# The development and validation of a multi-dimensional medical students’ learning self-efficacy questionnaire for clinical education

## TL;DR

This study created and validated a questionnaire to measure medical students' confidence in their clinical learning skills across multiple dimensions.

## Contribution

A novel multi-dimensional questionnaire for assessing medical students' learning self-efficacy in clinical education is developed and validated.

## Key findings

- A 24-item questionnaire grouped into seven factors was finalized with good validity and reliability.
- Six models were tested, with the final model showing four second-order dimensions and adequate fitness.
- All factors showed significant correlations, indicating strong convergent and discriminant validity.

## Abstract

Learning self-efficacy (SE) assesses how learners understand and evaluate their ability to polish their learning process. Learning clinical medicine requires prolonged training, traditionally premised on longitudinal immersion in patient care. Such a process is domain-specific, whereas learning SE for clinical education remains under-explored. Unidimensional assessment is insufficient for capturing the inherent capabilities upon which well-trained physicians provide care. We aimed to establish a multi-dimensional learning SE questionnaire for clinical education among undergraduate medical students, evaluating the structure validity, followed by assessing the dimensionality of different models. Medical students of 2nd to 4th grades from Taiwan in 2022–2023 completed a multi-dimensional medical learning SE (MLSE) questionnaire, including four factors for basic science learning (conceptual understanding (CU), higher-order cognitive skills (HC), practical work (PW), and everyday application (EA)), and three for clinical mastery performance (medical communication (MC), evidence-based medicine (EBM), and Professionalism)). We tested factors’ intercorrelation, used exploratory and confirmatory factor analysis (EFA/CFA) for structure and validity assessment, and compared the fitness and dimensionality between models. Twenty-four items grouped into seven independent factors (3, 3, 4, 3, 5, 3, and 3 items in CU, HC, PW, EA, MC, EBM, and Professionalism, respectively) were established and finalized, with sufficient fitness, good convergent and construct validities. All MLSE factors significantly correlated (0.49–0.87; p < 0.001), demonstrating good convergent and discriminant validity. We established six models (first-order uncorrelated or correlated construct, one to three second-order dimensions (‘basic medical SE’, ‘clinical medical SE’, ‘Cognition’, or ‘Application’ of different structures), and a final model 7 containing four second-order dimensions (Cognition, Application, MC, and clinical medical SE) exhibiting adequate model fitness and measured learning SE satisfactorily. Our MLSE model structure disclosed vital SE factors with intercorrelations associated with medical students’ learning processes during clinical education. Polishing these dimensions may help promote their learning SE.