为塔吉克斯坦的医学教育改革提供信息：两所护理学院学习环境的证据。
Informing the medical education reform in Tajikistan: evidence on the learning environment at two nursing colleges.
机构信息
Swiss Tropical and Public Health Institute, Socinstrasse 57, PO Box 4002, Basel, Switzerland.
University of Basel, Basel, Switzerland.
出版信息
BMC Med Educ. 2019 Mar 18;19(1):85. doi: 10.1186/s12909-019-1515-0.
BACKGROUND
The Tajik medical education system is undergoing a complex reform to enhance the transition of the healthcare system from its soviet legacy of emphasizing secondary level care/specialisation to become more family medicine and primary health care oriented. The current study presents the first empirical evaluation of the educational environment for nursing students in Tajikistan using the Dundee Ready Educational Environment Measure (DREEM). The study results contribute to the benchmarking efforts of monitoring and positively steering the educational environment over time.
METHOD
The study was based on a cross-sectional survey involving 630 nursing students at two nursing colleges in Tajikistan. Students' perception of the learning environment was measured using the DREEM. Internal consistency was examined using Cronbach's alpha. General scores were calculated and measured against international benchmarks. Data was further interpreted by comparing DREEM scores between students of different sex, at different colleges and different study years using T tests.
RESULTS
Cronbach's alpha ranged from 0.30 to 0.75 with an overall alpha of 0.89. General DREEM scores were slightly above average compared to similar studies with nursing students in other countries. In particular, results showed that students' academic self-perception and teachers' technical competences were generally favourably rated. Teachers' pedagogical skills were critically perceived by the study participants and teaching was generally viewed as too teacher-centred with an over-emphasis on factual learning.
CONCLUSIONS
Statistical results indicated acceptable levels of reliability of the DREEM tool when applied to the Tajik nursing educational context. Students rated the learning environment as generally satisfactory with average scores similar or slightly higher than comparable scores from similar studies involving nursing students. However, the on-going educational reform could have placed more emphasis on developing faculty pedagogical skills in nursing schools. Teaching approaches would benefit from being more competency based rather than so heavily focused on factual knowledge.
背景
塔吉克斯坦的医学教育体系正在进行复杂的改革，以加强医疗体系的转型，使其从苏联时代强调二级护理/专业化的模式转变为更加以家庭医学和初级卫生保健为导向。本研究首次使用都柏林准备教育环境测量（DREEM）评估塔吉克斯坦护理学生的教育环境。研究结果有助于基准监测，并随着时间的推移积极引导教育环境。
方法
该研究基于一项横断面调查，涉及塔吉克斯坦两所护理学院的 630 名护理学生。使用 DREEM 测量学生对学习环境的感知。使用 Cronbach's alpha 检验内部一致性。计算总得分，并与国际基准进行比较。通过使用 T 检验比较不同性别、不同学院和不同学习年限的学生之间的 DREEM 得分，进一步解释数据。
结果
Cronbach's alpha 范围为 0.30 至 0.75，总体 alpha 为 0.89。与其他国家的护理学生类似研究相比，DREEM 总得分略高于平均水平。特别是，研究结果表明，学生对学术自我认知和教师的技术能力评价普遍较高。研究参与者对教师的教学技巧评价较差，教学普遍被认为过于以教师为中心，过分强调事实学习。
结论
统计结果表明，当应用于塔吉克斯坦护理教育背景时，DREEM 工具具有可接受的可靠性水平。学生对学习环境的评价总体上令人满意，平均得分与类似研究中涉及护理学生的可比得分相似或略高。然而，正在进行的教育改革可能更加注重在护理学校培养教师的教学技能。教学方法将受益于更加基于能力的方法，而不是过于注重事实知识。
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