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Identifying the perceived weaknesses of a new curriculum by means of the 

Dundee Ready Education Environment Measure (DREEM) Inventory 

Hettie Till a 

a 

Canadian Memorial Chiropractic College, Toronto, Canada 

Online Publication Date: 01 February 2004 

To cite this Article Till, Hettie(2004)'Identifying the perceived weaknesses of a new curriculum by means of the Dundee Ready 

Education Environment Measure (DREEM) Inventory',Medical Teacher,26:1,39 — 45 

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Medical Teacher, Vol. 26, No. 1, 2004, pp. 39–45 

Identifying the perceived weaknesses of a new 

curriculum by means of the Dundee Ready Education 

Environment Measure (DREEM) Inventory 

HETTIE TILL 

Canadian Memorial Chiropractic College, Toronto, Canada 

Downloaded By: [University of Maastricht] At: 18:13 25 November 2008 

SUMMARY The Canadian Memorial Chiropractic College is in 

the fourth year of implementing a new four-year Integrative 

Curriculum. In order to determine how the students experienced the 

educational environment generated by the new curriculum, the 

Dundee Ready Education Environment (DREEM) Inventory 

was administered on the same day to 148 (96%) first-year, 131 

(87%) second-year, and 128 (84%) third-year students 

(n ¼ 407). Resultant scores indicated many areas of concern. 

However, bimodal and large numbers of ‘uncertain’ responses also 

occurred. In order to establish and compare areas of most concern 

between the three year groups, responses were calculated as 

percentages indicating for each item those who agree, disagree or 

are uncertain. This result clearly indicated areas of joint concern for 

each of the five domains addressed by the DREEM Inventory. 

Analysis of these concerns formed the basis of strategic planning 

in order to institute remedial action, and on which to focus 

institutional resources. 

Introduction 

Curriculum changes are usually undertaken in order to 

improve the whole learning environment for the students. 

Yet, the whole process of change, as well as the rate of 

change, is inevitably stressful for both students and faculty 

(McAleer et al., 1997; Roff et al., 1997). It is thus important 

to determine how our students are actually experiencing 

the educational environment created by a new curriculum 

by asking the question ‘‘What is (medical) education here 

really like?’’ (Genn & Harden, 1986). 

The Canadian Memorial Chiropractic College (CMCC) 

is situated in Toronto, Canada and offers a four-year professional 

programme. The majority of the students entering 

the programme have at least a bachelor’s degree with 2–3% 

per year also having graduate degrees. Until three years ago 

the educational programme consisted of three years of basic 

and clinical studies with the fourth year being a mix of 

didactic and practical teaching as well as an internship, all 

based very much on a traditional medical education model. 

In September 1999 a new Integrative Curriculum was 

introduced with the aim of placing the student’s focus 

on chiropractic studies through attempting to make taught 

material clinically meaningful from the first day of class. 

By December 2001, the first group of students to 

experience the new curriculum were halfway through their 

third year of study. These third-year students had indicated 

through focus-group meetings that they not only perceived 

themselves to be ‘guinea pigs’, but also that they were not 

satisfied with the third-year curriculum. The focus group 

meetings had also indicated that, although they did not 

appear seriously unhappy with the curriculum, the first- and 

second-year students were beginning to show similar signs 

of dissatisfaction with the educational environment, as did 

the third-year students. The focus-group messages were 

viewed very seriously, as evidence exists indicating that 

educational climate influences student behaviour and that 

it has a strong effect on student achievement, satisfaction and 

success (Pimparyon et al., 2000; Genn, 2001a; Cavanaugh & 

Simmons, 1997). The fact that the third-year students’ 

negative perception of the educational climate was being 

echoed by the first- and second-year students was therefore 

a source of great concern. The establishment of a healthy 

educational climate becomes obvious if one takes note of 

the fact that climate has been likened to a mist with the 

observation that one could not stay for long in a mist before 

becoming thoroughly soaked (Stern, 1970, as cited in Genn 

& Harden, 1986). 

Steps therefore had to be taken urgently to identify the 

elements operating in the educational environment of the 

institution, and to evaluate how the students perceive them in 

order to provide a basis for modifications that could enhance 

the students’ learning experiences in relation to our teaching 

goals (Genn, 2001b). We decided to undertake an institutional 

climate study and the present research is one part of 

a larger multipronged, longitudinal quality assurance study 

undertaken at the institution for the purposes of understanding, 

and possibly enhancing, the quality of the educational 

environment for the students. The purpose of the 

research reported here was to attempt to identify the 

perceived weaknesses of the new Integrative Curriculum in 

order to focus institutional resources on those areas that 

would require remedial action. 

Method 

I selected the Dundee Ready Education Environment 

Measure (DREEM) Inventory to measure the educational 

climate at CMCC. The DREEM Inventory is a validated 

inventory (McAleer et al., 1997; Roff et al., 1997) with proven 

high reliability (McAleer et al., 1997; Roff et al., 1997; 

Pimparyon et al., 2000; Roff et al., 2001) that has been 

used in various countries around the world to assess the 

educational climate of health professional/medical schools. 

Correspondence: Hettie Till, MSc M.Med.Ed D.Ed, Canadian Memorial 

Chiropractic College, 1900 Bayview Avenue, Toronto, Ontario, Canada M4G 

3E6. Tel: (416)-482-2340; fax: (416)-488-0470; email: htill@cmcc.ca 

ISSN 0142–159X print/ISSN 1466–187X online/03/040039-7 ß 2004 Taylor & Francis Ltd 39 

DOI: 10.1080/01421590310001642948

H. Till 


The inventory consists of 50 items with each item scored on 

a five-point Likert scale with 4 ¼ strongly agree, 3 ¼ agree, 

2 ¼ unsure, 1 ¼ disagree and 0 ¼ strongly disagree. Seven 

of the items are negative and are thus scored in reverse so 

that a higher score indicates a more positive reading. The 

Inventory measures five domains or subscales of students’ 

perceptions of a given institution: (1) students’ perceptions of 

learning, (2) students’ perceptions of teachers, (3) students’ 

academic self-perception, (4) students’ perception of atmosphere, 

and (5) students’ social self-perceptions. The scale 

allows the user to report a total environment score as well 

as scores for the five domains or subscales. 

The DREEM Inventory was administered on the same 

day at the end of February 2002 to all first-, second- and 

third-year students. The fourth-year students were excluded 

for the following two reasons. First, they were the last 

group of the previous curriculum and had thus not 

experienced the new curriculum that was being evaluated. 

Second, they were at that time involved in the—mostly— 

clinical part of their studies and were scattered among seven 

different clinics, only one of which was on campus. Although 

it would have been interesting to obtain their perceptions 

of the educational environment as part of the longitudinal 

quality assurance project planned, it was unfortunately not 

possible to get a representative sample from this group at 

the time of the study. 

Before the students completed the inventory, I addressed 

the classes explaining the purpose for collecting the data 

as well as the process of data collection, and stressing 

the anonymity of the participants and the fact that the data 

could not be tracked back to individual participants. I also 

explained that the data would be used for quality assurance as 

well as for research purposes and requested the students’ 

cooperation, making it clear that participation would be 

entirely on a voluntary basis. 

Students marked their responses to the items on a 

computer card which was then scanned in order to obtain 

responses per item. I also requested them to indicate on 

their computer cards their year of study as well as their 

gender. By means of the statistical package SPSS, Levene’s 

test was used to test for equality of variances, and the 

Independent Samples t-test to identify significant differences 

between the different year groups as well as between the 

male and female students in each group ( < 0.05). 

In order to get an overview of students per year of study 

that indicated specific problems with each item of the 

DREEM Inventory, the percentage of all the students 

who had strongly agreed and agreed (yes), those who were 

uncertain (neutral), as well as those who strongly disagreed 

and disagreed (no) were calculated and compared. Those 

items, per domain, where the majority of students indicated 

problems, were then extracted and listed. 

This study had received prior approval from the Internal 

Revue Board of CMCC as complying with the institutional 

Research Policy and Procedure manual. 

Results 

The DREEM Inventory was administered on the same day 

to all first-, second- and third-year students and 148 (96%) 

first-year, 131 (87%) second-year and 128 (84%) third-year 

students (n ¼ 407) returned valid responses. Unfortunately, 

not all of the students remembered to indicate their gender 

on the computer response forms, but of the 372 (91%) of the 

students who did so, 54% were female and 46% male, 

compared with the overall gender distribution of undergraduate 

students at the time which was about an equal 

distribution between male and female. 

Table 1 shows the mean DREEM scores per year of study. 

The mean total DREEM score was 97/200 and the mean 

scores for the five domains were as follows: (1) Perceptions 

of learning 19/48; (2) Perceptions of teaching 24/44; (3) 

Academic self-perception 15/32; (4) Perceptions of atmosphere 

25/48; and (5) Social self-perceptions 15/28. The 

results per year indicated large differences between the three 

years in the average scores per domain and showed that the 

scores decreased considerably from the first year, which 

had the best results, to the third-year students, who had the 

lowest scores. 

Several statistically significant differences were found 

between the responses of the three groups. Twenty-eight 

items registered as significantly different between the first 

and second years’ responses, 37 items between the second 

and third years’, and 44 between the first and third years. The 

only items where no significant differences were registered 

between all three the groups are listed in Table 2. 

A similar analysis between male and female students 

indicated only three significantly different responses for first 

years and four for the third years, while the second-year 

group registered 20 such differences between male and 

female responses. The first-year female students gave lower 

mean responses than the males for all three significantly 

different items, and the third-year female students gave 

higher mean responses for all four significantly different 

items. The second-year female students gave lower mean 

responses for six and higher mean responses for 14 of their 20 

significantly different items. 

Close investigation of the results indicated that bimodal 

and large numbers of ‘uncertain’ responses also occurred. 

The first-year students, in particular, sometimes gave mixed 

messages as indicated in Table 3. Such mixed messages also 

contributed to lower scores per item. 

Table 4 gives examples of the results obtained after 

calculating and comparing, for each of the items, the percentages 

of students who had strongly agreed and agreed (yes), 

those who were uncertain (neutral), as well as those who 

strongly disagreed and disagreed (no). Table 4 indicates, for 

example, that for Item 25 the majority of students in all three 

years felt that the teaching over-emphasized factual learning. 

Similarly 80% of the third years, 66% of the second years and 

37% of the first years disagreed with the statement in Item 47 

that long-term learning was emphasized over short-term 

learning. Tables 5 to 9 show the items per domain where the 

majority of the students indicated problems. 

Discussion 

The students were keen to complete the DREEM Inventory, 

as they perceived it as an ideal opportunity to ‘voice’ their 

opinions, and the good response rates ensured that we had 

access to the views of the majority of our students. 

The differences between the three years in the average 

scores per domain (Table 1), indicating different perceptions 

of the educational environment, were somewhat to be 

40

Identifying the weaknesses of a new curriculum 

Table 1. Mean DREEM scores per item and year of study. 


Item First year Second year Third year 

(1) I am encouraged to participate in class 2.3 2.0 1.5 

(2) The teachers are knowledgeable 2.8 2.9 2.6 

(3) There is a good support system for students who get stressed 1.7 1.3 1.0 

(4) I am too tired to enjoy the course 1.3 1.1 0.7 

(5) Learning strategies which worked for me before continue to work for me now 2.2 2.0 1.5 

(6) The clinicians are patient with patients 2.7 2.7 2.6 

(7) The teaching is often stimulating 1.9 1.5 0.9 

(8) The teachers ridicule the students 2.8 2.2 2.2 

(9) The teachers are authoritarian 2.1 1.7 1.3 

(10) I am confident about my passing this year 2.9 2.9 2.6 

(11) The atmosphere is relaxed during the clinic teaching 2.6 2.4 1.8 

(12) This college is well timetabled 1.6 0.9 0.3 

(13) The teaching is student centred 2.0 1.2 0.7 

(14) I am rarely bored on this program 1.8 1.4 1.1 

(15) I have good friends in this college 3.2 3.3 3.4 

(16) The teaching helps me to develop my competence 2.6 2.3 1.4 

(17) Cheating is a problem in this college 2.5 2.4 2.4 

(18) The clinicians have good communications skills with patients 2.6 2.6 2.5 

(19) My social life is good 2.5 2.4 1.9 

(20) The teaching is well focused 2.1 1.4 1.1 

(21) I feel I am being well prepared for my profession 2.1 1.5 1.3 

(22) The teaching helps to develop my confidence 2.3 1.6 1.0 

(23) The atmosphere is relaxed during lectures 2.7 2.5 2.2 

(24) The teaching time is put to good use 1.8 1.3 0.8 

(25) The teaching over-emphasizes factual learning 1.5 1.3 1.1 

(26) Last year’s work has been a good preparation for this year’s work 2.1 2.5 1.7 

(27) I am able to memorize all I need 1.3 1.5 0.9 

(28) I seldom feel lonely 2.5 2.4 2.0 

(29) The teachers are good at providing feedback to students 2.0 1.5 0.9 

(30) There are opportunities for me to develop interpersonal skills 2.8 2.5 1.9 

(31) I have learned a lot about empathy in my profession 2.1 1.9 1.4 

(32) The teachers provide constructive criticism here 2.2 1.9 1.2 

(33) I feel comfortable in class socially 3.2 3.1 3.0 

(34) The atmosphere is relaxed during seminars/tutorials 3.1 2.9 2.8 

(35) I find the experience disappointing 2.4 1.7 1.1 

(36) I am able to concentrate well 1.8 1.7 1.4 

(37) The teachers give clear examples 2.2 2.0 1.5 

(38) I am clear about the learning objectives of the program 2.1 1.7 1.4 

(39) The teachers get angry in class 2.6 1.7 2.1 

(40) The teachers are well prepared for their classes 2.7 2.6 2.1 

(41) My problem solving skills are being well developed here 1.9 1.7 1.6 

(42) The enjoyment outweighs the stress of the program 1.7 1.5 0.8 

(43) The atmosphere motivates me as a learner 1.9 1.4 0.7 

(44) The teaching encourages me to be an active learner 2.0 1.6 1.2 

(45) Much of what I have to learn seems relevant to a career in chiropractic 2.0 1.5 1.2 

(46) My accommodation is pleasant 2.9 3.1 3.1 

(47) Long-term learning is emphasized over short-term learning 2.0 1.3 0.8 

(48) The teaching is too teacher centred 1.8 1.5 1.0 

(49) I feel able to ask the questions I want 2.6 2.3 2.0 

(50) The students irritate the teachers 2.0 1.9 1.3 

I. Students’ perception of learning 24 19 13 

II. Students’ perception of teachers 27 24 20 

III. Students’ academic self-perception 17 16 12 

IV. Students’ perception of atmosphere 29 25 20 

V. Students’ social self-perception 16 15 13 

Total 113 98 79 

41

H. Till 

Table 2. List of DREEM Inventory items where no significant differences registered between the three years of study. 

Item Year 1 Year 2 Year 3 

6: The clinicians are patient with patients 2.64 2.65 2.60 

15: I have good friends in this college 3.05 3.34 3.37 

17: Cheating is a problem in this college 2.53 2.40 2.36 

18: The clinicians have good communication skills with patients 2.57 2.60 2.45 

33: I feel comfortable in class socially 3.14 3.05 3.00 

46: My accommodation is pleasant 2.89 3.06 3.07 

Total DREEM scores 16.8 17.1 16.9 

Table 3. Examples of first-year responses that gave an unclear message of their perceptions of 

the educational environment. 


Item Options Responses Percentage 

There is a good support system 

for students who get stressed 

expected. However, the low total scores for all three years 

were a matter of serious concern. The low scores for all five 

domains for the third-year students supported the information 

brought forward from the focus-group meetings that the 

A. Strongly agree 5 3 

B. Agree 12 8 

C. Uncertain 75 51 

D. Disagree 41 28 

E. Strongly disagree 14 9 

13. The teaching is teacher centred A. Strongly agree 3 2 

B. Agree 60 41 




21. I am being well prepared 

for my profession 

26. Last year’s work has been a good 

preparation for this year’s work 

Table 4. Examples of the percentage of students who 

agreed, disagreed, or were uncertain about the 

different items of the DREEM Inventory. 

Item 25: The teaching over-emphasizes factual learning 

Year 1 Year 2 Year 3 

Yes 53 68 74 

Neutral 24 13 7 

No 22 19 20 

Item 47: Long-term learning is emphasized over short-term 

learning 

Year 1 Year 2 Year 3 

Yes 39 21 10 

Neutral 22 13 11 

No 37 66 80 











third years perceived themselves to be guinea pigs and that 

they had found the third-year curriculum to be wanting 

in many aspects. The low mean scores from the first- and 

second-year students also supported the messages coming 

out of the focus-group meetings indicating that the first- and 

second-year students were beginning to show similar signs of 

dissatisfaction with the educational environment as did the 

third years. 

Some of the low mean scores of the first-year students 

might have been due to the fact that they had only been at the 

institution for six months when they were asked to complete 

the questionnaire and they had therefore not yet experienced 

some parts of the educational environment such as items 

relating to the clinic. In some of the areas surveyed by 

the DREEM Inventory the first years might thus not have 

been too sure of how to respond (Table 3). For example, 

51% of the first-year students indicated an ‘uncertain’ 

response to Item 3, ‘There is a good support system for 

students who get stressed’. Although this might simply 

mean that the first-year students were not (yet) too stressed 

by their studies, this result did contribute to the overall 

low score. Similarly for Item 13, ‘The teaching is teacher 

42



Table 5. Perceived weaknesses as indicated by the students 

in Domain I: Perceptions of Learning a . 

All three years of study agreed that: 

The teaching over-emphasizes factual learning (53/68/74) 

The second and third years (and some first years) agreed that: 

The teaching is not student centred (35/71/89) 

Teaching time is not put to good use (45/66/85) 

The teaching is not stimulating (41/62/83) 

The teaching is too teacher centred (40/55/98) 

The second and third years agreed that: 

The teaching over-emphasizes short-term learning (66/80) 

The teaching does not help them to develop confidence (58/79) 

The teaching is not well focused (57/78) 

The teaching does not encourage active learning (56/68) 

Notes: a Figures in parentheses indicate the percentages of 

students per year that agreed with the statement. Percentages 

are listed in ascending order, i.e. first years, second years, and 

third years. Where there are only two figures in the 

parentheses, the order is second years and then third years. 


in Domain II: Perceptions of Teachers a . 

None that all three years agreed upon 

The second and third years (and some of the first years) agreed 

that: 

The teachers are authoritarian (32/50/62) 

The teachers are not good at providing feedback to the students 

(43/53/83) 

As an added weakness must be seen the fact that in none of the 

years more than 50% of the students indicated that: 

They get constructive criticism (46/33/11) 

They get clear examples (48/37/21) 



are listed in ascending order, i.e. first years, second years, 

and third years. Where there are only two figures in the 



in Domain III: Academic Self-perceptions a . 

The third-year students perceived every item as negative except 

that they were confident about passing the year 

All three years of study agreed that: 

They are not able to memorize all that they need (67/62/80) 


They feel that they are not being well prepared for their 

profession (55/62) 

Much of what they had to learn did not seem relevant to a career 

in chiropractic (61/70) 




third years. Where there are only two figures in the 



in Domain IV: Perceptions of Atmosphere a . 

All three years agreed that: 

The institution is not well timetabled (53/79/94) 


The atmosphere does not motivate them as learners (62/91) 







in Domain V: Social Self-perceptions a . 

All three years agreed that: 

They are too tired to enjoy the programme (71/75/88) 


There is not a good support system for students who get stressed 

(62/71) 

They are sometimes bored with the programme (64/72) 






centred’ where only 2% strongly agreed and 41% agreed. 

The majority of the first years (57%) therefore did not agree 

with the statement. Part of the reason for students (in all 

three years) giving an ‘uncertain’ response, or giving a mixed 

message for items such as Item 13, can also be attributed 

to the fact that pockets of problem areas exist. For example, 

not all of the courses were poorly presented, or were too 

teacher centred, or poorly planned. Also, although the 

Integrative Curriculum was developed to place the student’s 

focus on chiropractic studies through attempting to make 

taught material clinically meaningful from the first day of 

class, it must also be noted that the first year of professional 

studies still includes a large proportion of basic sciences. 

The first-year students might, therefore, not have been too 

sure whether all this information was helping them in 

becoming well prepared for their profession. However, the 

fact that they were not too sure is possibly an indication 

that the material was not presented to them in a format that 

made its relevance to their chosen profession very clear. 

As far as Item 26 is concerned, ‘Last years’ work has been 

a good preparation for this years’ work’, for the majority 

of the first-year students their pre-professional studies might 

not have been too good a preparation for their first year 

of chiropractic studies. Again, that was not surprising as 

the students are selected from a variety of educational 

backgrounds. 

However, the strong message received from all three 

years of students required urgent action. What action to take, 

in other words how to take the DREEM results and turn 

them into a strategic plan, was, however, not so easy. 

As this was the first climate study done at this institution by 

43

H. Till 


means of the DREEM Inventory, there were no previous 

results to compare with. The literature also gave no indication 

of what institutions do after they get the results of a 

climate study. The first-year students’ total DREEM score 

of 113/200 was, for example, similar to the 118/200 reported 

by Roff et al. (2001) for the Nigerian undergraduate medical 

students. However, that paper contrasted the results from 

two medical schools and gave no indication of what strategic 

plans resulted at the Nigerian medical school in response 

to the measurement of their educational climate. 

In a further attempt to find usable information, the 

mean responses of the three groups were compared to find 

statistically significant differences between the years of study. 

The results of this comparison indicated large differences in 

the responses between the three groups and Table 2 lists 

the only six items where no significant differences registered 

between the three years of study. The apparent differences 

in how the different groups experienced the educational 

environment at the institution again supported the different 

levels of their experience not only of the institution, but 

also of the curriculum. So, not much guidance for the 

development of a focused plan of action came from this 

exercise. Also, the comparison between male and female 

students to find statistically significant differences between 

their responses similarly delivered no guidance for the 

development of a focused plan of action. Contrary to Roff 

et al. (2001), who found that both Nigerian and Nepalese 

female students were significantly less pleased with their 

educational environments, no such definite pattern could 

be determined at CMCC. For example, the female secondyear 

students were less satisfied with six aspects of their 

programme and more satisfied than the male students with 

14 aspects. The first-year female students were significantly 

less satisfied with only three aspects of their programme, 

whilst the third-year female students were more satisfied 

than the males with four aspects of their programme. 

Taking all of these facts into consideration, it was felt 

that institutional remedial action should rather be based 

on the actual number, or percentage, of students per year 

of study that indicated specific problems (Tables 5 to 9). 

The results obtained from these tables gave a very clear 

indication of where the majority of the students perceived 

areas of serious concern. Our students were telling us: 

that they were stressed; 

that they were too tired to enjoy the programme. 

This cry from students is, unfortunately, only too common 

to medical and many other healthcare professions programmes 

due in no small part to the quantity and quality of 

information that has to be absorbed during the time of 

studies. However, our students were also more specific 

in that they requested help with: 

the third-year curriculum in particular; 

content overload; 

not enough active learning; 

the perceived clinical relevance of material taught; 

the lack of feedback and constructive criticism; 

assessment methods that tested mostly recall and 

short-term memory (the commonly used multiple-choice 

examinations). 

Based on this very clear indication from our students, it was 

then possible to develop both short-term and long-term 

strategic plans to try and enhance the quality of the 

educational environment for our students, which will be 

addressed in a later paper. 

Conclusion 

It became clear that the students lost some of the neutrality 

that they exhibited in the first year and became more critical 

of the educational environment as they progressed through 

the programme. The low mean scores, particularly for the 

third years, required urgent remedial action and it was found 

that the DREEM Inventory was effective as a diagnostic 

tool in order to identify areas of most concern. The results 

obtained in this study were thus used to guide strategic 

planning and the institutional focus of available resources. 

In order to manage change successfully, it is necessary to 

obtain regular evaluation and feedback as it is only through 

the information obtained in this way that alterations can be 

made, mistakes corrected and momentum maintained. 

Further data received on an annual basis from the planned 

longitudinal study using the DREEM Inventory should 

thus provide further valuable input for strategic planning 

purposes. 

Practice points 

Climate studies are undertaken in order to determine 

how students experience the educational environment 

generated by a curriculum. 

Institutional remedial action should follow students’ 

indication of areas of concern. 

The DREEM Inventory can be used effectively as a 

diagnostic tool in that the results indicate clearly where 

the majority of the students perceived areas of serious 

concern. 

The DREEM Inventory can thus be used to guide 

strategic planning and focus institutional resources on 

those areas that require remedial action. 

Notes on contributor 

HETTIE TILL, M.Sc, M.Med.Ed, D.Ed is Professor and Associate Dean, 

Undergraduate Studies at the Canadian Memorial Chiropractic 

College (CMCC) in Toronto, Canada. She is actively involved in 

curriculum development and programme evaluation. 

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