Objectives: To describe and compare perceptions of the learning environment in large-class (~200 students) and small-class (~50 students) settings using the DREEM survey; To analyze the association between learning environment (DREEM) and academic adaptation (SACQ).
Methods: A cross-sectional descriptive study of 193 Indian medical students (YKQT K19 cohort) at Dai Nam University in May 2026. Analyses included paired t-tests (n=168) and Pearson correlations (n=154, using each student's mean DREEM score across large- and small-class settings).
Results: Total DREEM scores corresponded to 59.2–59.5% of maximum score, with no significant differences between class sizes in most domains. Total SACQ score was 5.38 ± 0.83, with Personal-emotional adaptation of 4.91 ± 1.12 being the only domain below the midpoint. DREEM correlated positively and strongly with SACQ (r=0.61, p<0.001).
Conclusions: The learning environment was perceived as moderately positive with no significant difference between class sizes. Personal-emotional adaptation showed the lowest mean score among SACQ domains, though this did not reach statistical significance relative to the theoretical midpoint. The strong DREEM–SACQ correlation was associated with better overall adaptation among international students; given the cross-sectional design, the direction of this association cannot be established.