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J Med Educ Curric Dev. 2020 Jan 27;7:2382120520902186. doi: 10.1177/2382120520902186. eCollection 2020 Jan-Dec.

Measuring Students' Perceptions of the Medical School Learning Environment: Translation, Transcultural Adaptation, and Validation of 2 Instruments to the Brazilian Portuguese Language.

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Department of Medical Education, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil.
Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.
Department of Family and Community Medicine, School of Medicine, Southern Illinois University, Carbondale, IL, USA.
Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
Department of Medicine and Colleges Advisory Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA.



Although learning environment (LE) is an important component of medical training, there are few instruments to investigate LE in Latin American and Brazilian medical schools. Therefore, this study aims to translate, adapt transculturally, and validate the Medical School Learning Environment Scale (MSLES) and the Johns Hopkins Learning Environment Scale (JHLES) to the Brazilian Portuguese language.


This study was carried out between June 2016 and October 2017. Both scales have been translated and cross-culturally adapted to Brazilian Portuguese Language and then back translated and approved by the original authors. A principal components analysis (PCA) was performed for both the MSLES and the JHLES. Test-retest reliability was assessed by comparing the first administration of the MSLES and the JHLES with a second administration 45 days later. Validity was assessed by comparing the MSLES and the JHLES with 2 overall LE perception questions; a sociodemographic questionnaire; and the Depression, Anxiety, and Stress Scale (DASS-21).


A total of 248 out of 334 (74.2%) first- to third-year medical students from a Brazilian public university were included. Principal component analysis generated 4 factors for MSLES and 7 factors for JHLES. Both showed good reliability for the total scale (MSLES α = .809; JHLES α = .901), as well as for each subdomain. Concurrent and convergent validity were observed by the strong correlations found between both scale totals (r = 0.749), as well as with both general LE questions: recommend the school to a friend (MSLES: r = 0.321; JHLES: r = 0.457) and overall LE rating (MSLES: r = 0.505; JHLES: r = 0.579). The 45-day test-retest comparison resulted in a Pearson correlation coefficient of 0.697 for the JHLES and 0.757 for the MSLES.


Reliability and validity have been demonstrated for both the MSLES and the JHLES. Thus, both represent feasible options for measuring LE in Brazilian medical students.


Medical education; learning environment; medical students; mental health

Conflict of interest statement

Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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