Beyond The Checkbox: Development And Validation Of A Scale Measuring MBBS Students’ Attitudes, Barriers, And Preferences Toward Academic And Clinical Documentation
Aug 2026· Adolescência e Saúde· Vol 21, pp. 903-915· 0 citations· 12 references
TL;DR
The AACDS's 40-item attitude/barrier core demonstrates robust, multi-method psychometric validation for assessing MBBS students' engagement with CBME documentation requirements, and is, to the authors' knowledge, the first instrument to jointly capture attitudes, barriers, and preferences across assignments, SDL, and logbook documentation while linking self-report data to objective institutional records.
Abstract
Background: Competency-Based Medical Education (CBME) in India relies on assignments, Self-Directed Learning (SDL) record book entries, and clinical logbook documentation as core mechanisms for developing self-regulated, lifelong learners. Prior survey work suggests these elements are inconsistently well received by MBBS students, yet no validated, multi-domain instrument exists to assess attitudes, perceived barriers, and preferences across all three tasks within a single framework, nor to link self-report data with objective compliance records.
Objective: To develop and psychometrically validate the Attitude, Barriers, and Preferences towards Academic and Clinical Documentation Scale (AACDS), including an item assessing preference for extending the National Medical Commission’s (NMC) postgraduate e-logbook mandate to undergraduate level.
Methods: The 48-item AACDS (40 Likert-scaled attitude/barrier items across four subscales, plus 8 preference/opportunity items) was evaluated across six validation strands: content validity (10-expert panel), face validity (pilot, n=15), internal consistency reliability (pilot, n=35), exploratory factor analysis (n=300), test–retest reliability (n=50, 2-week interval), and inter-rater reliability of a linked objective Entry Quality Rubric (2 raters, 20 entries).
Results: Content validity was excellent (S-CVI/Ave = 0.902; all 48 items I-CVI ≥ 0.78). Face validity was strong (mean clarity = 87.8%; 0/48 items flagged). Internal consistency was acceptable to good across subscales (α = 0.783–0.824). Exploratory factor analysis (KMO = 0.85; Bartlett's χ²(435) = 2217.67, p < .001) supported by parallel analysis confirmed the hypothesized three-factor structure (Assignments, SDL Record Book, Clinical Logbook) with small cross-loadings (< .15 in magnitude), explaining 37.68% of variance. Test–retest reliability was good (ICC = 0.78). Inter-rater reliability for the objective Entry Quality Rubric was almost perfect (pooled κ = 0.90; ICC = 0.88).
Conclusion: The AACDS's 40-item attitude/barrier core demonstrates robust, multi-method psychometric validation for assessing MBBS students' engagement with CBME documentation requirements; validation of the 8 Section E preference items remains pending. It is, to our knowledge, the first instrument to jointly capture attitudes, barriers, and preferences across assignments, SDL, and logbook documentation while linking self-report data to objective institutional records, positioning it as a practical tool for curriculum evaluation and for informing undergraduate digital documentation policy.
Introduction: In Competency-Based Medical Education, formative assessments are integrated throughout the curriculum to offer continuous feedback, promoting self-regulatory learning and helping learners to identify the areas for improvement. Peer and self-assessment play a crucial role in CBME by fostering collaboration, self-reflection, critical thinking, and professionalism. Assess the reliability of peer and self-assessment across different learning domains in a CBME framework for formative assessment. Methods: This observational study, conducted from January 2024 to December 2024 at a Government Tertiary Care Hospital, involved a universal sampling method with 100 second-year medical students. Assessments addressed knowledge through assignments, psychomotor skills through vitals and systemic exams, and affective skills through communication and interpersonal abilities. Evaluations by peers, self, and faculty were conducted using an internally validated tool, with anonymity maintained throughout. Results: Participants were aged 18–21 with a male-to-female ratio of 1:1.2. ANOVA tests showed no significant difference in knowledge scores between self, peer, and faculty assessments (ICC=0.708; P=0.106). Significant differences were found in psychomotor (P=0.001; ICC=0.483) and attitude (P=0.001; ICC=0.234) domains, with students and peers overestimating or underestimating performance. Bland–Altman plots confirmed good agreement for knowledge, moderate for psychomotor, and poor for attitude between self, peer, and faculty ratings. Conclusion: The study found moderate reliability in the knowledge domain but poor to no reliability in the attitude and psychomotor domains, with self and peer assessments tending to overestimate performance. These findings underscore the need for more training and structured assessment strategies to enhance the accuracy and consistency of self- and peer-assessment in medical education.
S. Kandasamy, Thilakavathi Kothandan, Shivkumar Gopalakrishnan et al.· Research and Development in...· 0 citations
Background: Self-directed learning (SDL) is a fundamental component of competency-based medical education (CBME), enabling students to develop lifelong learning skills, critical thinking, and professional autonomy. Successful implementation of SDL depends largely on learners' readiness to engage in independent learning. This study aimed to assess self-directed learning readiness among first-year MBBS students using the Self-Rating Scale for Self-Directed Learning (SRSSDL).
Materials and Methods: A descriptive cross-sectional study was conducted among 103 first-year MBBS students at a rural medical college in Bengaluru, Karnataka, India, over a three-month period. Universal sampling was employed. Data were collected using the validated 60-item SRSSDL questionnaire, which evaluates five domains: awareness, learning strategies, learning activities, evaluation, and interpersonal skills. Descriptive statistics were expressed as mean, standard deviation, median, interquartile range, frequencies, and percentages. The association between gender and SDL readiness was assessed using the Chi-square test, with statistical significance set at p < 0.05.
Results: The mean overall SRSSDL score was 231.2 ± 21.8, indicating high readiness for self-directed learning. Overall, 76 (73.8%) students demonstrated high SDL readiness, while 27 (26.2%) exhibited moderate readiness; none had low readiness. Female students had a marginally higher mean SRSSDL score than male students (231.9 ± 21.7 vs. 230.4 ± 22.1), although the association between gender and SDL readiness was not statistically significant (p = 0.47). Among the five domains, interpersonal skills demonstrated the highest mean score (47.0 ± 5.6), whereas evaluation recorded the lowest (45.6 ± 5.9).
Conclusion: First-year MBBS students demonstrated predominantly high readiness for self-directed learning, supporting the implementation of CBME. Targeted educational interventions focusing on reflective practice and self-evaluation may further strengthen SDL competencies and promote lifelong learning among future medical professionals.
Key words: Education, Medical, Undergraduate; Self-Directed Learning; Students, Medical; Competency-Based Education; Educational Measurement; Learning.
Ashok J, R. Dhar, Ramya Mp· International Journal of Hea...· 0 citations
INTRODUCTION
Clinical reasoning is a core competency in health professions education, which is supported by self-regulated learning (SRL) and adaptive expertise. The Master Adaptive Learner (MAL) framework describes four internal characteristics (curiosity, motivation, growth mindset, and resilience) that support clinical reasoning and SRL development. However, existing instruments typically measure these characteristics in isolation and lack validation within clinical reasoning contexts, limiting their utility for educators. The aims of this study were to generate a list of items that would reflect the four MAL characteristics and pilot, refine, and validate an instrument from the generated items.
METHODS
Following established best practices in scale development, a multi-phase, mixed-methods approach was used to develop and generate initial validity evidence for a unified Learner Mindset Instrument (LMI). Items were identified through systematic literature searches and refined using a two-round modified Delphi process with clinical faculty and preceptors. Focus groups with student pharmacists were conducted to evaluate item clarity and alignment with intended constructs. The resulting instrument was administered to student pharmacists across five institutions in the United States and Australia. Exploratory factor analysis with varimax rotation, item reduction procedures, and reliability testing were performed.
RESULTS
Nine existing instruments comprising over 150 items were identified through which self-directedness emerged as a distinct construct in addition to the four MAL characteristics. Through Delphi consensus and focus group refinement, the item pool was reduced to 43 items. Exploratory factor analysis supported this five-factor structure. Item reduction resulted in a final 27-item instrument. The reduced instrument demonstrated strong internal reliability (Cronbach's α = 0.893) and acceptable factorability (Kaiser-Meyer-Olkin = 0.77; Bartlett's test p < 0.0001).
DISCUSSION
The 27-item LMI demonstrates initial evidence of construct validity for measuring internal characteristics relevant to SRL and clinical reasoning. This unified tool may support formative assessment, targeted learner coaching, and evaluation of MAL-aligned educational interventions across health professions education.
Nicholas R. Nelson, Madison H. Ricco, Robert Hubal et al.· Medical Teacher· 0 citations
Background The implementation of competency-based medical education (CBME) demands robust, validated workplace-based assessment (WBA) tools. In this study, we aimed to develop and conduct an initial validation of the clinical competency logbook (CCL) as a structured instrument designed to assess the observed clinical competencies of undergraduate medical students in authentic practice settings. Methods A prospective validation study was conducted during the 2024–2025 academic year with 129 fourth-year medical students. The CCL was systematically constructed through literature review and expert consensus using a two-round Delphi process to establish content validity. Students were assessed using the CCL during two consecutive 4-week clinical rotations. Test–retest reliability was evaluated using the intraclass correlation coefficient (ICC) with a two-way random-effects model. Exploratory fairness analysis was conducted based on subgroup comparisons between male and female students. Results The CCL exhibited strong content validity throughout its expert-driven development process. Overall test–retest reliability was moderate to good (ICC = 0.711, 95% confidence interval [0.591, 0.796]). However, the reliability varied significantly by gender subgroups: ICC = 0.507 for males and ICC = 0.346 for females, which was attributed to ceiling effects and restricted score variance in the female subgroup. The mean scores differed significantly between genders, highlighting the need for further investigations of potential rater bias or other unmeasured variables, although these findings remain strictly exploratory. Conclusion The CCL exhibited acceptable psychometric properties for formative assessment in undergraduate medical education. The strong content validity and moderate overall reliability (though highly dependent on score distribution and varying by subgroup) support its use for tracking student progress and providing structured feedback. These findings highlight the importance of contextual interpretation of reliability coefficients and suggest that caution is required for high-stakes summative decisions. In this study, we produced an evidence-informed instrument and methodological framework for developing WBA instruments in CBME programs.
Tayseer Mansour, Marwa Zalat, A. Abdallah· Journal of Taibah University...· 0 citations
Background:Niazi Medical and Dental College (NMDC), Sargodha,has redefined the standards of medical pedagogy in the region since 2019. In keeping with this pursuit of excellence, the college utilizes MCQs as a primary modality for evaluating student competency, recognizing their critical role in valid and reliable written examinations.Material & Methods:This quasi-experimental study was conducted at multiple clinical specialties, Niazi Medical and Dental College (NMDC), Sargodha, to evaluate the impact of faculty training on the quality of Multiple Choice Questions (MCQs). A total of 20 house officers from the four different specialties, divided 5 in each of fourgroups, with no formal psychometric training,were asked to develop10MCQs.Subsequently, a three-hour seminar on standard MCQ construction guidelines was conducted. Following this intervention, the original items were revised in accordance withestablished pedagogical standards and re-administered to the same cohort. Comparative psychometric analysis was performed using Microsoft Exceland SPSS version 22.0, focusing on:Difficulty Index (P), Discrimination Index (DI), and Distractor Effectiveness (DE).Results:The educational intervention led to a statistically significant improvement in both student outcomes and the psychometric quality of the assessment items. Following the modification of MCQs in accordance with standard guidelines, the house officers' pass rate increased markedlyfrom pre-seminar (62.5%) to post-seminar(87.5%), the Difficulty Factor improved from 0.42to 0.55, and the Discrimination Index rose from 0.38to 0.52.Conclusion:Evidence suggests that the targeted workshop served as a critical catalyst for improving the assessment literacy of medical educators, resulting in a measurable enhancement in the quality of test construction.
Syed HyderRaza, Muneeb-Ur-Rehman Niazi, Farheen Zehra et al.· Asian Journal of Medical Res...· 0 citations
SCOPE-K shows promising initial psychometric properties as a novel, scenario-based measure of learners' self-referential expertise-mapping judgments within simulation-based IPE, and the pattern of improved expert-referenced concordance, improved ranking concordance, and stronger association with profession-attribution performance provides encouraging initial validity evidence.
C. Greengrass, Kianna Thelen, S. Vacek et al.· Journal of Interprofessional...· 0 citations