Students’ DREEM scores were compared among different groups of respondents as well as against those obtained in a previous study [2]. The study was carried out among first- to fourth-semester MD students during the last week of January 2014 using a validated instrument, DREEM [1]. The aims and objectives of the study were explained to the students, and their written informed consent was obtained. A semester of study consists of 15 weeks. Students are admitted three times a year—in January, May, and September. Information was collected about the participating students’ semester of study, gender, nationality, and age. Their perceptions of the institution’s educational environment were documented by noting their degree of agreement with a set of 50 statements using a modified Likert-type scale. The statements were grouped into five categories: perception of teaching/learning; perception of teachers, academic self-perception, perception of atmosphere, and social self-perception. Certain statements were negative, and their scores were reversed in the calculation of the category scores. The total score was obtained by adding together the scores of all the categories. The data were analyzed using IBM SPSS ver. 20 (IBM Co., Armonk, NY, USA). The scores of individual statements were noted. The average scores were compared among different groups of respondents using appropriate statistical tests (P < 0.05). The mean total score and category scores were also compared to those obtained in the previous study [2].The present third- and fourth-semester MD students were in their first and second semester, respectively, at the time of the previous survey. Their scores in the previous and present study were compared using a paired t-test. Sixty of the 69 students (86.9%) in the undergraduate medical program participated in the study. Table 1 shows the demographic characteristics of the student respondents. The majority of respondents (66.7%) were male, aged 20 to 25 years, and of American nationality. The mean±SD total score was 151.32±18.3. The mean±SD scores for perception of teaching/learning and perception of teachers were 38.45±4.40 and 33.90±4.77, respectively. The mean±SD scores for academic self-perception, perception of atmosphere, and social self-perception were 22.95±5.07, 36.32±5.53, and 19.70±3.57, respectively.

Table 2 shows the category and total scores according to the gender of the respondents. There was no significant difference in the scores according to gender. Table 3 shows the category scores and total scores according to the respondents’ semester of study. There were no significant differences in the scores of students of different semesters. Table 4 shows the category scores and total scores of students by nationality. Among the scores of individual statements, the scores of the following statements (i.e., those with scores of less than 2.5) were areas of concern: I seldom feel lonely (2.35), I am rarely bored in this course (2.28), There is a good support system for students who feel stressed (2.23), The school uses a good timetable (2.00), The enjoyment outweighs the stress of studying medicine (2.30), and The teaching overemphasizes factual learning (reversed score; 2.00). All scores except those for the category of academic self-perception were significantly higher in the present study compared to the 2013 investigation [2]. The mean score for perception of teaching/learning was 38.45 in the present study, whereas it was 31.97 (p < 0.001) in the previous one. The mean score for perception of teachers was 33.90, compared to 30.05 (p < 0.001) in June 2013. Then, the mean score for perception of atmosphere increased from 30.92 in June 2013 to 36.32 in January 2014 (p < 0.001), while the mean score for social self-perception increased from 16.96 to 19.70 (p < 0.001) and the mean total score increased from 131.79 in to 151.32 (p < 0.001). The mean scores of the present third-semester students were compared to the same scores reported in the previous study when the students were in their first semester (Table 5). The scores for perception of teaching/learning and perception of teachers, and the total score, were significantly higher compared to those reported previously. The mean scores of the present fourth-semester students were compared to those obtained previously (Table 6). The score for perception of teaching/learning and the total score were significantly higher.

In the free comments section, the students wrote as follows: “The sporadic changes in the timetable are confusing and at times frustrating,” “Group studying after school hours seems to be discouraged because classrooms are not allowed to be used by separate groups,” “Students need to conduct themselves properly outside of school,” “Studying at school is impossible, and study carousels are needed,” “I think we need to have relaxation time after integrated quizzes and exams, because we are often sleep deprived,” and “There needs to be better communication between teachers and students as well as among teachers.” Each of these statements was only mentioned by a single student.

There was a significant improvement in all category scores and in the total score when the results of this study were compared to those of the previous one. Other previous studies have compared DREEM scores in schools over a period of time. For example, a school in Saudi Arabia saw a significant improvement in scores in 2010/2011 compared to 2007/2008 [4]. In a medical school in the United Arab Emirates, mean total scores were significantly higher for second-year students who participated in an integrated curriculum than for second-year students who had learned under a discipline-based curriculum the previous year [5]. Kuwait University Medical School underwent a curricular transition from a traditional to a problem-based curriculum in 2006/2007. Following the transition, students’ academic self-perception deteriorated while their perception of the atmosphere improved [6]. The authors postulate that this may be because conventional learning strategies were perceived as being no longer useful. In our study, there was no significant change in academic self-perception. The amount of PBL has increased, but lectures continue to be the predominant learning method at Xavier University School of Medicine. In addition, there was an improvement in certain areas of concern noted during the previous study. Among these were “The teaching is too teacher centered,” “I am too tired to enjoy this course,” “The teachers ridicule the students,” “The teachers are authoritarian,” and “The atmosphere is relaxed during the teaching.” We are working towards creating areas in the school where students can learn together in groups. With the increased emphasis on small group learning during PBL sessions and other activities, the students seem to have discovered the benefits of working in a group where group work and cooperative learning are encouraged. We are also working towards streamlining the timetable and have fortnightly meetings to finalize the integrated timetable for the next two weeks; however, sometimes faculties request changes even after the timetable is finalized, which creates confusion. As the course of study is accelerated and completed over a 15-week period, it is difficult to provide free time to the students both before and after the exam.

In conclusion, there were significant improvements in the category scores and the overall score compared to the results from June 2013. The results of this investigation will be of particular interest to schools that are in the process of transitioning to an integrated curriculum or those that have recently transitioned, as the issues and challenges they face may be similar to those mentioned in this study.