Indian Journal of Dental Research

: 2017  |  Volume : 28  |  Issue : 3  |  Page : 256--260

Attitude of bachelor of dental surgery students and interns toward teaching-learning process in Government Dental College, Kottayam, Kerala, India

Sandhya Gopalakrishnan1, Philip Mathew2, Kannan Vaidyanathan3,  
1 Department of Prosthodontics, Government Dental College, Kottayam, Kerala, India
2 Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Center, Tiruvalla, Kerala, India
3 Department of Biochemistry, Pushpagiri Institute of Medical Sciences and Research Center, Tiruvalla, Kerala, India

Correspondence Address:
Sandhya Gopalakrishnan
Department of Prosthodontics, Government Dental College, Kottayam - 686 008, Kerala


Introduction: The educational environment affects the academic performance of students. One of the most widely utilized tools for measuring the educational environment is Dundee Ready Education Environment Measure (DREEM). The objective of the study was to assess the attitude toward study environment, as measured using DREEM questionnaire, and to find out the differences in perception of various batches of dental students. Materials and Methods: All Bachelor of Dental Surgery students from Government Dental College, Kottayam, Kerala, India, were included in the study. They were given the well-established DREEM questionnaire. A total of 234 students took part in the study, belonging to 2009, 2010, 2011, 2012, 2013, and 2014 batches. DREEM subcategories were analyzed for significance using analysis of variance. The significance of DREEM score across the different batches was further analyzed using post hoc test. Results: Overall, DREEM score was positive (111.14), but there is need for improvement. Individual questions also were given positive score for most questions. The maximum score was obtained for 3rd year students. Similar results are obtained for three of the five subcategories of DREEM. Conclusion: The total DREEM score was positive (111.14). The total score as well as the scores for the subcategories was highest in 3rd year dental students. The increase might be due to the excitement of clinical exposure for the first time in 3rd year students.

How to cite this article:
Gopalakrishnan S, Mathew P, Vaidyanathan K. Attitude of bachelor of dental surgery students and interns toward teaching-learning process in Government Dental College, Kottayam, Kerala, India.Indian J Dent Res 2017;28:256-260

How to cite this URL:
Gopalakrishnan S, Mathew P, Vaidyanathan K. Attitude of bachelor of dental surgery students and interns toward teaching-learning process in Government Dental College, Kottayam, Kerala, India. Indian J Dent Res [serial online] 2017 [cited 2022 Nov 27 ];28:256-260
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One of the important factors which determine the academic performance of students is the education climate or environment surrounding the student.[1] This factor can influence the students in a positive or negative way. The effects of educational environment, both academic and clinical, are important determinants of medical students' attitudes, knowledge, skills, progression, and behaviors.[2]

Many studies have been undertaken on Dundee Ready Education Environment Measure (DREEM) scores among medical students from India [3],[4],[5],[6],[7],[8] and those undergoing medical training in other nations.[9],[10],[11],[12],[13] However, only a few studies have been done on the educational environment of dental students.[14],[15],[16],[17],[18],[19] The scenario is more bleak in India concerning research into educational environment of dental students, as only three studies were found despite an extensive literature search of various medical databases.[18],[20],[21] Even the few studies done among dental students has been reported from private institutions which vary widely from government institutions in student profile, admission procedures, and even institutional priorities. The study was necessitated by the lack of data regarding the educational environment and learning process in the government run dental schools in the country.

Government Dental College, Kottayam, Kerala, India was established in the year 2002. It has 40 undergraduate student intake based on common entrance test. College is affiliated to Kerala University of Health Sciences (from year 2010) and has a 4 years 6 months course study and 1 year of compulsory rotatory internship. The students undergo 2 years of preclinical training followed by 2 years and 6 months of clinical training.

DREEM questionnaire has been used internationally as a measure of the educational environment. This tool has been developed and validated in different academic environments. DREEM is considered an ideal instrument for examining students' opinions, and a systematic review of 79 original articles concluded that DREEM is “likely to be the most suitable instrument for undergraduate medicine, postgraduate medicine, nursing, and dental education.”[22],[23] Other tools are also being developed, but as of now DREEM is the most popular and acclaimed one; hence, this has been used in this study.

The aim of this study was to determine whether the attitudes of students toward teaching-learning process differ between various years of study. The attitude of the students toward learning process and their perception of the educational environment was measured as DREEM scores, and the study was planned to compare the mean scores obtained by students from different years.

 Materials and Methods

This was a cross-sectional study based on questionnaire which was constructed to collect information such as the participant's gender, age group, and year of study. The 50-item DREEM questionnaire was used to collect information on the students' perception of the environment in government dental college. The study was conducted in the year 2015. Ethical clearance was obtained from the Institutional Ethics Committee of Government Dental College, Kottayam, as per Order No: IEC/M/10/2015/DCK dated 16/12/2015. The study conformed to the guidelines of the Helsinki declaration as revised in 1975.

Six batches of students were enrolled for the study, including two batches of interns. Two batches were doing their internship simultaneously due to a change in their university affiliations. Each batch has a sanctioned strength of forty students, but a few number of students may leave the course before completion, due to various reasons. The students of each year were approached after their theory class, and the interns were enrolled during their weekly clinical club session. They were briefed about the study designs and confidentiality, and consent was obtained. Each batch was briefed together about the objectives of the study, study designs and measures to ensure confidentiality, and subsequently, written informed consent was obtained. All the students who were present on the day of the survey were included in the study, and those who were on leave were not included. Among the students present on the day of survey, no one refused to give consent for participation. The student representative from each batch collected the filled consent form along with the DREEM questionnaire and returned to the investigator.

The DREEM questionnaire has fifty items organized into five domains, namely, students' perception of learning (SPoL), students' perception of teaching (SPoT), students' academic self-perception (SASP), students' perception of the atmosphere (SPoA), and students' social self-perception (SSSP). The responses are scored on a 5-point Likert scale as 4 for strongly agree (SA), 3 for agree (A), 2 for uncertain (U), 1 for disagree (D), and 0 for strongly disagree (SD). However, nine of the 50 items (numbers 4, 8, 9, 17, 25, 35, 39, 48 and 50) are negative statements and should be scored 0 for SA, 1 for A,2 for U, 3 for D and 4 for SD Item scores count toward an overall environment score as well as one of the five subscales or domains. The overall DREEM score is out of 200 while the subscale scores are 48, 44, 32, 48 and 28 for SPoL, SPoT, SASP, SPoA, and SSSP, respectively.

An approximate guide for interpreting overall scores was provided by McAleer and Roff,[23] and indicated that a score of 0–50 indicates “very poor,” 51–100 indicates “plenty of problems,” 101–150 is “more positive than negative,” while 151–200 indicates “excellent.” Indeed, it is advised that a score of 100 should be interpreted as being viewed with “considerable ambivalence by students and as such needs to be improved.”

Individual item can also be interpreted to pinpoint more specific strengths and weaknesses within the educational climate. Items that have a mean score of 3.5 or more are real-positive points. Any item with a mean of 2 or less should be examined more closely as they indicate problem areas. Item with a mean score between 2 and 3 is aspect of climate that could be enhanced.

The reliability of the study tool was assessed using Cronbach's alpha coefficient. The total DREEM scores and the subscores of SPoL, SPoT, SASP, SPoA, and SSSP were assessed for each batch of students. The total DREEM scores and the subscores were compared between the batches, using the analysis of variance method. Post hoc analysis with Bonferroni technique was done for internal comparison of the scores, between various batches of students. The mean scores among males and females were compared using independent samples t-test. The study participants were further divided using the median age, and the mean scores were compared using independent samples t-test. p< 0.05 was taken as statistically significant.


The Cronbach's alpha was 0.866 for the questionnaire, and this shows good internal consistency. DREEM scores and subcategories are summarized in [Table 1]. The mean DREEM score was positive; however, there are scopes for improvement. The analysis of DREEM questionnaire shows that 2012 Bachelor of Dental Surgery batch (3rd years) had maximum DREEM score; statistically significant differences from the other batches, namely, interns, 4th years and 2nd years when analyzed by post hoc analysis by Bonferroni technique. A high DREEM score was also seen for two other batches, 2014 1st year batch and 2010 batch of interns, but the values were not as high as the 2012 3rd year batch.{Table 1}

When the DREEM subcategories are analyzed, some differences were seen in two of the five subcategories. The SPoL is maximum for 2010 batch of interns followed by 2014 1st year batch, SASP is maximum for 2014 1st years. The other categories, SPoT, SPoA, and SSSP were maximum for 2012 batch, 3rd years.

There were no significant differences in total DREEM scores or subscores between males and females [Table 2]. When median age was used to divide the participants into two groups, the mean scores in SPoL was significantly higher among participants aged 21 years or more [Table 3].{Table 2}{Table 3}


The objective of this study was to find out the students' perception of educational environment and their general attitude toward the teaching-learning process, as measured using DREEM scores and to compare the scores obtained by students in various years of study.

The results show that mean DREEM score was 111.14, and this shows a positive educational environment in the educational institution under study. The study results and mean DREEM scores conformed to result obtained from other similar studies. In the few studies among dental students which reported a DREEM score, a multicentric study from Pakistan reported an overall score of 115.06.[15] A study done among second to 5th year students of a Greek dental school had an overall DREEM score of 112.[17] Among studies done on Indian Dental students, the only study which gave an overall DREEM score was a project done in Hyderabad, and the score reported was 125.24.[18] Among the other studies done in India, a report from Belgaum, which was conducted among students pursuing various health-related courses at a university gave an overall DREEM score of 120.21.[24] Another study from India, which was done among medical students of a private university in Mysore, gave an average score of almost 120 for final year medical students and interns.[4] A study reported from Manipal, India also showed a positive educational environment among students pursuing study in medicine.[3] Suboptimal DREEM scores were obtained only in very few studies done among students of medicine and allied sciences in India. A study done in New Delhi, India showed negative overall results with mean scores below 100. The scores were found to be lowest for 8th semester students (89.8) whereas 2nd semester students had positive, but suboptimal DREEM scores (101.3).[5]

In our study, the 3rd year dental students had the highest overall DREEM scores, indicating a general positive attitude toward the teaching-learning process. Subscores of DREEM also showed that 3rd year students were significantly better over other batches of students in three of the five subcategories. The next question was why 3rd years have a higher DREEM score. The dental education in India follows a unique system, in which the learning process is scheduled in such a way as to stimulate learning-by-doing and the students practice in a semi-controlled environment. The third year is the time when students are first getting exposed to a clinical setting, where they can have patient interactions and take treatment decisions, albeit in a controlled and supervised environment. This may be the reason for a higher score observed in 3rd year dental students. A similar finding reported in another study done among dental students in Hyderabad, India, which showed highest DREEM scores for 3rd year students and lowest score for 4th years.[18] This finding is not in line with some other international studies which showed a relatively stagnant scores across various years of study.[17] A study from Saudi Arabia reported that the overall DREEM scores of dental students were negative at the beginning of the study and stayed in the negative range as the students were followed up through the course of the study. Some of the subdomains showed a decrease, as the students progressed through the years.[19] A study done at Manipal, India, also had similar findings with students in preclinical phase of their study showing a better perception toward the learning process than those in the clinical phase.[6]

In our study, the scores obtained by male respondents were higher when compared to their female counterparts though not statistically significant. The study done in a Greek dental school did not show any gender influences in the results.[17] At the same time, the study which reported findings among dental students in a college in Hyderabad, India, showed that females had a better perception of the educational environment and had higher DREEM scores.[18] Among other studies from India, a study done at Belgaum, India also showed higher scores for male students.[24] Interestingly, another study from Manipal, India, showed that the academic perception among females was significantly lower than males, when we take medical students who are academic underachievers.[2] A study reported from Western Maharashtra showed that females reported a positive educational environment and a better appreciation of the learning process.[8]

Students aged 21 years or above had higher DREEM scores when compared to those who were below the age of 21, but the difference was not statistically significant. This may have been due to the fact that the students of the two batches with highest scores (3rd years and final years) would be generally aged at least 21 years, considering the selection process for dental education in India. No other study had looked at age as an independent factor in determining perceptions about academic environment in dental students. It is important that further studies look at the age of the students also, in light of the fact that age can be an important confounder in determining the relationship between year of study and DREEM scores.

Finally, this study was done on a cross-sectional population of students. Further studies need to be done as a cohort, following up the same batch of students over time to get an accurate understanding of how the behavior of students is changing. In addition, a multicentric study which includes data from other government dental colleges can improve the external validity of the study. A relatively lower sample size from each batch has probably resulted in higher standard deviation of mean DREEM scores, and this can decrease the internal validity of the research project, but not to the extent of making the conclusions illogical. This study, however, serves as an initiating point since no similar studies have been undertaken in the government sector.


The total DREEM score was positive (111.14). The score was highest in 3rd year dental students and lowest in 4th year students. Similar results were seen in three of the five DREEM subcategories. The increase might be due to the excitement of clinical exposure for the first time in 3rd year students. Future studies shall be planned to follow-up the batches as a cohort.


Dr. Anilkumar S, Professor and Head, Department of Prosthodontics, Dr. Migi Johnson, Intern, Government Dental College, Kottayam, Kerala, India.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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