Accelerating Change in Medical Education

Med students' perceptions of learning environment matter

One of the keys to student success in medical school is a positive perception of the learning environment—it’s linked to academic performance as well as higher scores on the United States Medical Licensing Exam (USMLE). A new study has found that student perceptions aren’t shaped as much by individual student backgrounds as they are by campus cultures.

Evaluating campus perceptions

After just one year of medical school, a student’s perception about his or her learning environment is shaped by the culture at the campus where they are taking classes, according to a recent AMA-authored study in Academic Medicine.

Researchers asked more than 4,000 students from 28 medical schools to report the frequency of 17 aspects of the learning environment from the Medical School Learning Environment Survey (MSLES) on a scale from “never” to “very often” at the end of the first year of medical school. Among the items they ranked:

  • Students gather for informal activities.
  • Competition for grades is intense.
  • Students in school are distant from each other.
  • Faculty are reserved and distant with students.
  • Courses emphasize the interdependence of facts, concepts and principles.

The students’ demographic characteristics accounted for very little of the total variance in student perceptions, according to the paper, which came out of the AMA’s Learning Environment Study. The greater variation was between schools, a finding that suggests the campus culture has an impact on students.

“The student’s school or campus location, with its inherent local institutional culture, explains 90 percent of the measured variance in student perception and the learning environment,” study authors concluded. “The relationships between the MSLES scores, student demographic and personal attribute measures, although statistically significant, only explained about 2 percent of the variance.”

Students’ impressions of the learning environment are important because they have been linked to academic performance. Studies also have shown that students who feel more positive about their learning environment perform better on the USMLE.

“Schools have the most influence on students’ perceptions of their learning environment early in their education,” said lead study author Susan E. Skochelak, MD, the AMA’s group vice president for medical education. “Some schools are doing a better job than others. It will be important for schools to look to best practices so that they can support the best learning environment possible for our students.”

More research needed

The study results suggest that medical schools can examine their institutional learning environments—such as grading policies, the hidden curriculum, learning communities and curricular change efforts—to enhance student experiences in undergraduate medical education. Study authors said more studies are needed to identify specific factors that may contribute to student perceptions.

Some of that research is underway.

“We are doing additional analysis of the data that we have collected,” Dr. Skochelak said. “We have papers about learning communities and other implications that will be published. Other organizations are also studying and reporting on these issues, including the Association of American Medical Colleges and individual medical schools.”

The study by Dr. Skochelak and colleagues is related to the AMA’s Accelerating Change in Medical Education initiative, which is working to transform medical education to meet the evolving needs of physicians and patients.

For more about how medical education is changing