Medical students’ perceptions of their educational environment: expected versus actual perceptions Susan Miles & Sam J Leinster OBJECTIVE To compare Year 1 medical students’ perceptions of their educational environment at the end of Year 1, with their expectations at the begin- ning of the year using the Dundee Ready Education Environment Measure (DREEM). METHODS Year 1 students (n ¼ 130) at the University of East Anglia Medical School were asked to complete the DREEM during their induction week at the beginning of Year 1, thinking about the educational environment they expected to encounter (Expected DREEM), and again as part of a compulsory evaluation at the end of Year 1, thinking about the educational environment they had actually experienced (Actual DREEM). A total of 87 students (66.92% of the starting cohort) completed the DREEM on both occasions and gave permission for their data to be published. RESULTS The Expected DREEM score was 153 out of a maximum of 200, and the Actual DREEM score was 143. Student’s expected perceptions of learning and teachers, and their expected academic self- and social self-perceptions were all more positive than their actual perceptions. There was no difference between expected and actual perceptions of atmosphere. Specific aspects of the educational environment showing dissonance were identified. In some areas students’ low expectations had been matched by their actual experience. CONCLUSIONS Medical students had started Year 1 with expectations about the educational environment that had not been met. However, areas showing dissonance received low item scores on the Actual DREEM and as such would be picked up for remediation, even without information about student expectations. KEYWORDS students, medical ⁄ *psychology; humans; *perception; *attitude of health personnel; *education, medical, undergraduate; comparative study; questionnaires. Medical Education 2007; 41: 265–272 doi:10.1111/j.1365-2929.2007.02686.x INTRODUCTION Interest in examining perceptions of educational environment (also referred to as ÔclimateÕ 1 ) in medical schools has been increasing in recent years. The quality of the educational environment reflects the quality of the curriculum. 2 In addition, the learning environment is an important determinant of behaviour; 2 elements of the education environment are related to academic achievement, course satisfaction and aspirations. 2–6 Perceptions of the climate may be affected by the increasing diversity of the student population. 7 Critically, we can both measure and change the educational climate. The Dundee Ready Education Environment Measure (DREEM) is an instrument designed to measure educational environment specifically for health professions. 8 It has been used diagnostically to identify areas of strength and weakness in a current educational environment. 9,10 It has also been used to compare different medical education institutions, 9,11 students at different stages of the course, 9,12,13 and gender. 6,9–11,13 It has been used to measure the existing educational environ- ment as a precursor to curriculum change; to identify priority areas for change and to act as a baseline for comparison after curriculum change; 13,14 to compare student well-being School of Medicine, University of East Anglia, Norwich, UK Correspondence: Dr Susan Miles, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK. Tel: 00 44 1603 591292; Fax: 00 44 1603 593752; E-mail: susan.miles@uea.ac.uk Ó Blackwell Publishing Ltd 2007. MEDICAL EDUCATION 2007; 41: 265–272 265