Preliminary Validation of an Instrument to Assess Students’ Perceptions of Clinical Learning Environments at U.S. Dental Schools

Abstract

Research on dental students' perceptions of clinical learning environments is needed to identify strengths, weaknesses, and need for interventions to sustain high-quality dental education, but a primary challenge has been the absence of an instrument designed to assess these perceptions. The Dental Clinical Learning Environment Instrument (DECLEI) is a new instrument developed specifically for dental clinical learning environments according to psychometric standards and validated in Europe. The aim of this study was to perform a preliminary validation of DECLEI in a U.S. dental school, thus providing data for subsequent validation in a larger, multi-institution sample. After five experienced faculty members assessed DECLEI's item relevance and content validity, the instrument was distributed in 2016 to 144 third- and fourth-year dental students at the University of Iowa College of Dentistry & Dental Clinics. All 144 questionnaires were completed (100% response rate). The results were tabulated and submitted to principal component analysis with an orthogonal rotation to assess internal structure of the measure. Internal consistency reliability was assessed using Cronbach's alpha coefficient and corrected item-total correlations. The results showed that, of the initial 24 items, principal component analysis allowed 18 items grouped in five domains: student-faculty interaction, equipment and patient issues, didactic-clinical components interaction, negative perceptions, and self-assessment. The Cronbach's alpha coefficients for these five domains ranged from 0.52 to 0.80. These results suggest that DECLEI has the potential for use as a reliable instrument to assess students' perceptions of clinical learning environments at U.S. dental schools, thus supporting the need for a definitive validation analysis in a larger sample.

Preliminary validation of the Dental Clinical Learning Environment Instrument in a Brazilian dental school

“…In contrast to gender and race, a significant difference was found when comparing 7th‐ and 8th‐semester students (Table 2). Similar results were observed in the initial validation study in Athens ( 11 ) and in the US study 13 . From a validity standpoint, these differences seem to make intuitive sense with what one would expect to see, ie that more experience in the clinical learning environment may impact the way in which it is perceived by dental students.…”

“…The 1‐component PCA solution retained 17 items with satisfactory internal consistency reliability whilst also maintaining a sufficient number of items to preserve the content validity of the instrument. The 17‐item scale contains 13 items in common with the 18‐item scale that resulted from a preliminary DECLEI validation study in a US dental school, 13 and all 17 items are contained into the 20‐item DECLEI‐USA scale resulting from the latest steps towards validation in 2 USA dental schools 14 . Therefore, there is a core of items that had the highest correlation to the total DECLEI score that are common to the DECLEI analysis performed in two different countries to date.…”

“…Each item answered received the following scores: Strongly Disagree (STD): 0, Disagree (D): 20, Slightly Disagree (SLD): 40, Slightly Agree (SLA): 60, Agree (A): 80, and Strongly Agree (STA): 100. For items with negative wording (#8, 13, 23 and 24), a reverse scoring interpretation scheme was used: Strongly Disagree (STD): 100, Disagree (D): 80, Slightly Disagree (SLD): 60, Slightly Agree (SLA): 40, Agree (A): 20, and Strongly Agree (STA): 0 12,13 …”

“…A two‐phase approach was employed for examining the internal structure and performance of the DECLEI in this Brazilian sample. First, a Principal Components Analysis (PCA) was used like in the preliminary validation study completed in the US sample 13 . In addition the correlation matrices, Kaiser‐Meyer‐Olkin (KMO) and Bartlett's Test of Sphericity statistics were used to assess sampling adequacy and factorability of the sample with benchmarks of 0.80 (KMO) and P < .05 (Bartlett's).…”

“…A pilot validation analysis of DECLEI was performed at a US dental school, 13 and an extended validation at 2 US dental schools was recently published 14 . The English version of the original 24‐item DECLEI instrument has also been validated in Saudi Arabia 15 and Pakistan, 16 indicating that it has the potential to be used as an instrument to assess dental clinical learning environment in multiple cultures.…”