Development and psychometric evaluation of scales to measure professional confidence in manual medicine: a Rasch measurement approach

Abstract

BackgroundHealth professionals in athletic training, chiropractic, osteopathy, and physiotherapy fields, require high-level knowledge and skills in their assessment and management of patients. This is important when communicating with patients and applying a range of manual procedures. Prior to embarking on professional practice, it is imperative to acquire optimal situation-specific levels of self-confidence for a beginner practitioner in these areas. In order to foster this professional self-confidence within the higher education context, it is necessary to have valid and reliable scales that can measure and track levels and how they change. This study reports on the development and psychometric analysis of two new scales, Patient Communication Confidence Scale (PCCS) and the Clinical Skills Confidence Scale (CSCS), to measure confidence in these two areas for students in manual medicine programs. The Rasch measurement model was used to guide the development of the scales and establish their psychometric properties.MethodsThe responses to 269 returned questionnaires over two occasions were submitted to psychometric analysis, with various aspects of the scales examined including: item thresholds; item fit; Differential Item Functioning; targeting; item locations; item dependencies; and reliability. To provide further evidence of validity, scores were correlated with two existing valid scales.ResultsAnalyses showed that the scales provided valid and reliable measures of confidence for this sample of persons. High Person Separation Indices (0.96 for PCCS; 0.93 for SCSC) provided statistical evidence of reliability, meaning the scales are able to discriminate amongst persons with different levels of confidence. For the PCCS, item categories were operating as required, and for the CSCS only two items’ thresholds were slightly disordered. Three tests of fit revealed good fit to the model (indicating the internal consistency of both scales) and results of the correlations with two existing valid scales were consistent with expectations.ConclusionsThe importance of confidence cannot be overlooked in health education because students learning new information and skills, and dealing with challenging situations can be negatively impacted by a lack of confidence which can result in students disengaging from placements or leaving a program. Valid and reliable instruments are essential in tracking change in levels of confidence in specific skills over time and the examination of the degree of congruence between confidence and competence. Analysis of responses to the two confidence scales established that they are valid and reliable instruments.

Inexperienced examiners and the Foot Posture Index: A reliability study

“…The ωh values for both examiners were greater than 0.70 suggesting that the calculation of a total score is valid (Hecimovich, Styles, 2014 supporting the internal structure of the FPI-6.…”

“…Three reliability estimates were calculated to evaluate the internal structure of the FPI-6: Cronbach's alpha (α) and McDonald's omega total (ωt) and hierarchal (ωh) (Zinbarg et al , 2005). McDonald's ωh values over 0.7 provide support for the calculation of a total score (Hecimovich et al , 2014).…”

Does trainee confidence influence acceptance of feedback?

“…Clayton et al 11 identified overconfidence in trainees on surgical procedures in which they had no experience, and highlighted the potential dangers to patient care of such overconfidence. Although the literature on the congruence between self-confidence and competence in health education is mixed, 11 Hecimovich et al 12 developed and validated scales of trainee confidence in patient communication and in clinical skills, and concluded that tracking change in levels of confidence in specific skills over time can be used to identify students who require additional help. We argue that confidence as a construct is important and ideally trainees should be able to selfmonitor their levels of confidence so that they are appropriately confident.…”

Exploratory Factor Analysis Research Instrument Confidence Attitude Toward Students

“…They found two factors of Clinical Decision-Making Self-Confidence Scale (CDMSCS). [12] developed a scale to measure professional confidence. They conclude that the importance of self-confidence cannot be ignored in health education because students who are learning new information and skills, and dealing with challenging situations can be adversely affected by a lack of trust that can result in students disconnecting from placement or leaving the program.…”