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



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Data Sources and selection of instruments

Our search plan included electronic and hand searching. We systematically searched 7 databases for relevant publications describing the development of medical educational environment instruments: Academic Search Premier, CINAHL, EMBASE, ERIC, MEDLINE, PsycARTICLES and PsycINFO. The search was performed in May 2011. The keywords used were



  1. develop*, construct*, devis*, devic* or design* in title or in abstract;

  2. survey, test, scale, measure, instrument, inventory or questionnaire in title or abstract;

  3. ‘learning environment’ or ‘education* environment’ in title or abstract; and

  4. ‘medical education’, ‘medical school’ or ‘medical training’ in text.

We limited our searches to publications in English. The first author performed the literature search.


We included studies that were readily accessible through the library or via internet, or that could be obtained through personal contact, if they met the following inclusion criteria:

a) the principal aim of the study was to develop an instrument



  1. for medical education

  2. measuring the educational environment.

We excluded



  1. studies in which the development of an educational environment instrument only implied abbreviating an existing instrument;

  2. studies focusing on educational settings other than the medical education setting, for example nursing or dentistry;

  3. (narrow) studies focusing on specific aspects of the educational environment;

  4. (extensive) studies in which the educational environment was not the main focus of the instrument constructed;

  5. paper and poster abstracts, proceedings of conferences, dissertation abstracts, editorials and letters.

Two authors decided on the basis of title and abstract whether the inclusion criteria were met. They discarded irrelevant citations and evaluated the full text articles of the remaining citations for eligibility. Disagreements and uncertainties were resolved by consulting the other authors. We supplemented our search with relevant publications from the reference lists of publications identified as eligible. To ensure that our search was comprehensive at the time that we submitted our manuscript, we supplemented our electronic search with a manual search of four leading medical education journals: Medical Education, Academic Medicine, Advances in Health Sciences Education and Medical Teacher. We scanned the tables of contents in the issues from January through December 2011 and inspected early online releases. Conform our electronic search, we checked the abstracts of potentially relevant articles and – upon inclusion – we also checked their reference lists.






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