Examining the perception of undergraduate health professional students of their learning environment, learning experience and professional identity development: a mixed-methods study | BMC Medical Education

Quantitative phase

The response rate was 57.8% (525 responses out of 908), while the usability rate was 74.3% (390 responses out of 525) after excluding students who only completed the demographic section. The demographic and professional characteristics of the participants are presented in Table 1. The majority were Qataris (37.0% [n = 142]), females (85.1% [n = 332]), and of the age group of 21–23 years (51.7% [n = 201]). The students were predominantly studying at the CHS (36.9%[n = 144]), in their second professional year (37.4% [n = 146]), and had yet to be exposed to experiential learning, that is, clinical rotations (70.2% [n = 273]).

Perceptions of students of their learning environment

The overall median DREEM score for study participants indicated that QU Health students perceive their learning environment to be “more positive than negative” (132 [IQR = 116–174]). The reliability analysis for this sample of participants indicated a Cronbach’s alpha for the total DREEM score of 0.94, and Cronbach’s alpha scores for each domain of the DREEM tool, SPoL, SPoT, SASP, SPoA, and SSSP of 0.85, 0.74, 0.81, 0.85, and 0.65, respectively.

Individual item responses representing each domain of the DREEM tool are presented in Table 2. For Domain I, QU Health students perceived the teaching approach in QU Health to be “more positive” (32 [IQR = 27–36]). Numerous participants agreed that the teaching was well-focused (70.7% [n = 274]), student-focused (66.1% [n = 254]) and aimed to develop the competencies of students (72.0% [n = 278]). The analysis of students’ perceptions related to Domain II revealed that faculty members were perceived to be “moving in the right direction” (30 [IQR = 26–34]). Most students agreed that faculty members were knowledgeable (90.7%[n = 345]) and provided students with clear examples and constructive feedback (77.6% [n = 294] and 63.8% [n = 224], respectively. Furthermore, the analysis of Domain III demonstrated that QU Health students were shown to have a “positive academic self-perception” (22 [IQR = 19–25]). In this regard, most students believed that they were developing their problem-solving skills (78% [n = 292]) and that what they learned was relevant to their professional careers (76% [n = 288]). Furthermore, approximately 80% (n = 306) of students agreed that they had learned empathy in their profession. For Domain IV, students perceived the atmosphere of their learning environment to be “more positive” (32 [IQR = 14–19]). A substantial number of students asserted that there were opportunities for them to develop interpersonal skills (77.7% [n = 293]), and that the atmosphere motivated them as learners (63.0% [n = 235]). Approximately one-third of students believed that the enjoyment did not outweigh the stress of studying (32.3% [n = 174]). Finally, analysis of Domain V indicates that students’ social self-perception was “not very bad” (17 [IQR = 27–36]). Most students agreed that they had good friends at their colleges (83% [n = 314]) and that their social lives were good (68% [n = 254]).

Table 3 illustrates the differences in the perception of students of their overall learning environment according to their demographic and professional characteristics. No significant differences were noted in the perception of the learning environment among the subgroups with selected demographic and professional characteristics, except for the health profession program in which they were enrolled (p-value < 0.001), whether they had relatives who studied or had studied the same profession (p-value < 0.002), and whether they started their experiential learning (p-value = 0.043). Further analyses comparing the DREEM subscale scores according to their demographic and professional characteristics are presented in Supplementary Material 1.

Students’ perceptions of their professional identities

The students provided positive responses relating to their perceptions of their professional identity (24.00 IQR = [22–27]). The reliability analysis of this sample indicated a Cronbach’s alpha of 0.605. The individual item responses representing the MCPIS-9 tool are presented in Table 2. Most students (85% [n = 297]) expressed pleasant feelings about belonging to their own profession, and 81% (n = 280) identified positively with members of their profession. No significant differences were noted in the perception of students of their professional identity when analyzed against selected demographic subgroups, except for whether they had relatives who had studied or were studying the same profession (p-value = 0.027). Students who had relatives studying or had studied the same profession tended to perceive their professional identity better (25 IQR = [22–27] and 24 IQR = [21–26], respectively) (Table 3).

Association between MCPIS-9 and DREEM

Spearman’s rank correlation between the DREEM and MCPIS-9 total scores indicated an intermediate positive correlation between perceptions of students toward their learning environment and their professional identity development (r = 0.442, p-value < 0.001). The DREEM questionnaire, with its 50 items divided into five subscales, comprehensively assessed various dimensions of the learning environment. Each subscale evaluated a distinct aspect of the educational experience, such as the effectiveness of teaching, teacher behavior and attitudes, academic confidence, the overall learning atmosphere, and social integration. The MCPIS-9 questionnaire specifically assessed professional identity through nine items that measure attitudes, values, and self-perceived competence in the professional domain. The positive correlation demonstrated between the DREEM and MCPIS-9 scores indicated that as students perceive their learning environment more positively, their professional identity is also enhanced.

Qualitative phase

Thirty-seven students from the QU Health colleges were interviewed: eleven from CPH, eight from CMED, four from CDEM, and fourteen from CHS (six from Nut, three from PS, three from Biomed, and three from PH). Four conventional themes were generated deductively using Gruppen et al.’s conceptual framework, while one theme was derived through inductive analysis. The themes and sub-themes generated are demonstrated in Table 4.

Theme 1. The personal component of the learning environment

This theme focused on student interactions and experiences within their learning environment and their impact on perceptions of learning, processes, growth, and professional development.

Sub-theme 1.1. Experiences influencing professional identity formation

Students classified their experiences into positive and negative. Positive experiences included hands-on activities such as on-campus practical courses and pre-clinical activities, which built their confidence and professional identity. In this regard, one student mentioned:

“Practical courses are one of the most important courses to help us develop into pharmacists. They make you feel confident in your knowledge and more willing to share what you know.” [CPH-5]

Many students claimed that interprofessional education (IPE) activities enhanced their self-perception, clarified their roles, and boosted their professional identity and confidence. An interviewee stated:

“I believe that the IPE activity,…., is an opportunity for us to explore our role. It has made me know where my profession stands in the health sector and how we all depend on each other through interprofessional thinking and discussions.” [CHS-Nut-32]

However, several participants reported that an extensive workload hindered their professional identity development. A participant stated:

“The excessive workload prevents us from joining activities that would contribute to our professional identity development. Also, it restricts our networking opportunities and makes us always feel burnt out.” [CHS-Nut-31]

Sub-theme 1.2. Strategies used by students to pursue their goals

QU Health students employed various academic and non-academic strategies to achieve their objectives, with many emphasizing list-making and identifying effective study methods as key approaches:

“Documentation. I like to see tasks that I need to do on paper. Also, I like to classify my tasks based on their urgency. I mean, deadlines.” [CHS-Nut-31]

“I always try to be as efficient as possible when studying and this can be by knowing what studying method best suits me.” [CHS-Biomed-35]

Nearly all students agreed that seeking feedback from faculty was crucial for improving their work and performance. In this context, a student said:

“We must take advantage of the provided opportunity to discuss our assignments, projects, and exams, like what we did correctly, and what we did wrongly. They always discuss with us how to improve our work on these things.” [CHS-Nut-32]

Moreover, many students also believed that developing communication skills was vital for achieving their goals, given their future roles in interprofessional teams. A student mentioned:

“Improving your communication skills is a must because inshallah (with God’s will) in the future we will not only work with biomedical scientists, but also with nurses, pharmacists, and doctors. So, you must have good communication abilities.” [CHS-Biomed-34]

Finally, students believe that networking is crucial for achieving their goals because it opens new opportunities for them as stated by a student:

“Networking with different physicians or professors can help you to know about research or training opportunities that you could potentially join.” [CMED-15]

Subtheme 1.3. Students’ mental and physical well-being

Students agreed that while emotional well-being is crucial for good learning experiences and professional identity development, colleges offered insufficient support. An interviewee stated:

“We simply don’t have the optimal support we need to take care of our emotional well-being as of now, despite how important it is and how it truly reflects on our learning and professional development” [CDEM-20]

Another student added:

“…being in an optimal mental state provides us with the opportunity to acquire all required skills that would aid in our professional identity development. I mean, interpersonal skills, adaptability, self-reflection” [CPH-9]

Students mentioned some emotional support provided by colleges, such as progress tracking and stress-relief activities. Students said:

“During P2 [professional year 2], I missed a quiz, and I was late for several lectures. Our learning support specialist contacted me … She was like, are you doing fine? I explained everything to her, and she contacted the professors for their consideration and support.” [CPH-7]

“There are important events that are done to make students take a break and recharge, but they are not consistent” [CHS-PS-27]

On the physical well-being front, students felt that their colleges ensured safety, especially in lab settings, with proper protocols to avoid harm. A student mentioned:

“The professors and staff duly ensure our safety, especially during lab work. They make sure that we don’t go near any harmful substances and that we abide by the lab safety rules” [CHS-Biomed -35]

Theme 2. Social component of the learning environment

This theme focused on how social interactions shape students’ perceptions of learning environments and learning experiences.

Sub-theme 2.1. Opportunities for community engagement

Participants identified various opportunities for social interactions through curricular and extracurricular activities. Project-based learning (PBL) helped them build connections, improve teamwork and enhance critical thinking and responsibility as stated by one student:

“I believe that having PBL as a big part of our learning process improves our teamwork and interpersonal skills and makes us take responsibility in learning, thinking critically, and going beyond what we would have received in class to prepare very well and deep into the topic.” [CMED-12]

Extracurricular activities, including campaigns and events, helped students expand their social relationships and manage emotional stress. A student stated:

“I think that the extracurricular activities that we do, like the campaigns or other things that we hold in the college with other students from other colleges, have been helpful for me in developing my personality and widening my social circle. Also, it dilutes the emotional stress we are experiencing in class” [CDEM-22]

Sub-theme 2.2. Opportunities for learner-to-patient interactions

Students noted several approaches their colleges used to enhance patient-centered education and prepare them for real-world patient interactions. These approaches include communication skills classes, simulated patient scenarios, and field trips. Students mentioned:

“We took a class called Foundation of Health, which mainly focused on how to communicate our message to patients to ensure that they were getting optimal care. This course made us appreciate the term ‘patient care’ more.” [CHS-PH-38]

“We began to appreciate patient care when we started to take a professional skills course that entailed the implementation of a simulated patient scenario. We started to realize that communication with patients didn’t go as smoothly as when we did it with a colleague in the classroom.” [CPH-1]

“We went on a field trip to ‘Shafallah Center for Persons with Disability’ and that helped us to realize that there were a variety of patients that we had to care for, and we should be physically and mentally prepared to meet their needs.” [CDEM-21]

Theme 3. Organizational component of the learning environment

This theme explored students’ perceptions of how the college administration, policies, culture, coordination, and curriculum design impact their learning experiences.

Sub-theme 3.1. Curriculum and study plan

Students valued clinical placements for their role in preparing them for the workplace and developing professional identity. A student stated:

“Clinical placements are very crucial for our professional identity development; we get the opportunity to be familiarized with and prepared for the work environment.” [CHS-PS-27]

However, students criticized their curriculum for not equipping them with adequate knowledge and skills. For example, a student said:

“… Not having a well-designed curriculum is of concern. We started very late in studying dentistry stuff and that led to us cramming all the necessary information that we should have learned.” [CDEM-20]

Furthermore, students reported that demanding schedules and limited course availability hindered learning and delayed progress:

“Last semester, I had classes from Sunday to Thursday from 8:00 AM till 3:00 PM in the same classroom, back-to-back, without any break. I was unable to focus in the second half of the day.” [CHS-Nut-38]

“Some courses are only offered once a year, and they are sometimes prerequisites for other courses. This can delay our clinical internship or graduation by one year.” [CHS-Biomed-36]

Additionally, the outdated curriculum was seen as misaligned with advancements in artificial intelligence (AI). One student stated:

“… What we learn in our labs is old-fashioned techniques, while Hamad Medical Corporation (HMC) is following a new protocol that uses automation and AI. So, I believe that we need to get on track with HMC as most of us will be working there after graduation.” [CHS-Biomed-35]

Sub-theme 3.2. Organizational climate and policies

Students generally appreciated the positive university climate and effective communication with the college administration which improves course quality:

“Faculty members and the college administration usually listen to our comments about courses or anything that we want to improve, and by providing a course evaluation at the end of the semester, things get better eventually.” [CPH-2]

Students also valued faculty flexibility with scheduling exams and assignments, and praised the new makeup exam policy which enhances focus on learning:

“Faculty members are very lenient with us. If we want to change the date of the exam or the deadline for any assignment, they agree if everyone in the class agrees. They prioritize the quality of our work over just getting an assignment done.” [CHS-PS-37]

“I am happy with the introduction of makeup exams. Now, we are not afraid of failing and losing a whole year because of a course. I believe that this will help us to focus on topics, not just cramming the knowledge to pass.” [CPH-9]

However, students expressed concerns about the lack of communication between colleges and clinical placements and criticized the lengthy approval process for extracurricular activities:

“There is a contract between QU and HMC, but the lack of communication between them puts students in a grey area. I wish there would be better communication between them.” [CMED-15]

“To get a club approved by QU, you must go through various barriers, and it doesn’t work every time. A lot of times you won’t get approved.” [CMED-14]

Theme 4. Materialistic component of the learning environment

This theme discussed how physical and virtual learning spaces affect students’ learning experiences and professional identity.

Sub-theme 4.1. The physical space for learning

Students explained that the interior design of buildings and the fully equipped laboratory facilities in their programs enhanced focus and learning:

“The design has a calming effect, all walls are simple and isolate the noise, the classrooms are big with big windows, so that the sunlight enters easily, and we can see the green grass. This is very important for focusing and optimal learning outcomes.” [CPH-5]

“In our labs, we have beds and all the required machines for physiotherapy exercises and practical training, and we can practice with each other freely.” [CHS-PS-27]

Students from different emphasized the need for dedicated lecture rooms for each batch and highlighted the importance of having on-site cafeterias to avoid disruptions during the day:

“We don’t have lecture rooms devoted to each batch. Sometimes we don’t even find a room to attend lectures and we end up taking the lectures in the lab, which makes it hard for us to focus and study later.” [CDEM-23]

“Not having a cafeteria in this building is a negative point. Sometimes we miss the next lecture or part of it if we go to another building to buy breakfast.” [CHS-Nut-29]

Sub-theme 4.2. The virtual space for online learning

Students appreciated the university library’s extensive online resources and free access to platforms like Microsoft Teams and Webex for efficient learning and meetings. They valued recorded lectures for flexible study and appreciated virtual webinars and workshops for global connectivity.

“QU Library provides us with a great diversity and a good number of resources, like journals or books, as well as access medicine, massive open online courses, and other platforms that are very useful for studying.” [CMED-16].

“Having your lectures recorded through virtual platforms made it easier to take notes efficiently and to study at my own pace.” [CHS-PS-38]

“I hold a genuine appreciation for the provided opportunities to register in online conferences. I remember during the COVID-19 pandemic, I got the chance to attend an online workshop. This experience allowed me to connect with so many people from around the world.” [CMED-15]

Theme 5. Characteristics of an ideal learning environment

This theme explored students’ perceptions of an ideal learning environment and its impact on their professional development and identity.

Sub-theme 5.1. Active learning and professional development supporting environment

Students highlighted that an ideal learning environment should incorporate active learning methods and a supportive atmosphere. They suggested using simulated patients in case-based learning and the use of game-based learning platforms:

“I think if we have, like in ITQAN [a Clinical Simulation and Innovation Center located on the Hamad Bin Khalifa Medical City (HBKMC) campus of Hamad Medical Corporation (HMC)], simulated patients, I think that will be perfect like in an “Integrated Case-Based Learning” case or professional skills or patient assessment labs where we can go and intervene with simulated patients and see what happens as a consequence. This will facilitate our learning.” [CPH-4]

“I feel that ‘Kahoot’ activities add a lot to the session. We get motivated and excited to solve questions and win. We keep laughing, and I honestly feel that the answers to these questions get stuck in my head.” [CHS-PH-38].

Students emphasized the need for more opportunities for research, career planning, and equity in terms of providing resources and opportunities for students:

“Students should be provided with more opportunities to do research, publish, and practice.” [CMED-16]

“We need better career planning and workshops or advice regarding what we do after graduation or what opportunities we have.” [CHS-PS-25]

“I think that opportunities are disproportionate, and this is not ideal. I believe all students should have the same access to opportunities like having the chance to participate in conferences and receiving research opportunities, especially if one fulfills the requirements.” [CHS-Biomed-35]

Furthermore, the students proposed the implementation of mentorship programs and a reward system to enable a better learning experience:

“Something that could enable our personal development is a mentorship program, which our college started to implement this year, and I hope they continue to because it’s an attribute of an ideal learning environment.” [CPH-11]

“There has to be some form of reward or acknowledgments to students, especially those who, for example, have papers published or belong to leading clubs, not just those who are, for example, on a dean’s list because education is much more than just academics.” [CHS-PS-26]

Subtheme 5.2. Supportive physical environment

Participants emphasized that the physical environment of the college significantly influences their learning attitudes. A student said:

“The first thing that we encounter when we arrive at the university is the campus. I mean, our early thoughts toward our learning environment are formed before we even know anything about our faculty members or the provided facilities. So, ideally, it starts here.” [CPH-10]

Therefore, students identified key characteristics of an optimal physical environment which included: having a walkable campus, designated study and social areas, and accessible food and coffee.

“I think that learning in what they refer to as a walkable campus, which entails having the colleges and facilities within walking distance from each other, without restrictions of high temperature and slow transportation, is ideal.” [CPH-8]

“The classrooms and library should be conducive to studying and focusing, and there should also be other places where one can actually socialize and sit with one’s friends.” [CDEM-22]

“It is really important to have a food court or café in each building, as our schedules are already packed, and we have no time to go get anything for nearby buildings.” [CHS-Biomed-34]

Data integration

Table 5 represents the integration of data from the quantitative and qualitative phases. It demonstrates how the quantitative findings informed and complemented the qualitative analysis and explains how quantitative data guided the selection of themes in the qualitative phase. The integration of quantitative and qualitative data revealed both convergences and divergences in students’ views of their learning environment. Both data sources consistently indicated that the learning environment supported the development of interpersonal skills, fostered strong relationships with faculty, and promoted an active, student-centered learning approach. This environment was credited with enhancing critical thinking, independence, and responsibility, as well as boosting students’ confidence and competence through clear role definitions and constructive faculty feedback.

However, discrepancies emerged between the two phases. Quantitative data suggested general satisfaction with timetables and support systems, while qualitative data uncovered significant dissatisfaction. Although quantitative results indicated that students felt well-prepared and able to memorize necessary material, qualitative findings revealed challenges with concentration and focus. Furthermore, while quantitative data showed contentment with institutional support, qualitative responses pointed to shortcomings in emotional and physical support.