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The Medical School Learning Environment Survey: an examination of its factor structure and relationship to student performance and satisfaction

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The Medical School Learning Environment Survey (MSLES) was used with a sample of 311 undergraduate medical students in British Columbia, Canada, to assess the seven scales of Medical Breadth of Interest, Personal Breadth of Interest, Emotional Climate, Flexibility, Meaningful Learning Experience, Organization, Nurturance and Student–Student Interaction. Confirmatory factor analysis was used to support the validity of the MSLES when used with this sample.

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The authors wish to thank Chris Lovato for her helpful comments in preparing this manuscript.

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Correspondence to Shayna Rusticus.



Medical School Learning Environment Survey Items

Medical Breadth of Interest

8. Faculty emphasise the personal as well as the technical aspects of health care

32. Faculty try to get students interested in the broad social context of medicine

53. Faculty foster an understanding of the psychological dynamics of being ill

Personal Breadth of Interest

16. The environment of the school allows for interests outside of medicine

34. Students have difficulty finding time for family and friendsa

38. Students are so preoccupied with their studies that they lack time for recreationa

Emotional Climate

5. The educational experience makes students feel depresseda

17. The educational experience tends to make students feel a sense of achievement

23. The educational experience makes students feel angrya

27. Students’ anxiety hinders them from achieving up to their full potentiala

33. Students talk about leaving schoola

46. The educational experience makes students feel anxiousa

48. There are tensions among students that interfere with learninga

50. The educational experience makes students value themselves

55. The educational experience tends to make students feel confident of their academic abilities


1. Faculty try out new teaching methods and materials

2. Students are able to shape their academic program to fit their individual needs and preferences

13. Students hesitate to express their opinions and ideas to the facultya

18. Curricular and administrative policies are inflexiblea

26. Student complaints are responded to with meaningful action

39. Students participate in decisions that affect their academic life at the school

56. The program accommodates students from diverse personal and family backgroundsb

57. The program generally allows for students to learn in ways that suit their own individual learning styleb

61. The program accommodates the diversity of knowledge, skills, and backgrounds that students have prior to entering medical schoolb

62. The program generally allows for students to learn at their own paceb

Meaningful Learning Experience

9. Students feel that they are learning what they need to learn in order to become competent physicians

12. Exams emphasise understanding of concepts rather than memorisation of facts

19. Students are called upon to actively put methods and ideas to use in new situations

24. The relationship between basic science and clinical material is not cleara

28. Faculty exhibit enthusiasm for the subject matter of their special field

35. Courses emphasise memorisation of trivial detailsa

37. Students can see the relationship between what they are studying and the kinds of patient care situations they will meet when they graduate

40. Courses emphasise the interdependence of facts, concepts, and principles

44. Courses develop skills in formulating and testing hypotheses, and drawing conclusions

45. Courses are dull and tediousa


4. Instructors outline course objectives at the beginning of their courses

10. Classes progress systematically from week to week

14. Course assignments are vague and ambiguousa

21. Instructors explain what students should get out of their courses, and why the material is important

25. Students have difficulty integrating course material into a cohesive wholea

30. Assignments are given out well in advance so students can plan their time accordingly

42. Students are uncertain as to what will be expected of them on examinationsa

51. Examinations provide a fair measure of student achievement

54. There is lack of consistency between stated course objectives and what is actually taughta


6. The emphasis given to a particular content area on an exam is in proportion to the emphasis given to that content in the course

11. Faculty are reserved and distant with studentsa

20. Faculty and administrators give personal help to students having academic difficulty

29. The school takes an interest in the personal welfare of the students

36. When giving criticism or answering a question, faculty are genuinely interested in helping the student

41. Students are uncomfortable around the facultya

47. Faculty are helpful to students seeking advice not directly related to academic matters

49. Faculty regard their teaching responsibilities as a burdena

Student–Student Interactions

7. Students in the school are distant with each othera

15. Students in the school get to know each other well

22. Students gather together in informal activities

31. Students spend time assisting each other

43. Competition for grades is intensea

52. Students are reluctant to share with each other problems they are havinga

Dropped Items (based on factor analysis results)

3. A background in the behavioural sciences is seen as important in the development of a physician

58. The program allows for time to participate in school-related social functionsb

59. Students have time to participate in student-organised clubsb

60. Students have time to participate in community/volunteer service, either as part of or external to the medical programb

  1. aReverse-coded item
  2. bNew item

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Rusticus, S., Worthington, A., Wilson, D. et al. The Medical School Learning Environment Survey: an examination of its factor structure and relationship to student performance and satisfaction. Learning Environ Res 17, 423–435 (2014).

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