The Dundee Ready Education Environment Measure (DREEM): a review of its adoption and use

The Dundee Ready Education Environment Measure DREEM a review of its adoption and use


Background: The Dundee Ready Education Environment Measure (DREEM) was published in 1997 as a tool to evaluate educational environments of medical schools and other health training settings and a recent review concluded that it was the most suitable such instrument.

Aims: This study aimed to review the settings and purposes to which the DREEM has been applied and the approaches used to analyse and report it, with a view to guiding future users towards appropriate methodology.

Method: A systematic literature review was conducted using the Web of Knowledge databases of all articles reporting DREEM data between 1997 and 4 January 2011.

Results: The review found 40 publications, using data from 20 countries. DREEM is used in evaluation for diagnostic purposes, comparison between different groups and comparison with ideal/expected scores. A variety of non-parametric and parametric statistical methods have been applied, but their use is inconsistent.

Conclusions: DREEM has been used internationally for different purposes and is regarded as a useful tool by users. However, reporting and analysis differs between publications. This lack of uniformity makes comparison between institutions difficult. Most users of DREEM are not statisticians and there is a need for informed guidelines on its reporting and statistical analysis.

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The DREEM, part 1: measurement of the educational environment in an osteopathy teaching program


Measurement of the educational environment has become more common in health professional education programs. Information gained from these investigations can be used to implement and measure changes to the curricula, educational delivery and the physical environment. A number of questionnaires exist to measure the educational environment, and the most commonly utilised of these is the Dundee Ready Educational Environment Measure (DREEM).


The DREEM was administered to students in all year levels of the osteopathy program at Victoria University (VU), Melbourne, Australia. Students also completed a demographic survey. Inferential and correlational statistics were employed to investigate the educational environment based on the scores obtained from the DREEM.


A response rate of 90% was achieved. The mean total DREEM score was 135.37 (+/- 19.33) with the scores ranging from 72 to 179. Some subscales and items demonstrated differences for gender, clinical phase, age and whether the student was in receipt of a government allowance.


There are a number of areas in the program that are performing well, and some aspects that could be improved. Overall students rated the VU osteopathy program as more positive than negative. The information obtained in the present study has identified areas for improvement and will enable the program leaders to facilitate changes. It will also provide other educational institutions with data on which they can make comparisons with their


The educational environment has been studied across the entire spectrum from primary through to tertiary level, and even beyond to post-graduate training. Components of the educational environment include, but are not limited to: the physical infrastructure such as rooms for lectures, tutorials and clinical activities; facilitating and constraining factors for learning; the atmosphere created by fellow students; and faculty including teaching, clinical and administrative staff [12]. For an excellent discourse on the concepts and issues around the educational environment see Genn [34] who points out the environment created by a program impacts student behaviour i.e. approach to study [45], understanding of practice [6] and the educational outcomes achieved [37].

Understanding an educational program environment can assist with quality assurance by identifying where a program can be improved, and subsequently evaluating changes that are implemented [389]. Within health professional education, measurement of the environment has received some attention exploring particularly the impact on educational outcomes. Although not based on any specific educational theory [1], numerous measures of the educational environment in health professional programs have been published [10]. The most commonly utilised measure is the Dundee Ready Education Environment Measure (DREEM) [11]. Previous work by Brown et al. [12] utilised the DREEM to assess the educational environment within the allied health programs at a single Australian university (Monash University, Melbourne). These authors demonstrated a small range in total DREEM scores from 133 (Pharmacy) to 145.5 (Dietetics). As Osteopathy in Australia sits within the field of allied health, comparisons between the Monash University pre-professional programs and the current osteopathy program are appropriate. This is explored further within the discussion of the present study.

Although widely used in medical education, there is only one study in the literature adopting this measure in osteopathic education. Luciani et al. [13] employed the DREEM with the final year cohorts of three European osteopathy teaching institutions. There are currently no studies examining the educational environment of students in earlier year levels of an osteopathic curriculum, none that compare responses between year levels, nor any that investigate changes over the students’ entire time within a programme of study. The aim of the present study is to investigate the educational environment, using the DREEM, in all 5 year levels of an osteopathy program.



This study was approved by the Victoria University Human Research Ethics Committee.


This study was undertaken in the osteopathic discipline within the College of Health and Biomedicine at Victoria University (VU), Melbourne, Australia. The osteopathy program is five (5) years in duration with students completing a Bachelor of Science (Clinical Science) in years one to three, and a Master of Health Science in years four and five. Both degrees are required for registration as an osteopath in Australia.


All students enrolled in the core subject Osteopathic Science were eligible to participate in the study. All students enrolled in semester two, 2013 were sent an email by the primary author (BV) informing them of the study and inviting them to participate. The email also contained a plain language statement and students were informed that all responses were anonymous and confidential.


Participants were invited to complete two measures: 1) a demographic questionnaire; and 2) the Dundee Ready Education Environment Measure (DREEM). The demographic questionnaire contained 11 items (Figure 1).

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