The medical educational environment has been studied extensively in the past decades

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Running head: Key elements in assessing the educational environment
Title: Key elements in assessing the educational environment: Where is the theory?

J. Schönrock-Adema, T. Bouwkamp-Timmer, E.A. van Hell, J. Cohen-Schotanus

Center for Research and Innovation in Medical Education, University of Groningen and University Medical Center Groningen, The Netherlands


Johanna Schönrock-Adema,

University Medical Center Groningen, University of Groningen

Center for Research and Innovation in Medical Education,

Antonius Deusinglaan 1,

9713 AV Groningen, The Netherlands

Tel: +31 50 363 8378; Fax +31 50 363 7390



The educational environment has been increasingly acknowledged as vital for high-quality medical education. As a result, several instruments have been developed to measure medical educational environment quality. However, there appears to be no consensus about which concepts should be measured. The absence of a theoretical framework may explain this lack of consensus. Therefore, we aimed to 1) find a comprehensive theoretical framework defining the essential concepts, and 2) test its applicability. An initial review of the medical educational environment literature indicated that such frameworks are lacking. Therefore, we chose an alternative approach to lead us to relevant frameworks from outside the medical educational field; That is, we applied a snowballing technique to find educational environment instruments used to build the contents of the medical ones and investigated their theoretical underpinnings (Study 1). We found two frameworks, one of which was described as incomplete and one of which defines three domains as the key elements of human environments (personal development/goal direction, relationships, and system maintenance and system change) and has been validated in different contexts. To test its applicability, we investigated whether the items of 9 medical educational environment instruments could be mapped unto the framework (Study 2). Of 374 items, 94% could: 256 (68%) pertained to a single domain, 94(25%) to more than one domain. In our context, these domains were found to concern goal orientation, relationships and organization/regulation. We conclude that this framework is applicable and comprehensive, and recommend using it as theoretical underpinning for medical educational environment measures.

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