Development and cross-cultural Validation of a German short version of the Health Education Learning Environment Survey in an Undergraduate Health Professions Students Cohort in Switzerland: A Cross-sectional Study

Imagine walking into a classroom or a hospital ward where you are learning to become a doctor, a nurse, or a therapist. The air in that room is filled with more than just textbooks and medical equipment; it is charged with a complex mix of feelings, relationships, and expectations. This atmosphere is what educators call the "learning environment." It is the invisible backdrop against which students grow, defined by how they interact with teachers, how they treat one another, and whether the system around them feels supportive or overwhelming. For anyone training to care for others, this environment is not just a setting; it is a critical ingredient in their success. If the atmosphere is toxic or confusing, students may struggle to engage, lose confidence, or even drop out. If it is nurturing, they are more likely to thrive and become skilled professionals. Because this environment is so vital, researchers and school leaders need a reliable way to measure it, asking students directly how they feel about their training. However, finding a tool that works well across different languages and cultures, and that is short enough to be practical, has been a persistent challenge.

In a recent study conducted at the Bern University of Applied Sciences in Switzerland, a team of researchers set out to solve this problem for German-speaking students. They focused on a specific group: undergraduate students training in nursing, physiotherapy, nutrition, and midwifery. These students come from diverse backgrounds and study in both classroom settings and real-world clinical placements. The researchers wanted to adapt an existing English-language survey, known as the Health Education Learning Environment Survey, for use in Switzerland. Their goal was twofold: first, to translate the survey accurately so it made sense in German, and second, to trim it down into a shorter, more efficient version that would still capture the full picture of the students' experiences. They knew that long questionnaires often lead to fatigue, where students stop paying attention, so a concise tool was essential for getting honest and useful feedback.

The process began with a careful translation. The team did not simply use a computer program to convert the words; they engaged in a rigorous back-and-forth process involving native speakers of both English and German. They debated the meaning of every sentence to ensure the cultural nuances were preserved. During this phase, they realized that one of the original questions was too vague, so they split it into two clearer questions. Before sending the survey to the entire student body, they tested a draft version with a small group of eight students from different degree programs. These students acted as a focus group, pointing out any instructions or words that felt confusing. Once the survey was polished, the researchers distributed it online to 290 students in the summer of 2024. Of those, 271 completed the survey, providing a rich dataset representing a mix of genders, ages, and years of study.

When the researchers analyzed the answers, they discovered that the original structure of the survey, which was designed with six distinct categories, did not fit the Swiss-German context perfectly. The data suggested that the students' experiences were better described by a different arrangement. Through a statistical process that looked for natural groupings in the answers, the researchers found that a five-part structure worked much better. They combined some of the original categories and removed questions that did not fit well, resulting in a streamlined survey with just 22 questions instead of the original 35. This new, shorter version grouped the students' perceptions into five clear themes: how they relate to their teachers and understand expectations; their ability to balance study with personal life; their sense of community with fellow students; how well the program supports diversity and inclusion; and the opportunities they have to practice real clinical skills.

The results showed that this new, shortened German survey was a strong and reliable tool. The students' answers consistently grouped together in the way the researchers hoped, confirming that the five themes were distinct and meaningful. The survey proved to be internally consistent, meaning that the questions within each theme were all measuring the same underlying idea without contradiction. When the researchers looked at the scores, they found that, on average, students felt quite positive about their learning environment. The highest scores were for peer relationships, suggesting that students felt a strong sense of community and support from one another. The lowest, though still positive, scores were related to work-life balance, indicating that managing the demands of their studies alongside their personal lives remained a challenge. The survey also revealed that students felt their teachers were generally supportive and that they had good opportunities to practice their skills, though there was room for improvement in how expectations were communicated.

This study confirms that the new German version of the survey is a valid way to measure the learning environment for health professions students in Switzerland. It offers school leaders and educators a practical, quick, and culturally appropriate way to listen to their students. By using this tool, institutions can identify specific strengths and weaknesses in their programs, such as whether a particular department is struggling with diversity or if students in a specific year are feeling overwhelmed. While the researchers noted that the survey focuses more on the classroom and interpersonal aspects than on physical facilities or technology, it provides a solid foundation for understanding the human side of medical education. The work demonstrates that with careful adaptation, we can create tools that respect the unique cultural context of a country while still capturing the universal needs of students learning to care for others.