Brief report

J Educ Eval Health Prof 2020;17:7 • https://doi.org/10.3352/jeehp.2020.17.7

Perception of physical therapy students about educational environment in physical therapy institutes in

Pakistan

Muhammad Adeel1*, Asad Chaudhry2,

1College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan;

2District Headquarter Hospital, Narowal, Pakistan;

* Corresponding email: d845108004@tmu.edu.tw

Editor: Sun Huh, Hallym University, Korea

Received: December 9, 2019; Accepted: February 24, 2020; Published online: February 24, 2020

This article is available from: https://jeehp.org

© 2020, Korea Health Personnel Licensing Examination Institute

(cc) This is an open-access article distributed under the terms of the Creative Commons Attribution License

(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in

any medium, provided the original work is properly cited.

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Abstract

It aimed to assess the perception of doctor of physical therapy (DPT) students about an educational environment in

public and private physical therapy institutes in Pakistan.

This cross-sectional study was conducted in 6 physical therapy institutions of Punjab, Pakistan from April 2018 to

December 2019. A total of 500 Dundee Ready Educational Environment Measure (DREEM) questionnaires were

distributed among conveniently selected students of doctor of physical therapy with response rate, 86.4%. The

correlation was tested for each of the items in the DREEM score.

It showed the overall mean DREEM score of 128 (± 19.63) in all the 5 subscales. The score ranged from 33 to 166

with a standard error mean of 0.954. Correlation analysis for atmosphere, learning, and self-perception with the

whole educational environment in physical therapy institutes as r = 0.896, r = 0.853, and r = 0.846 respectively. The

student-centered approaches to be more effective toward an educational environment than teacher-centered in

subjected institutes.

Total word count: 157 (excluding headings count)

Keywords: Atmosphere; Learning; Pakistan; Physical therapy modalities; Students

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Background/rationale: Doctor of physical therapy (DPT) is a five-year educational program consisting of teaching

of basic medical sciences in first two years and clinical sciences in next three years. All students enrolled in DPT

were eligible for participation in the study. DPT curriculum is supervised under Higher Education Commission

(HEC) of Pakistan and according to HEC it is categorized as a 5-year degree/10 semesters program with 175 credit

hours and after completing a degree 1-year house job is also assimilated [1]. What a student perceived from his/her

learning environment is what he/she represents in his/her professional life. Therefore, in order to successfully

handle improvements, it is important to acquire frequent assessment and input, as it is possible to make adjustments,

correct errors, and maintain momentum only through information obtained in this manner. The expectations of

students about the educational environment can be a basis for making improvements and thus enhance the

educational environment. Significant learning correlates favorably with the insights of the educational environment

of the students, which depend on the learning familiarities and outcomes of the students. This affects the way

students learn, why, and what [2,3]. However, most of the researchers concluded that overall educational

environments are from average to poor across the globe. No research was conducted exclusively for doctor of

physical therapy (DPT) students in Pakistan.

Objectives: The aim of this research was to evaluate DPT students' understanding of an educational environment in

the physical therapy institutes by helping in fluctuating the current typical educational environment according to

student’s needs.

Ethics statement: The study got approval from research and ethics committee of school of physiotherapy, King

Edward Medical University, Lahore with the institutional review board (IRB) number IRB-SPT-0004562. Informed

consent was taken from each participant before data collection.

Study design: This is a cross-sectional study and conducted in 6 public and private medical institutions of Punjab

during April 2018 to December 2019. The data collection was carried out by using demographic and Dundee Ready

Educational Environment Measure (DREEM) questionnaire [4].

Materials and/or Subjects: A total of 500 (response rate=86.4%) printed questionnaires were distributed among

conveniently selected students of doctor of physiotherapy from 2 public (King Edward medical University, School

of Physiotherapy and Children Hospital Lahore, School of Allied Health Sciences) and 4 private (Imperial College

of Business Studies Department of Physical Therapy & Rehabilitation Sciences, University of Sargodha Lahore

Campus Department of Physical Therapy, University of Lahore University Institute of Physical Therapy, and

Federal Institute of Health Sciences Department of Physical Therapy) physical therapy institutions. Questionnaires

were distributed among students after their scheduled classes. Use of the questionnaires was permitted by the

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original author of the tool. An administrative member of an institution helped in data collection process and

completed survey.

DREEM scale is most reliable, valid, and culture free public tool that is used internationally for assessing what

student perceive about their educational environment. It analyses the advantages and disadvantages of the

educational environment faced by students regardless of geographical region, ethnicity, or gender etc. It consisted

of 50-questions, with five subscales, 1) students’ perceptions of learning (SPL), 2) students’ perceptions of

teaching (SPT), 3) students’ academic self-perceptions (SASP), 4) students’ perceptions of atmosphere (SPA), and 5)

students’ social self-perceptions (SSSP).

Every question is rated 4-0 scale with 4 = strongly agree, 3 = agree, 2 = unsure, 1 = disagree, and 0 = strongly

disagree on a five-point Likert scale. This inventory has a total score of 200, representing the ideal learning

atmosphere as observed by students. The lowest and most unsettling rating is a score of 0. The subscales scores can

be evaluated against generic parameters and individual question rating can also be reviewed, to pinpoint specific

advantages and disadvantages [5].

Statistical analysis: Statistical package for social sciences (SPSS) version-21 (IBM Corp., Armonk, NY, USA) was

used for the statistical analysis of data. The demographics of the study were presented with mean and standard

deviation for DREEM variables, total DREEM, and five subscales scores. The level of statistical significance was P

< 0.00. The correlation was tested for each items in DREEM score.

Key results:

The study presented data of 423 participants (drop out=77 participants) with a mean age of 22.95 (± 2.413). Out of

these, 47.5% (n= 201) were male and 52.5% (n = 222) female. The questionnaires were filled by 2 public 26.2% (n =

111) and 4 private 73.8% (n = 312) institute students. This survey contained 48.2% (n = 204) responses from an

annual examination system and 51.8% (n = 219) from a semester system. The characteristics of participants are

presented in Table 1.

The results showed the overall DREEM score of 128 (± 19.63) in all the 5 components of the scale. The score

ranged from 33 to 166 with standard error mean (SEM) of 0.954. The Cronbach’s alpha for DREEM scale was

0.806. The descriptive statistics of each subscale and inter-class correlation are shown in Tables 2 and 3 respectively.

The reliability of DREEM scale was 80.6 % which is evident from the responses filled by physical therapy students.

It is enhanced by removing the following items: “The teaching over emphasizes factual learning”, “The teaching is

too teacher centred”, “My problem solving skills are being well developed here”, and “I am rarely bored on this

course”. The subscales students’ academic self-perception (ASP) and perception of atmosphere (PoA) exhibited

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good reliability (in terms of Cronbach’s alpha) as 0.749 and 0.734 respectively. However, the mean values higher for

students’ perception of learning (PoL) and perception of atmosphere (PoA) as 31.99 (± 5.24) and 31.20 (± 6.42)

respectively (Table 2).

It showed that atmosphere, learning, and self-perception were strongly linked with the whole educational

environment provided in physical therapy institutes (r = 0.896, r = 0.853, and r = 0.846 respectively). PoT and SSP

took least part, but substantial role on DREEM overall score (r = 0.728 and r = 0.696 respectively). Out of 5 these

subscales, correlation between perception of learning (PoL) and academic self-perception (ASP) was found to be

maximum (r = 0.708) (Table 3).

Interpretation and suggestion: The evaluation of an educational environment is a significant method to make sure

quality and to distinguish dimensions of progress. The academic atmosphere is not only a proportion of student

fulfillment, yet in addition influences student conduct and forecasts accomplishment. Educational environment can

best be translated as by total and subscale scores, using DREEM questionnaire [6]. It is evident in this study that the

student centered perceptions in terms of student’s academic self-perception (ASP), perception of environment

(PoA), and perception of learning (PoL) showed good reliability (alpha = 0.749, 0.734 and 0.684) and mean scores

22.75 (± 4.72), 31.20 (± 6.42), and 31.99 (± 5.24) respectively suggesting more favorable students perception on

learning environment. Student’s social self-perception (SSP) domain needs further strengthening. It is shown by the

lowest reliability and mean scores on DREEM subscale in SSP (alpha = 0.347 and 17.37± 3.36). This is already being

achieved through a holistic system that provides mentoring, academic, and psychological health support and advice

[6]. This study highlighted that teacher centered approaches would influence educational environment not as good

as student centered approaches as depicted through low reliability (alpha = 0.575) and mean scores 25.64 (± 4.24) in

perception of teachers and improvement in student’s perception of learning Cronbach’s alpha score by removing

teacher over emphasizes factual learning.

Comparison with previous studies: In a research conducted by Rehman R et al, 2016 stated the mean total score for

the DREEM was 126/200, which is more or comparable to other research studies from medical colleges round the

world. This score categorizes Aga Khan University, Karachi’s bachelor medical education system as more positive

than negative as indicated by the perception in the literature [7]. A research conducted in an Australian University

highlighted that students have shown overall positive insight about the educational environment with the highest

DREEM score of 137.3 (± 18.3). This concluded that the university has a student-centered approach which causes

the students to show a positive outcome [87]. The same result was presented by another study conducted in Agha

Khan University Karachi Pakistan, that overall DREEM score was concluded to be a more positive approach [7].

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A previously published paper suggested that the highest rated items were knowledgeable teachers, good friends, and

the confidence to pass the exams, though three of the most troublesome elements were the unsuitable method for a

stressful situation, the failure to remember everything, and the focus on factual learning [9]. Researchers concluded

that stress, tiredness, and insufficient feedback from teachers provide a stimulus for the negativity of student

perception and the domains which influence positivity and feeling of happiness in students were social comforts,

school friends, and accommodation [10].

Strengths and limitations: There are good response level and consistency in this study. Further study is needed to

analyses the educational environment at the year levels. Generalization cannot be made because more government

or/and private institutes data should be included. This study included only 6 institutes of a province Punjab.

Conclusion: The study concluded that student’s academic self-perception, atmosphere, and learning perceptions

affect the educational environment for included physical therapy institutes. It also highlighted the student-centered

approaches to be more effective toward an educational environment than teacher-centered. This study may give

insights to modify teacher-oriented behaviors for better academic performance by focusing on the teacher’s way of

teaching and student’s social life.

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ORCID

Muhammad Adeel: https://orcid.org/0000-0002-3681-6453

Asad Chaudhry: https://orcid.org/0000-0002-1438-643X

Authors’ contributions

Conceptualization. MA

Data curation: MA

Formal analysis: AC.

Methodology: AC.

Visualization: MA.

Writing – original draft: MA.

Writing – review & editing: MA. AC

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Funding: None.

Data availability

Dataset 1. Raw data of the responses by subjects

Acknowledgment: None.

Supplementary materials: None.

Appendix: None.

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Table 1. Characteristics of Participants (n = 423)

Exam system of
Gender Institutes types
Institutes
Male Female Government Private Annual Semester
(n=201) (n=222) (n=111) (n=312) (204) (219)

47.5% 52.5% 26.2% 73.8% 48.2% 51.8%

n = total number of participants or characteristics

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Table 2. Descriptive Statistics of DREEM Score
Std. Subscale score
Mean Alpha
Deviation Interpretation
A more positive 0.684 a),
Students Perception of Learning 31.99 5.24
approach b b)
Moving in the right
Students Perception of Teachers 25.64 4.24 0.575
direction
Feeling more on the
Students Academic Self Perception 22.75 4.72 0.749 c)
positive side
A more positive
Students Perception of Atmosphere 31.20 6.42 0.734
atmosphere
Students Social Self Perception 17.37 3.36 Not too bad 0.347 d)
More positive than
Total DREEM score 128.96 19.63 0.806
negative
a)
improves to 0.746 if the teaching over emphasizes factual learning removed
b)
improves to 0.754 if The teaching is too teacher centred removed
c)
decreases to 0.705 if My problem solving skills are being well developed here is removed
d)
improves to 0.419 if I am rarely bored on this course is removed

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Table. 3. Correlation between DREEM items score
PoL PoT ASP PoA SSP
PoT .497**
ASP .708** .478**
PoA .690** .592** .671**
SSP .487** .419** .541** .530**
DREEM TOTAL MEASURE .853** .728** .846** .896** .696**
**. Correlation is significant at the 0.01 level (2-tailed)
PoL: Perception of Learning
PoT: Perception of Teachers
ASP: Academic Self-Perception
PoA: Perception of Atmosphere
SSP: Social Self-Perception

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