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


Keywords educational environment; instrument development; learning environment; medical education; theoretical framework Introduction



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Keywords educational environment; instrument development; learning environment; medical education; theoretical framework

Introduction
The educational environment has been increasingly acknowledged as vital for high-quality medical education (Roff, 2005; WFME/AMSE, 2007; WFME, 2003; Genn, 2001a, b). Important components of the educational environment include atmosphere, number of (formal) learning opportunities and available facilities. The value of the educational environment for the quality of education is underpinned by research outcomes, showing that students’ perceptions of the educational environment quality influence their involvement, satisfaction and success (De Young, 1977; Haertel et al., 1981; Karagiannopoulou & Christodoulides, 2005; Müller & Louw, 2004). For example, a positive educational environment is a necessary condition to motivate student learning (Kirkpatrick, 1996; Müller & Louw, 2004). In medical education, the growing acknowledgement that a positive environment contributes to the quality of education has stimulated the development of several educational environment instruments (Roff et al., 1997; Bloomfield & Subramaniam, 2008; Cassar, 2004; Holt & Roff, 2004; Mulrooney, 2005; Roff et al., 2005; Rotem et al., 1995).

Examination of recent medical educational environment instruments reveals that there are many differences between them. These differences are in part attributable to the fact that the instruments are often tailored to a specific setting of interest (Bloomfield & Subramaniam, 2008; Cassar, 2004; Holt & Roff, 2004; Mulrooney, 2005; Roff et al., 2005; Rotem et al., 1996). However, even though differences between settings may call for some tailoring of instrument content (Holt & Roff, 2004; Patel & Dauphinee, 1985), the array of differences is not restricted to item formulation: it also concerns instrument structure (i.e. the organization of items in scales) and scale names. From these differences, we gather that up till now there is no consensus about which concepts should be measured to ascertain the quality of the medical educational environment adequately.

From the publications on the development processes of the medical educational environment instruments, we noticed that the majority of them were not based on theory. The absence of a theoretical framework may explain the differences regarding the concepts measured. Having such a framework might help us to construct instruments that cover the entire educational environment and measure the essential concepts. As a result, educational environment quality might be measured more adequately. Therefore, the aims of this study were 1) to find a comprehensive theoretical framework that outlines the key concepts that should be measured to ascertain the quality of the educational environment, and 2) to test the applicability of this framework. We hoped such a framework would help us to answer two important questions. First, which concepts should be measured? Second, do medical educational environment instruments measure these essential concepts?

Based on our observation that the majority of the medical educational environment instruments were not founded on a theoretical framework and given the value and importance that is increasingly attached to the use and explicit formulation of a theoretical framework (Prideaux & Bligh, 2002; Eva, 2008; Eva & Lingard, 2008; Bordage, 2009), we wondered whether there are any theoretical frameworks that specify which elements of the medical educational environment should be measured to obtain an adequate and complete picture of its quality. Therefore, we originally conducted a systematic review of the literature to find theoretical frameworks that define which key concepts should be measured to ascertain the quality of the medical educational environment. However, our search of medical education databases and of educational and psychological databases did not yield any generally accepted theoretical frameworks. In a further attempt to find a theoretical framework, we chose a different approach to lead us to relevant frameworks from outside the medical field: using a snowballing technique (Teunissen & Westerman, 2011), we tried to ascertain which educational environment instruments were used to build the contents of the medical ones. We then explored the descriptions of the developments of these underlying instruments to find out which theoretical frameworks, if any, were used to build the contents of these instruments (Study 1). To test the applicability of potentially relevant theoretical frameworks for medical education, we investigated whether the contents of available medical educational environment instruments corresponded with the framework (Study 2). The methods and results sections of each study are described ‘en bloc’.





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