Comparisons Between Preclinical and Clinical Dental Students’ Perceptions of the Educational Climate at the College of Dentistry, Jazan University

Figures & data

Table 1 Summary of Dental Student’s Perception Using DREEM Inventory for EC at Different Local and Worldwide Studies

Researchers/Publication Year	College, University City, Country	Students Levels and Response Rate	Sample Size, Male and Female	DREEM Total Score/200 and Subscale and Domains	Overall Score, Subscales and Weak Items, Gender Significances
Dental studies conducted in dental colleges in SA
Current study Aldowsari et al, 2020	Dental College, Jazan University, SA DC, JU	3rd to 6th year RR; 91%	272 M 57.4% F 42.6% Preclinical 51.5% Clinical 48.5%	125.19±15.11 Preclinical; 126,21±16,02 (mean) Clinical; 124,1±14,04 (SPL) 31.88±4.99 (31.36±4.69) 30.82±4.29 (SPT) 26.26±3.44 (26.18±3.24) 26.09±3.03 (SASP) 21.98±3.07 (21.92±3.52) 21.86±3.05 (SPA) 28.26±5.4 (28.08±5.29) 27.89±5.18 (SSSP) 17.83±3.08 (17.64±3.03) 17.45±2.97	More positive than negative Nonsignificant differences ween preclinical and clinical phases Nonsignificant differences between gender Items scored ≤2 were teaching overemphasizes factual learning, too teacher-centered. Teachers ridicule students, are authoritarian, get angry in teaching sessions. Students irritate teachers, cheating is problem in this course, experience disappointing, and good support for students who get stressed.
Al-Saleh et al, 2018^Citation9	Dental College, King Saud University, SA DC, KSU	All students and intern RR; 60.73%	302 M 44% F 56%	108.42 (18.92) 2nd year; 118.36±15.8 (mean) Interns; 105±21.3 (SPL) 27.88±4.96 (25.30) 23.91±5.62 (SPT) 26.06±4.81 (24.42) 22.28±4.90 (SASP) 20.06±3.92 (19.80) 18.43±2.85 (SPA) 29.87±4.52 (25.16) 24.21±6.86 (SSSP) 16.47±4.54 (14.47) 13.02±0.54	More positive than negative NS among four subscales, SAP was significant Nonsignificant differences in CGPA and marital status Items scored ≤2 were teaching overemphasize factual learning, too teacher-centered. Teachers ridicule students, authoritarian, get angry in teaching sessions. Able to memorize everything I need. Atmosphere is relaxing during clinical teaching. Cheating is a problem on this course,atmosphere motivates me as a learner, good support for students who get stressed, and I am tootired to enjoy course
Halawany et al, 2016^Citation11	Dental College, King Saud University, SA DC, KSU	All students RR 52%	613 M 49.3% F 50.7%	DECLEI 64.1/100 Dental Clinical Learning Environment Inventory 4th−5th year, 3rd year clinical experience	More positive than negative Significant difference in commutation grade point average among participants
Al‑Samadani et al, 2016^Citation12	Dental College, University of Taibah, SA DC, TU	3rd–5th year RR; 91%	110 M 53% F 47% 3rd year 98 (49%) and 4th year 84 (42%)	90 (45%) Study level gender (SPL) 19.38 (7.43) 19.38 (7.43) (SPT) 19.39 (6.77) 19.39 (6.77) (SASP) 17.15 (5.60) 17.15 (5.60) (SPA) 18.35 (7.93) 18.35 (7.93) (SSSP) 13.8 (3.85) 13.8 (3.85)	Plenty of problems Low SP, nonsignificant differences among gender in DREEM items. Females much more dissatisfied compared to males, and 4th year was most problematic Females were more stressed Most items in the five subscales scored ≤2
Farooqi et al, 2015^Citation13	College of Dentistry, Dammam University, SA DC, DU	Different level RR; 72%	55 M 45.5% F 54.5%	Expected (114.7) and (105.5) actual Expected actual DREEM (SPL) 28.16 25.95 (SPT) 25.05 23.89 (SASP) 19.71 16.09 (SPA) 26.26 24.64 (SSSP) 15.29 14.94	More positive than negative Nonsignificant differences between males and females Nonsignificant differences between expected and actual in all subscales Items scored ≤2 were teaching overemphasize factual learning, too teacher-centered, teachers ridicule students, authoritarian, get angry in teaching sessions. I feel able to ask questions I want Cheating is problem on this course. I find experience disappointing, I am too tired to enjoy course
Ahmed et al, 2015^Citation14	Dental College, Taibah University, Al-Madinah Al-Munawara, SA DC, TU	1st–6th year RR; 97% for 2009 RR; 100% for 2014	64 34 (2009) and 30 (2014)	90.4 92.3 (2009) and 88.4 (2014) Academic year (2009) (2014) (SPL) 21.62±5.82 19.43±6.27 (SPT) 21.26±6.55 21.03±5.28 (SASP) 17.74±5.59 16.87±5.48 (SPA) 21.53±6.19 21.30±5.84 (SSSP) 10.15±2.40 9.77±3.00	Plenty of problems SPs were relatively low from beginning throughout study Nonsigificant changes in mean domain, total scores, some improvement, most lower over study period. Less than 1good support for students who get stressed, and ≤2 were I am encouraged to participate in the class, teaching is often stimulating, helps to develop my confidence, encourages me to be an active learner, too teacher-centered. Teachers well prepared for their class, I am able to memorize all I need, college is well timetabled, enjoyment outweighs stress of studying dentistry, atmosphere motivates me as learner, too tired to enjoy this course, really bored on this course.
Al-Ansari et al, 2015^Citation15	Dental College, Dammam University, SA DC, DU	All students Years 2–6 year RR; 81.7%	162 84.6% M 15.4% F For 2nd–6th year 33.3%, 24.1%, 16.0%, 11.1% and 15.4%	97.7^b  Assessed predictability of DS’ grades as indicator of academic performance through their perceptions of EE (SPL) 23.7/48 (SPT) 22.1/44 (SASP) 14.8/32 (SPA) 22.8/48 (SSSP)14.3/28	Plenty of problems Improved SPL higher number high achievers, whereas higher perception of problems in SPA and SSSP higher number of low achievers and failing students. Nonsignificant difference between genders, and CGPA No relation between DREEM domains and past academic performances as measured by GPA Less than 1^a enjoyment outweighs the stress of the course and 42 items scored less ≤2.
Mahrous et al, 2013^Citation16	Dental College, Taibah University, Al-Madinah Al-Munawara, SA DC, TU	1st and 2nd years RR; 97%	34 male students	101.4 1st 112.8±19.6 (101.4±26.3) 2nd (89.1±23.5) First year (mean) second year (SPL) 23.71 (21.62) 19.53 (SPT) 28.40 (24.45) 20.58 (SASP) 21.00 (17.74) 14.47 (SPA) 25.15 (23.49) 21.83 (SSSP) 15.74 (14.21) 12.69	At margin of positive EE. SPL, SPT, SPSA, SSSP were SH among 1st compared to 2nd year students. Less than 1^a, good support system for students who get stressed. Sores ≤2 were daily studying load causes them heavy course, examination and assessment style is very difficult, improving effectiveness of role of academic advisors to students to prepare them for clinical phase.
Al-Shamrani, 2002^Citation17	Dental College, King Saud University, SA DC, KSU	4th, 5th years Dental students and Interns RR; 100%	154 M 43.6% 4th 62.5% 5th and 47.1% interns F 56.4% 4th, 38% 5th and 52.9% intern	Importance of unified pre-health program in response to learning outcomes	Two thirds of interns and students said that program is important and necessary Nonsignificant difference between interns and students Significant difference between males and females
Dental studies conducted worldwide
Alraweei et al, 2020^Citation18	Private Dental College, Turkey	3rd–5th year RR; 96.69%	185 M 53.8% F 46.2%	100,61±19.81 M 100.97±22.18: F100.19±16.77 (SPL) 23.52±5,85 23.34±5.25 (SPT) 22.78±4.67 22.63±4.46 (SASP) 17.73±4.43 17.20±3.67 (SPA) 22.14±7.51 21.91±5.59 (SSSP) 14.79±3.72 15.10±3.39 3rd, 95.36±18.67 4th 103.02±20.75 5th 103.31±19.31	At border of positive direction. Nonsignificant difference in gender, age, monthly family income, housing type SASP significant graduated school type SPT and SPA significant in 0000. Items scores ≤2 two were teaching is registrar-centered, overemphasizes factual learning, too teacher-centered. Teachers ridicule their registrars, authoritarian. I can memorize important facts, course is well timetabled, enjoyment outweighs stress of studying medicine. Good support for registrars who get stressed and I am too tired to enjoy this course.
Stratulat et al, 2019^Citation19	Faculty of Dental Medicine, Romanian Eastern University, Romania	6th year	259 Romanian=111 (M 51 and F 60), International=148 English (M 19 and F 24) and French (M 46 and F 59)	117.82 Total 117.82±18.78; Romanian 128.91±17.26 (SPL) 29.61±6.17 32.52±6.17 (SPT) 25.43±4.73 27.97±4.48 (SASP) 18.37±3.80 18.93±3.82 (SPA) 27.39±5.17 29.97±5.11 (SSSP) 17.02±3.76 19.51±2.51 English 116.91±13.04; French 106.47±15.16 (SPL) 29.63±5.35 26.52±4.90 (SPT) 25.16±3.55 22.85±3.95 (SASP) 17.81±3.02 18.00±4.01 (SPA) 27.19±3.79 24.75±4.34 (SSSP) 17.12±3.39 14.34±3.13	More positive than negative Lower score in SPA and SSSP. Significant difference between subscales in different nationality. International students were negative SPs in EC. Needing social support for satisfying EC.
Batra et al, 2018^Citation20	Dental Medicine School, Zagreb, Surendera, Croatia Dental College & Research Institute, Sri Ganganagar, India, and People’s Dental College, Nepal	All students RR; 29.6%	849 188; Croatia (M 18.1%; F 81.9%), 373; India (M 43.2%;F 56.8%), 288; Nepal (M 27.4%; F 72.6%)	Dental Student Learning Environment Survey (DSLES) Flexibility, “Student-to-Student Interactions, Emotional Climate, Supportiveness, Meaningful Experience, Organization & Breadth of Interest.“	“Flexibility“ was identified as area of weakness in all three educational systems. Students in Croatia rated their school only with grades excellent and good, while their colleagues in India and Nepal were more critical Highest mean scales were “Student-to-student interactions” in India and Nepal, and “Emotional Climate” in Croatia
Tomas et al, 2013^Citation21	Nine Public Schools of Dentistry, Spain	All students RR; 80%	1391 M 29.0% F 71.0% 3rd 35.0% 4th 33.6% 5th 31.4%	124.0 One 123.1 two 130.6 three 140.0 SPL 28.0 29.7 32.7 SPT 26.8 28.5 30.1 SASP 20.8 21.6 24.5 SPA 29.7 31.9 33.5 SSSP 17.7 18.7 19.0	More positive than negative, Items scored ≤2 were teaching is too teacher-centered, teachers are authoritarian, good timetable, course is well timetabled, teaching will over-emphasize factual learning. Enjoyment outweighs stress of studying medicine. Good support system for registrars who get stressed, I am too tired to enjoy this course.
Kossioni et al, 2012^Citation22	Athens University, Dental School, Athens, Greece	2nd–final year RR; 69.2% 2nd RR; 89% 3rd RR; 66.9% 4th RR; 52.8% 5th RR; 63.8%	323 M 31.7% F 55.8% Non 12.4% 2nd 83 3rd 89 4th 84 5th 67 Final	111.6^c Preclinical 2nd–3rd 116.4% clinical 4th–5th 106.2 SPL 27.0 24.6 SPT 25.0 23.0 SASP 18.5 18.0 SPA 28.0 25.0 SSSP 17.9 15.6	More positive than negative, Clinical phase SH than preclinical Nonsignificant difference between genders. Most SP for EC are positive for preclinical years except SASP. SD were revealed only for SPL subscale between 3rd and 4th year students. Items scores ≤2 were teaching will overemphasize factual learning. Teacher-centered, good providing feedback from students, provide constructive criticism here. Able to memorize what I need. Enjoyment outweighs the stress of studying medicine. Cheating is problem in this course, good timetable. Good support system for registrars who get stressed, I am too tired to enjoy this course, and rarely bored on this course.
Ostapczuk et al, 2011^Citation23	Medical College, Heinrich‐Heine, Düsseldorf University Moorenstr, Düsseldorf, GERMANY	All students RR; 66% for all and 74% for F	205 M 29.8% F 70.2%	122.95±15.52 SPL 28.58±4.67 SPT 27.14±3.71 SASP 19.94±3.80 SPA 28.84±5.09 SSSP 18.45±2.98	More positive than negative Small and early clinically oriented classes, traditional curricula can generate positive EC. SPA more negatively among clinical phase, but SASP among clinical phase more positively than preclinical. Items scored ≤2 were teaching overemphasize factual learning. Teachers authoritarian, well timetabled, good support for students who get stressed, and am too tired to enjoy this course
Vakil and Singh 2019^Citation24	Government Dental College of Jammu, Nepal	All students RR; 100	224 M 81.2% F 18.2%	127.70/200 (SPL) 30.22/48 (SPT) 27.18/44 (SASP) 21.34/32 (SPA) 32.05/48 (SSSP) 16.91/28	More positive than negative Implementation of PBL sessions and integrated teaching are endorsed to create better EC. Items scored ≤2 were teaching overemphasized factual learning, teachers ridicule them and good support system for stressed students.
Zafar et al, 2017^Citation25	Lahore Medical and Dental College, Lahore, Pakistan	All students RR;70%	533 M 39% F 61%	120.27±20.56 M 121.50±32 (mean) F 123±22 (SPL) 28±11 (28.31±7.18) 29±8 (SPT) 26±7 (26.92±5.75) 27±6 (SASP) 22±7 (21.37±5.16) 22±6 (SPA) 28±9 (27.72±6.58) 29±8 (SSSP) 16±6 (16.4±4.23) 17±5	More positive than negative Remained step below highest rank. Nonsignificant difference between gender, age in all domains or subscales.
Motghare et al, 2019^Citation26	Private Chhattisgarh Dental College, AYUSH University, India	One-year follow-up RR; 96%	84 M 34.5% F65.5%	147.8 (Beginning) and124.6 (After year) At beginning and after year (SPL) 36.9±8.35 27.4±0.0 (SPT) 32.02±0.35 20±6.90 (SASP) 20.12±6.7 33.9±9.70 (SPA) 34.8±8.40 15.31±5.30 (SSSP) 21.02±3.20 26.33±0.24	More positive than negative at time of joining institute and after completion of year on both occasions. Significant differences were obtained for all subscales and overall DREEM scores Items scored ≤2 were cheating problem and students would irritate teachers.
Methre et al, 2016^Citation27	Dr D. Y. Patil Medical college, Pimpri, Pune, India	All students RR; 87% BDS RR; 57% BPT	160 (100 BDS) and (60 BPT)	133.39±15.96 (BDS) and 119.35±23.18 (BPT) BDS and BPT (SPL) 31.25±4.06 28.46±6.73 (SPT) 27.88±4.31 25±4.36 (SASP) 23.65±4.75 20.67±5.6 (SPA) 32.62±5.72 29.09±8.01 (SSSP) 17.98±3.85 16.11±4.06	More positive than negative, More in BDS compared to BPT college. Significant difference between all subscales Items scores ≤2 in both BDS and BPT; teacher being authoritarian, centered teaching, students irritating teachers, get angry in class. Cheating problem, good support for student who get stressed, and too tired to enjoy course
Jnaneswar et al, 2016^Citation28	Private Dental School, Bhubaneswar City, India	3rd 48% and 5th 52% 27% under academic achiever and 53% academic achiever RR; 88.14	171 M 38% F 62%	119.65±19.68 M 118.29±21.27 and F120.48±18.70 3rd 119.93±20.4 (mean) 5th 119.39±19.1 SPL 29.23±5.189 (32.56±5.90) 30.03±5.08 SPT 26.59±5.61 (29.61±5.53) 27.13±4.64 SASP 20.02±4.25 (22.02±4.54) 19.93±4.27 SPA 27.94±5.82 (30.22±6.14) 27.04±5.48 SSSP 16.15±3.14 (17.49±3.83) 15.25±3.80	More positive than negative Female higher than male without significance SPT significant differences between subjects Nonsignificant differences between 3rd and 5th years Nonsignificant differences between achiever and non-achiever
Chandran and Ranjan, 2015^Citation29	Tagore Dental College, Tamil Nadu, India	All student RR;83.7%	257 M 19.8% F 80.2%	124 1st, 123.13 (0.45), 2nd 136.04 (0.58), 3rd 122.18 (0.44), 4th 114.48 (0.44) (SPL) 30.1/48 (SPT) 26.69/44 (SASP) 21.48/32 (SPA) 28.23/48 (SSSP) 16.52/28	More positive and moving in right direction Females were significantly greater 2nd year was the highest, Significant difference between 1st and 5th year Items scored ≤2 were teaching overemphasizes factual learning, is too teacher oriented. Lecturers are authoritarian, I feel able to ask questions I want, cheating is rampant in this course, students irritate lecturers, I am too tired to enjoy the course.
Thomas et al, 2009^Citation30	Manipal College of Dental Sciences, Manipal, INDIA	1st and final year RR; 100%	126 M 50% F 50%	109^c 1st year (122) final year (96) SPL 31 (2.73±0.38) 24 (2.10±0.56) SPT 27 (2.66±0.41) 22 (2.28±0.56) SPSP 19 (2.74±0.50) 15 (2.10±0.60) SPA 31 (3.92±0.47) 23 (2.11±0.61) SSSP 14 (2.69±0.39) 12 (2.11±0.64)	More positive than negative, HSD between 1st and final year in most subscales and items Items scores ≤2 were teaching overemphasizes factual learning, too centered, course organizer authoritarian. Cheating is a problem in this course, enjoyment outweighs stress of studying medicine, good support system for registrars who get stressed, rarely bored on this course.
Babar et al, 2015^Citation31	Dental Private Colleges and public Universities, Malaysia	All students 1st to 5th year	529 M 23.6% F 76.4% 68.6% Malays 28.%% Chinese 2.9% others	Dental Environment Stress (MSL) Fear of failing exams (MSL=5.57); Completion clinical work (MLS=5.30); Final examination results and grades (MSL=5.27) were found as top stressors among dental students	Female students had higher stress scores than males with respect to personal issues, academic performance, EC and learning of clinical skills. Students from public had higher stress scores than fromprivate universities
Idon et al, 2015^Citation32	Faculty of Dentistry, Maiduguri University, Nigeria	All Students RR 95% and 100% F	134 M 66.4% F 33.6%	138.2 2nd 145.6 and 5th 127.7 SPL 34.4 SPT 30.8 SASP 23.5 SPA 32.1 SSSP 17.5	More positive than negative, Preclinical is lesser than clinical in SP Problem areas; ≤2 were school timetabling, teaching overemphasis on factual learning, boredom and stress, am rarely bored on this course.
Stormon et al, 2018^Citation33	Dental Science (Honours) Program, Queensland University, Australia	1–4th Year RR; 90%	192 Males 43.2% Females 56.8%	127.2 Preclinical 130.5±17.9 (mean) Clinical 121.0 21 0.1 (SPL) 32.1±5.4 (31.2±5.7) 29.3±5.8 (SPT) 29.7±4.6 (28.6±5.2) 26.4±5.6 (SASP) 20.2±4.0 (19.6±4.2) 18.5±4.4 (SPA) 31.8±6.4 (31.0±6.4) 29.4±6.1 (SSSP) 17.3±3.1 (17.3±3.0) 17.5±2.8	More positive in their EC Preclinical more positive than clinical students in all domains of EC. Males reported SH in learning perception SSSP was at the margin of EC among preclinical students.
Tisi-Lanchares et al, 2017^Citation34	Dental Career, Arturo Prat University in Iquique, Chile	All levels RR; 91.1% Basic 27.2% Preclinical 49.5% Clinical 23.3%	103	117.8 Basic 131.78 preclinical 120.80 Clinical 100.87 SPL 32.52 29.06 24.35 SPT 30.39 28.52 22.64 SASP 22.96 21.96 19.25 SPA 29.39 26.56 20.75 SSSP 16.21 14.76 14.68	More positive than negative Significant difference between basic and preclinical with clinical phases Items scored ≤2 were teaching overemphasizes factual learning, too teacher-centered. Teachers are authoritarian. Well timetabled, cheating is problem in this school, enjoyment outweighs stress of the course. There is a good support for students who get stressed, am too tired to enjoy course, I am rarely bored in this course
Kang and Foster 2015^Citation35	Faculty of Dentistry, University of Otago, New Zealand	All students from 1st to final year RR; 82–94%	66 M 50% F 50%	Expected 145±15.4/2009 and actual; 143±16.8/2009, 132±17.0/2010, 134±15.0/2011 and 134±16.5/2012 SPL 36±4.4 and 34±5.1; 31±5.4; 31± 6.3; 32± 6.1 SPT 32±4.7and 33±4.5; 30±4.2; 28±4.3; 29±5.2 SASP 24±3.4 and 21±3.9; 21±3.2; 22±3.2; 22±3.4 SPA 33±4.6 and 35±4.8; 31±4.9; 31±4.7; 32±4.4 SSSP 20±2.9 and 20±3.6; 18±3.5; 20±3.1; 20±3.6	More positive than negative, Significant differences between 1st and 2nd year and between expected and actual Significant difference between genders. Significant differences at SPL and SASP Items scored ≤2 were teaching overemphasizes factual learning. Teachers will be authoritarian; school is well timetabled. Cheating is a problem in this school. Good support for students who get stressed, Able to memorize all I need.

Abbreviations: M, males; F, females; RR, response rate; SH, slightly higher; SP, student’s perceptions; LE, learning environment; PBL, problem-based learning; AP, academic performance; DECLEI, Dental Clinical Learning Environment Inventory; SA, Saudi Arabia; DS, dental students; MSL, mean stress level; BDS, Bachelor of Dental Surgery; BPT, Bachelor of Physiotherapy; CGPA, cumulative grade point average.

Table 2 Guide for the Interpretation of the Total DREEM and the Five DREEM Subscales and 50 Items.^3,4,38,39

DREEM, Subscales and Items	Score	Interpretation
Guide to interpret total overall DREEM scores
DREEM	0–50	Very poor
	51–100	Plenty of problems
	101–150	More positive than negative
	151–200	Excellent
Guide to interpret DREEM subscale scores
SPL/12	0–12	Very poor
	13–24	Teaching is viewed negatively
	25–36	More positive perception
	37–48	Teaching is highly thorough
SPT/11	0–11	Abysmal
	12–22	In need of some retraining
	23–33	Moving in the right direction
	34–44	Model course organizers
SASP/8	0–8	Feeling of total failure
	9–16	Many negative aspects
	17–24	Feeling more on the positive side
	25–32	Confident
SPA/12	0–12	A terrible environment
	13–24	There are many issues that need changing
	25–36	A more positive attitude
	37–48	A good feeling overall
SSSP/7	0–7	Miserable
	8–14	Not a nice place
	15–21	Not too bad
	22–28	Very good socially
Guide to interpret DREEM-item
Induvial items score	≤2	Problem areas
	Between 2 and 3	Aspect of climate that could be enhanced
	≥3	Real positive point

Abbreviations: SPL, students’ perceptions of learning; SPT, students’ perceptions of course organizers; SASP, students’ academic self-perceptions; SPA, students’ perceptions of atmosphere; SSSP, students’ social self-perception. .

Notes: ^aScored <1. ^bEstimated from bar chart. ^cConverted from percentage.

Figure 1 Demographic profiles of respondents (n=272).

Table 3 Mean Scores of the Total DREEM, Preclinical and Clinical Phases and Its Subscales

Variables	Min–Max	Mean ±SD Overall DREEM	Mean ±SD Preclinical	Mean ±SD Clinical	Percentage of maximum score
Total DREEM	84–169	125.19±15.1	126.21±16.02	124.1±14.04	74.08%
SPL	18–44	31.36±4.69	31.88±4.99	30.82±4.29	71.27%
SPT	17–36	26.18±3.24	26.26±3.44	26.09±3.03	72.72%
SASP	11–32	21.92±3.52	21.98±3.77	21.86±3.25	65.80%
SPA	9–44	28.08±5.29	28.26±5.4	27.89±5.18	63.82%
SSSP	9–25	17.,64±3.03	17.83±3.,08	17.45±2.97	70.56%

Table 4 Dental Students’ Mean Item DREEM Scores (n=272)

DREEM Subscale	Question No.	Items	Mean ±SD	Median
SPL	25	The teaching overemphasizes factual learning^a,b	1.86±0.76	2
	47	Long-term learning is emphasized over short-term learning	3.06±0.94	3
	48	The teaching is too teacher-centered^a,b	1.72±1.01	2
SPT	2	The teachers are knowledgeable.^b	3.17±0.57	3
	8	The teachers ridicule their registrars^a,b	1.5±0.98	1
	9	The teachers are authoritarian^a,b	1.93±0.9	2
	39	The teachers get angry during teaching sessions^a,b	1.53±0.91	2
	50	The registrars irritate the course organizers^a,b	1.51±1.03	1
SASP	5	I am confident about passing this year.	3.04±0.72	3
SPA	17	Cheating is a problem in this course^a,b	1.55±1.0	2
	35	I find the experience disappointing^a,b	1.35±0.92	1
SSSP	3	There is a good support system for registrars who get stressed^b	1.87±0.98	2
	15	I have good friends in this course/school	3.10±0.94	3
	46	I have a pleasant accommodation	3.04±0.94	3

Notes: ^aNegative statements are scored in reverse. ^bItems scored <2.

Table 5 Mean Score of DREEM Based on the Demographic and Education Characteristics of Dental Students (n=272)

		Total DREEM	SPL	SPT	SASP	SPA	SSSP
		Mean ±SD	Mean ±SD	Mean ±SD	Mean ±SD	Mean ± SD	Mean ± SD
Educational level	Preclinical phase	126,21±16,02	31,88±4,99	26,26±3,44	21,98±3,77	28,26±5,4	17,83±3,08
	Clinical phase	124,1±14,04	30,82±4,29	26,09±3,03	21,86±3,25	27,89±5,18	17,45±2,97
	p^a	0249	0062	0660	0775	0557	0300
Age	19–22	125,4±15,34	31,77±4,79	26,04±3,23	21,82±3,82	28,08±5,4	17,7±2,98
	23–25	125±14,94	31,01±4,59	26,3±3,25	22,01±3,26	28,08±5,21	17,6±3,08
	p^a	0826	0185	0507	0659	0997	0781
Type of school	Government	125,08±15,05	31,37±4,67	26,14±3,26	21,88±3,54	28,08±5,23	17,61±3
	Private	129,43±17,48	31±5,6	27,71±2,14	23,57±2,23	28,14±7,65	19±3,92
	p^a	0453	0836	0205	0209	0975	0230
Gender	Male	125,12±15,19	31,17±4,62	26,24±3,4	22,04±3,46	27,97±5,22	17,69±2,67
	Female	125,28±15,03	31,62±4,79	26,1±3,03	21,75±3,61	28,23±5,39	17,58±3,46
	p^a	0927	0437	0737	0496	0684	0767
UGPA	Pass	122,33±23,42	31,11±7,06	26,44±3,91	19,89±5	28,22±7,72	16,67±3,07
	Good	123,75±15,12	30,78±4,59	25,96±3,17	21,76±3,41	27,59±5,27	17,65±3,04
	Very Good	127,55±13,3	32,08±4,27	26,43±3,24	22,23±3,07	28,99±4,65	17,81±3,08
	Excellent	126,86±13,2	32,21±4,4	26,31±3,21	23±3,85	27,66±5,29	17,69±2,83
	p^b	0225	0159	0732	0021*	0270	0543
Monthly family income	Up to 3000	128,3±12,62	32±4,85	25,9±3,03	23,4±1,58	28,6±3,86	18,4±2,32
	Between 3 and10,000	124,28±15,81	31,23±4,51	25,83±3,44	21,3±3,65	28,41±5,18	17,51±2,9
	Between 10 and 15,000	123,18±14,05	30,82±4,75	26,04±3	21,58±3,22	27,1±5,16	17,64±3,06
	Over 15,000	129,92±15,71	32,53±4,67	26,98±3,37	23,2±3,81	29,48±5,62	17,72±3,27
	p^b	0032*	0131	0176	0004*	0032*	0844

Notes: ^aStudent's t-test. ^bOne-way ANOVA test. *p<0.05.

Table 6 Association Between Preclinical and Clinical Phase Students and Educational Characteristics (DOMINE) with the Mean Overall Score of DREEM and Subscale of Dental Students (n=272)

Level of Score Based on Domain	Educational Level n (%)			p-value
	Preclinical Phase	Clinical Phase	Overall
Total DREEM
Many problems	6 (4,3%)	7 (5,3%)	13 (4,8%)	0345^a
More positive than negative	123 (87,9%)	120 (90,9%)	243 (89,3%)
Excellent	11 (7,9%)	5 (3,8%)	16 (5,9%)
SPL
Teaching is viewed negatively	14 (10%)	9 (6,8%)	23 (8,5%)	0180^a
More positive perception	109 (77,9%)	114 (86,4%)	223 (82%)
Teaching highly through of	17 (12,1%)	9 (6,8%)	26 (9,6%)
SPT
In need of some retraining	20 (14,3%)	13 (9,8%)	33 (12,1%)	0072^b
Moving in the right direction	116 (82,9%)	119 (90,2%)	235 (86,4%)
Model course organizers	4 (2,9%)	0 (0%)	4 (1,5%)
SASP
Many negative aspects	11 (7,9%)	6 (4,5%)	17 (6,3%)	0468^a
Feeling more in positive side	98 (70%)	99 (75%)	197 (72,4%)
Confident	31 (22,1%)	27 (20,5%)	58 (21,3%)
SPA
A terrible environment	1 (0,7%)	1 (0,8%)	2 (0,7%)	0865^b
There are many issues that need changing	24 (17,1%)	26 (19,7%)	50 (18,4%)
A more positive attitude	106 (75,7%)	99 (75%)	205 (75,4%)
A good feeling overall	9 (6,4%)	6 (4,5%)	15 (5,5%)
SSSP
Not a nice place	23 (16,4%)	22 (16,7%)	45 (16,5%)	0800^a
Not too bad	102 (72,9%)	99 (75%)	201 (73,9%)
Very good socially	15 (10,7%)	11 (8,3%)	26 (9,6%)

Notes: ^aChi-squared test, ^bFisher–Freeman–Halton test.

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