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

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Participants and procedure

Nine researchers of medical education participated in this study. Each of them worked at a medical educational department and they were all involved in curriculum development, teaching, and research of education. They independently ascertained whether the items corresponded with Moos’ theoretical framework. The instruction was to indicate to which of the three domains each item was most applicable. When an item was not considered apt for measuring any of these domains, the participants could check a box “none of them”. If at least 6 participants assigned an item to the same domain, we considered the overtone of the item clear and allocated the item to that domain.

About 94% of the items related to Moos’ framework. Of the total number of 374 items, 256 (68%) were allocated to one single domain, 94 (25%) matched with more than one domain and 24 (6%) could not be mapped into it either because they did not clearly pertain to environment or because the purposes of the items in question were unclear to the raters. Examples of items allocated to one single domain are “I feel I am being well prepared for my profession” and “I am encouraged to develop autonomy in my work here”. These items were assigned to the goal direction domain and pertain to the contents and aims of education. Examples of items assigned to the relationship domain are “I feel part of the team”, “I feel comfortable discussing problems in this job”, and “there is a sense of cooperation and mutual respect in the department”. These items all relate to a friendly atmosphere. Examples of the system maintenance and system change domain are: “there is a clearly defined pathway to address problems”, “I have protected educational time in this post”, and “my workload in this job is fine”. These items concern organizational or regulative aspects of the environment.
An example of an item that related to more than one domain is ‘I have opportunities to acquire the skills appropriate to my level of learning. This item concerns the first domain (the aim of education) as well as the third (the organization in terms of offering enough opportunities) and, hence, could not clearly be allocated to one single domain. Accordingly, half of the raters assigned this item to the first domain and the other half assigned it to the third domain.
An example of the items that could not be classified at all is ‘I am too tired to enjoy the course’. The cause of the tiredness mentioned in this item may lie outside the educational environment. Therefore, this item does not clearly pertain to educational environment.

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