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Omidi N, Yazdankhahfard M, Bahreini M, Mohamadi S. Revision And Psychometric Evaluation of The Clinical Education Stressors Questionnaire Among Medical Sciences Students. Iranian Journal of Medical Education 2026; 26 :53-60
URL: http://ijme.mui.ac.ir/article-1-5931-en.html
URL: http://ijme.mui.ac.ir/article-1-5931-en.html
Nursing Education Department, School of Nursing and Midwifery, Bushehr University of Medical Sciences, Bushehr, Iran. , m.r.yazdankhah@bpums.ac.ir
Abstract: (16 Views)
Introduction: Medical education integrates theoretical instruction with clinical training, the latter representing a core component of medical sciences curricula. Clinical training, however, exposes students to a wide range of stressors that can adversely affect their learning, professional development, and overall well-being. Accurately identifying these stressors is essential for informing interventions that reduce stress, improve educational outcomes, support the development of competent healthcare professionals, and ultimately enhance the quality of healthcare services. Although several instruments have been developed to assess stressors in clinical education, many have important methodological and psychometric limitations. Therefore, this study endeavored to revise and evaluate the psychometric properties of the Clinical Education Stressors Questionnaire among medical sciences students.
Methods: This methodological study was conducted in 2025 at Bushehr University of Medical Sciences. Following Waltz’s (2010) framework for instrument development, the present study focused on the fourth phase, namely the evaluation of the validity and reliability of the Clinical Education Stressors Questionnaire developed by Yazdankhahfard et al. The original questionnaire comprised 60 items across five dimensions: interpersonal communication, clinical experiences, educational environment, unpleasant feelings, and humiliating experiences. Face validity was assessed both qualitatively and quantitatively by ten students representative of the target population, including students of medicine, nursing, midwifery, operating room technology, and anesthesia. Content validity was evaluated qualitatively and quantitatively by a panel of ten experts in medical education and faculty members from nursing and midwifery with extensive experience in clinical teaching. To assess internal consistency reliability, the questionnaire was administered to a separate sample of 30 students representative of the population, and Cronbach’s alpha coefficients were calculated for each dimension and for the overall scale.
Results: During the psychometric evaluation, 13 items were removed from the initial version of the Clinical Education Stressors Questionnaire: two during qualitative content validity assessment, one based on the content validity index, eight based on the content validity ratio, and two following reliability assessment. As a result, the final instrument comprised 47 items across five dimensions: interpersonal communication (14 items), clinical experiences (16 items), educational environment (5 items), unpleasant feelings (7 items), and humiliating experiences (5 items). All retained items achieved an impact score greater than 1.5. The scale also demonstrated acceptable content validity, with a content validity ratio of 0.82 and a content validity index of 0.92. Internal consistency was acceptable overall (Cronbach’s α = 0.82). The Cronbach’s alpha coefficients for the five dimensions were 0.87 for interpersonal communication, 0.86 for clinical experiences, 0.59 for educational environment, 0.76 for unpleasant feelings, and 0.91 for humiliating experiences.
Conclusion: The revised questionnaire demonstrated satisfactory psychometric properties and addresses the limited availability of specialized instruments for assessing stressors in clinical education. It therefore provides a useful tool for identifying factors that contribute to stress during clinical training and for informing strategies to improve the clinical learning environment. Future research should examine the construct validity of the questionnaire to further establish the validity of its underlying dimensions. In addition, because the instrument was developed based on the perspectives of faculty members and students at Bushehr University of Medical Sciences, further validation across different universities and student populations is warranted to examine its generalizability and broader applicability.
Methods: This methodological study was conducted in 2025 at Bushehr University of Medical Sciences. Following Waltz’s (2010) framework for instrument development, the present study focused on the fourth phase, namely the evaluation of the validity and reliability of the Clinical Education Stressors Questionnaire developed by Yazdankhahfard et al. The original questionnaire comprised 60 items across five dimensions: interpersonal communication, clinical experiences, educational environment, unpleasant feelings, and humiliating experiences. Face validity was assessed both qualitatively and quantitatively by ten students representative of the target population, including students of medicine, nursing, midwifery, operating room technology, and anesthesia. Content validity was evaluated qualitatively and quantitatively by a panel of ten experts in medical education and faculty members from nursing and midwifery with extensive experience in clinical teaching. To assess internal consistency reliability, the questionnaire was administered to a separate sample of 30 students representative of the population, and Cronbach’s alpha coefficients were calculated for each dimension and for the overall scale.
Results: During the psychometric evaluation, 13 items were removed from the initial version of the Clinical Education Stressors Questionnaire: two during qualitative content validity assessment, one based on the content validity index, eight based on the content validity ratio, and two following reliability assessment. As a result, the final instrument comprised 47 items across five dimensions: interpersonal communication (14 items), clinical experiences (16 items), educational environment (5 items), unpleasant feelings (7 items), and humiliating experiences (5 items). All retained items achieved an impact score greater than 1.5. The scale also demonstrated acceptable content validity, with a content validity ratio of 0.82 and a content validity index of 0.92. Internal consistency was acceptable overall (Cronbach’s α = 0.82). The Cronbach’s alpha coefficients for the five dimensions were 0.87 for interpersonal communication, 0.86 for clinical experiences, 0.59 for educational environment, 0.76 for unpleasant feelings, and 0.91 for humiliating experiences.
Conclusion: The revised questionnaire demonstrated satisfactory psychometric properties and addresses the limited availability of specialized instruments for assessing stressors in clinical education. It therefore provides a useful tool for identifying factors that contribute to stress during clinical training and for informing strategies to improve the clinical learning environment. Future research should examine the construct validity of the questionnaire to further establish the validity of its underlying dimensions. In addition, because the instrument was developed based on the perspectives of faculty members and students at Bushehr University of Medical Sciences, further validation across different universities and student populations is warranted to examine its generalizability and broader applicability.
Type of Study: Original research article |
Subject:
Clinical Teaching
Received: 2025/12/7 | Accepted: 2026/04/4 | Published: 2026/04/30 | ePublished: 2026/04/30
Received: 2025/12/7 | Accepted: 2026/04/4 | Published: 2026/04/30 | ePublished: 2026/04/30
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