Individual and Institutional Components of the Medical School Educational Environment

Purpose To examine, using a systems framework, the relative influence of individual-level and institution-level factors on student perceptions of the medical school educational environment. Method A series of hierarchical linear models were fit to a large, 18-school longitudinal dataset of student perceptions of the educational environment, various demographics, and student empathy, tolerance of ambiguity, coping, and patient-provider orientation. Separate models were evaluated for individual-level factors alone, institution-level factors alone, and the combination of individual-and institution-level factors. Results The individual-level model accounted for 56.7% of the variance in student perceptions of the educational environment. However, few specific variables at the individual level had noteworthy direct effects on these perceptions. Similarly, the institution-level model accounted for 10.3% of the variance in student perceptions, but the specific characteristics of the institution explained little of this impact. The combined individual-and institution-level model attributed 45.5% of the variance in student perceptions to individual-level factors and 10.8% to institution-level factors. Again, specific variables explained little of this impact. Conclusions These findings indicate that the impact of individual-level factors on perceptions of the educational environment is about four times greater than institution-level factors. This contrast reflects the fact that the educational environment is defined through a learner, not institutional lens. Nonetheless, institutions vary in learner perceptions of their environments, and these differences may provide some support for institutional initiatives to improve the educational environment. More broadly, these results evidence the complexity of the educational environment, both in defining it and in understanding its dynamics.