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

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We would like to thank Prof Yvonne Steinert for her useful suggestions to improve our study and the researchers who participated in Study 2. In addition, we would like to thank the authors of medical educational environment instruments who provided additional information.

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Figure 1 Flowchart of Search and Selection Strategy

Academic Search Premier







255 duplicates removed

579 records identified through database searching

15 records identified as potentially relevant; full-text articles assessed for eligibility

309 records discarded on the basis of titles and abstracts

10 studies included in review

6 full-text articles excluded

1 additional article from reference lists of studies included in review

11 studies examined

324 records retained and screened

9 studies included in review

1 additional, relevant article – found through manual search – included in review

Table 1 Brief summaries of medical educational environment instruments included in review




of items

Scales (N items)

Bloomfield & Subramaniam, 2008

DR-CLE questionnaire – Diagnostic Radiology Clinical Learning Environment Questionnaire


  1. Supervision (6)

  2. Social atmosphere (6)

  3. Work-based learning (6)

  4. Formal training programmes (3)

  5. Workload (3)

Boor, Van der Vleuten, Teunissen, Scherpbier & Scheele, 2011

D-RECT – Dutch Residency Educational Climate Test


  1. Supervision (3)

  2. Coaching and assessment (8)

  3. Feedback (3)

  4. Teamwork (4)

  5. Peer collaboration (3)

  6. Professional relations between attendings (3)

  7. Work is adapted to residents’ competence (4)

  8. Attendings’ role (8)

  9. Formal education (4)

  10. Role of the specialty tutor (6)

  11. Patient sign out (4)

Cassar, 2004

STEEM – Surgical Theatre Educational Environment Measure


  1. Perceptions of trainer and training (13)

  2. Perceptions of learning opportunities (11)

  3. Perceptions of the atmosphere in the operating theatre (8)

  4. Perceptions on supervision, workload and support (8)

Holt & Roff, 2004

ATEEM - the Anaesthetic Theatre Educational Environment Measure


  1. Autonomy (8)

  2. Perceptions of atmosphere (10)

  3. Workload/supervision/support (7)

  4. Perceptions of teaching and teachers (5)

  5. Learning opportunities and orientation to learning (10)

Marshall, 1978

MSLES - Medical School Learning Environment Survey


  1. Breadth of interest

  2. Student interaction

  3. Organization (goal direction)

  4. Flexibility (authoritarianism)

  5. Meaningful learning experience

  6. Emotional climate

  7. Nurturance

Mulrooney, 2005

PEEM - Practice-based Educational Environment



  1. The practice job (14)

  2. GP trainer (10)

  3. Teaching and learning (10)

  4. Interaction with other health professionals (3)

Roff, McAleer & Skinner, 2005

PHEEM - Postgraduate Hospital Educational Environment Measure


  1. Perceptions of role autonomy (14)

  2. Perceptions of teaching (15)

  3. Perceptions of social support (11)

Roff, McAleer, Harden, Al-Qahtani, Ahmed, Deza, Groenen & Primparyon, 1997

DREEM - Dundee Ready Education Environment Measure


  1. Perceptions of teaching (12)

  2. Perceptions of teachers (11)

  3. Academic self-perceptions (8)

  4. Perceptions of atmosphere (12)

  5. Social self-perceptions (7)

Rotem, Godwin & Du, 1995

SLHS - Survey of Learning in Hospital Settings


  1. Autonomy

  2. Supervision

  3. Social support

  4. Workload

  5. Role clarity

  6. Variety

  7. Orientation to learning and teaching

  8. Orientation to general practice

Rothman & Ayoade, 1970

LEQ - Medical School Learning Environment Questionnaire


  1. Evaluative

  2. Academic enthusiasm

  3. Goal direction

  4. Authoritarianism

  5. Breadth of interest

  6. Student interaction

  7. Intellectual maturity

Wakeford, 1981

MSEQ - Medical School’s Environment Questionnaire


  1. friendly

  2. emphasis on concepts (not detail)

  3. emphasis on scholarship

  4. emphasis on ethical aspects

  5. intensive

  6. vocational (versus ‘scientific’) bias

  7. student involvement (in curriculum etc)

  8. administratively flexible

  9. educationally facilitative

  10. emphasis on extra-curricular activities

  11. emphasis on written work

  12. enjoyable

Figure 2 Overview of foundations of education environment instruments included in the study*

bold font – included instruments

regular font – underlying instruments

BOLD font – theoretical framework

* Underlying instruments not purely focusing on the educational environment or only concentrating on one or some specific aspects of the environment were omitted

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