Purpose: The medical school learning environment (LE), encompassing the physical, social, and psychological context for learning, holds significant influence on students' professional development. Among these myriad experiences, the authors sought to gauge what students judge as influencing their perceptions of the LE. METHOD: Fourth-year medical students at Johns Hopkins University participated in this cohort survey study before their 2010 graduation. A list of 55 events was iteratively revised and pilot-tested before being administered online. Responses assessed whether students experienced each event and, if so, the degree of impact on perceptions of the LE. A calculated mean impact score (MIS) provided a means to compare the relative impact of events. RESULTS: Of 119 students, 84 (71%) completed the survey. Students rated the overall LE as exceptional (29/84; 35%), good (36/84; 43%), fair (17/84; 20%), or poor (2/84; 2%). Eighty percent of students experienced at least 41 of the 55 events. MIS values ranged from 2.00 to 3.76 (highest possible: 4.00). Students rated positive events as having the highest impact. Few significant differences were found across gender, age, or surgical/nonsurgical specialty choice. MIS distributions differed between those perceiving the LE as exceptional or fair to poor for 22 (40%) of 55 events. CONCLUSIONS: This study attempted to identify the discrete events that medical students perceive as most affecting their sense of the LE. Knowing the phenomena that most strongly influence student perceptions can inform how settings, relationships, and interactions can be shaped for meaningful learning and professional formation.
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