact of school on life, and perception of clinical learning environment amongst nursing and medical students
Authors: Ezeme Constantine , Soneye Oluwafunmilayo , Akinbami Nurudeen , Ugwu Ebere , Olagunju Naomi , Amusat Olanrewaju , Jesse Tanko , Ogundipe Habeeb , Abayomi Olukayode , Onah Kenneth , Ekwuazi Hyginus , Akachuku Hari , Farinre Olumide , Adeyemo Moshood , Owoaje Eme , Adedeji Olufunso A. 
Published: December 2023

Background: The learning environment impacts students’ motivation,success, and fulfilment, and central to this is the psychological safety ofstudents. Psychologically safe environments lead to collaboration, positivelearning experiences, and effective practitioners.Objectives: The study aimed to assess the perception of the clinicallearning environments of medical and nursing students at the Collegeof Medicine, University of Ibadan, Ibadan, Nigeria.
Methods: This was a cross-sectional study carried out in November, 2021using the validated questionnaires – Dundee Ready Education Measure(DREEM) and the John Hopkins Learning Environment Scale (JHLES)as well as two open-ended questions (OEQs). The OEQs were ‘tell usabout a memorable learning experience in medical/nursing school’ (MLE)and ‘what impact has your time in medical/nursing school had on yourlife’ (IoL). Data were collected from third to sixth-year clinical medical,and first to third-year nursing students and analysed using SPSS v23. Forthe OEQs, an inductive approach was used for manual coding and thematicanalysis. Coding and themes were both semantic and interpretiveand data were managed using NVIVO v14 software. The responses to theOEQs were graded on a Likert scale from 1 (very negative) to 5 (verypositive).
Results: A total of 193 students completed the validated questionnaireswith a mean age of 22 (±2.58) years. The mean total DREEM score was111/200 (±10.2), interpreted as more positive than negative. However, theperceptions were more negative than positive in two of the five DREEMdomains – perception of the atmosphere and social self-perception. Themean overall JHLES score was 91/140 (±14.8), also more positive thannegative, and this was so for all its seven domains. Nursing students hadbetter academic self-perception than medical students (P = 0.002) whilemedical students had better perception of their learning atmosphere(P = 0.021).Seventy-five students (39%) answered one or both OEQs, with 57(29%) answering the memorable learning experience (MLE) and 59(30%), the impact of medical/nursing school on life (IoL) question.Sixteen and twenty-two percent of answers to MLE and IoLquestions were negative. No students gave negative answers to bothOEQs. Overall, 29% of students gave a negative response to onequestion.
The overall themes for memorable learning experience questions were:1. Novelty2. Enhancing experiences – ‘That teaching method made me feel seen asa student and got me excited to solve problems’, by a 4th year medicalstudent3. Learning environment atmosphere – ‘I was impressed by the way hewas able to change the atmosphere from a very tense one to a funnyand calm one’4. Psychological effects.
For the impact on life questions, the overall themes were as follows:1. Personal development – this included appreciation of hard work,motivation to be better people, purpose and direction in life, social andintellectual development.2. Aspirational3. Psychological – ‘it made me see that broken people break people’
Conclusion: Whatever the positive benefits of being a student are, psychologicallyunsafe environments, even for the very few, lead to negative psychologicalsequelae, poor overall learning process and health practitionersill-prepared for the future. Despite the overall positive picture of the clinicallearning environment in this study, there are significant areas of students’welfare that need to be addressed. It has been shown that a formalpedagogic programme for clinicians to improve the quality of their studentcentred teaching (1).Reference1. Poon H, Ahmad MF, Lowry D, et al. Two-year longitudinal observationstudy of junior doctors as clinical teachers: the Associated ClinicalTeaching Fellow Program. J Glob Med 2021; 1(2): e43. doi: 10.51496/jogm.v1.43