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Medical Students’ Perception on the Medical Education Learning Environment at the University of Nairobi: A Qualitative Study.

Daniel Ojuka, Faith Bonareri, Beth Githambo, Michael Wambua

Department of Surgery, University of Nairobi, Kenya

Correspondences to: Daniel Ojuka, Email:



The educational environment (EE) plays a significant influence in effective student learning. The Dundee Ready Education Environment Measure (DREEM) is a validated tool to assess the EE.  DREEM survey done early 2019 among medical students indicated lots of problems. It was therefore important to explore why there was such perception among the medical students.  


To explore medical students’ perception on the medical education learning environment at the University of Nairobi.

Materials and methods

Qualitative focus group discussions were held among medical students from year III-VI in groups of between 8-12 students. The discussions were recorded using phone Samsung J6 voice recorder, transcribed, coded, and analyzed for themes until saturation was reached.


We held 6 focus discussion groups with students from year 3-6.  There were four thematic areas that were identified during these focus group discussions. 1. Poor educational infrastructure 2. Poor educational structure 3. Teaching is teacher-centered 4. Lack of social support for student in difficulties.


The exploration of the perception of the educational environment confirms students have poor view of the educational environment and the issues are a good feedback on teaching and governance issues including the social culture of the institution.

Key words: learning environment, DREEM, medical students, qualitative methods

Ann Afr Surg. ****; **(*):***


Conflicts of Interest: None

Funding: None

© 2020 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.


An educational environment is constituted of  curriculum, infrastructure, administrative structure  and personalities of teachers and students combined (1). The experiences by students  on these factors affects quality of learning (2). The DREEM is an internationally validated instrument for evaluating the learning environment of medical education and outlines the strengths and weaknesses of institutions based on students’ perceptions (3). High scores indicate good perception of the environment while low indicate poor or problematic environment. Core to the learning environment is the curriculum the traditional curriculum has been found to be associated with low score (4-8).  Other factors include authoritarianism among the teachers and upper clinical classes that always score low marks for some reason (6,7).

DREEM has been used to improve quality of the surgical environment through reflection on its outcomes (9,10). In improving quality, the reasoning of the responses received sometimes will need to be explored to understand to and increase students’ achievement, happiness, motivation, and success. This is done to improve the learning environment without compromising the standards through feedback.

DREEM  is one of the validated  culturally non-specific tools used to measure the medical education environments  , demonstrating the  weakness or strength of an institution(9,10).A survey done at the  University of Nairobi( unpublished) , school of medicine recently indicated a score of 96/200 that implied weaknesses in the learning environment . We sought to explore the factors that were responsible for this negative perception by the students.


Materials and Methods

After obtaining ethical approval from Kenyatta National Hospital-University of Nairobi Ethics and Research Committee (P55/01/2019), focus group discussions (FGD) were held in the principal researcher’s office with 8-12 students for 45 minutes to 60 minutes based on the guiding questions by the principal researcher together with co-investigators. The guiding question was, “The DREEM survey indicated there are more negative perception than positive, what would be the reasons?”. The study population were third to sixth year medical students, who consented in writing for the interview.  Purposive sampling was used to recruit the students in stratification according to class until group had 8-12 members. The groups were recruited and interviewed until saturation of themes.  During the interviews, the conversations were recorded using Samsung J6 recorder. All the interviews were held in the presence of the three researchers-BG, FA and OD.

Discussions of the interviews were done between the three to agree on the codes and themes there were coming out and memos written on the same. The voice recorders were shared among the three investigators to listen again and confirm the content after transcription for member check.  After transcription, the notes coded and entered ATLAS.ti GmbH