It takes two to tango : an inquiry into healthcare professional education environments

摘要

Investigations into healthcare professional education environments have been increasinglyacknowledged and it is widely recognized that the environment is an important determinantof educational outcomes and educational stakeholders’ behavior and sense of well-being.However, the phenomenon of the educational environment constitutes a somewhat vagueconstruct with a multitude of connotations, and exploring the environment can be intricatebecause of the various settings in healthcare professional education. Moreover, someprofessional groups have been investigated less than others, and there is a scarcity ofperspectives from specific stakeholders. The overall aim of this thesis was to provide a deeperunderstanding of the phenomenon of the educational environment in healthcare professionaleducation. More specifically, to explore what constitutes educational environments and whatit means in the context of chiropractic and physiotherapy undergraduate education from theperspective of students and teachers. A mixed methods multiple case study approach with amulti-lens focus anchored in a pragmatic stance was embraced, thus employing quantitativedescriptive surveys using a well-established instrument, the Dundee Ready EducationalEnvironment Measure (DREEM), and a psychometric investigation using a non-parametricapproach of item response theory. In-depth qualitative explorations using focus groups withstudents and semi-structured individual interviews with teachers was also executed. InStudies I and II, students’ perceptions of the environment were introspected. Study I revealedthat physiotherapy students perceived a very good overall environment. Students in terms 1and 2 were most positive and term 4 most negative. Two DREEM items stood out: teachingoveremphasizing factual learning and authoritarian teachers. In Study II, chiropracticstudents perceived an excellent overall environment at two time points (2009 and 2012). Year1 students were most positive at both time points, and years 3 and 4 students were mostnegative in 2009 and 2012, respectively. Students’ perceptions about teachers decreasedbetween the two time points. Three DREEM items stood out in 2009, 2012, and also in alongitudinal sample of students: teaching overemphasizing factual learning, authoritarianteachers, and limited support for stressed students. There were tendencies of a more positiveperception about different aspects of the environment among the longitudinally surveyedstudents. Study III examined the DREEM’s psychometric properties. The findings could notsupport the a priori subscale construction of the instrument (subpar scalability coefficients),and reversely worded items proved most problematic. Study IV explored chiropracticstudents’ experiences of the meaning of their educational environment. The findingsindicated a sense of a changing environment, with five themes emerging: Being part of acommunity; Scaffolding relationships; Personal growth; A place of meaningfulness, andTrust in a regulated system. Study V explored and contrasted chiropractic and physiotherapyteachers’ experiences and conceptualizations of the meaning of the educational environment.Contextual differences were uncovered between the two groups of teachers as well as fivecommunal conceptualizations of the educational environment: Physical, Organizational,Relational, Communicational, and Pedagogical.Conclusively, this thesis argues that the educational environment is not an all-encompassing,solitary, and static phenomenon but, rather, a more complex, less fixed and measurablephenomenon than previously thought – a multilayered and multidimensional phenomenon ina relentless state of flux and a product of the contextual climate and culture.