Advancing Health Workforce Education: Development and Psychometric Validation of the Challenges in Team-Based Learning Questionnaire (CTBLQ) in Vietnam
Jul 2026· International Journal of Nursing Information· Vol 5, pp. 81-95· 0 citations· 45 references
TL;DR
Overall, the CTBLQ demonstrated satisfactory psychometric properties and provides a standardized diagnostic instrument for identifying barriers to Team-Based Learning implementation and may support evidence-informed curriculum evaluation, educational planning, and future research in nursing education while contributing to the advancement of health workforce education through improved implementation of collaborative learning.
Abstract
Although Team-Based Learning (TBL) is widely adopted in health professions education to strengthen collaborative competencies, instruments specifically designed to identify barriers to its implementation remain limited, particularly in transitioning educational contexts. This study aimed to develop and psychometrically validate the Challenges in Team-Based Learning Questionnaire (CTBLQ) among undergraduate nursing students in Vietnam. A methodological research design was employed involving 280 undergraduate nursing students selected through stratified simple random sampling. The 18-item questionnaire underwent expert content evaluation and linguistic review before reliability testing and exploratory factor analysis. The CTBLQ demonstrated excellent internal consistency (Cronbach’s α = 0.910), and all corrected item–total correlations exceeded the recommended threshold of 0.30. Sampling adequacy was confirmed by a Kaiser–Meyer–Olkin value of 0.853, while Bartlett’s test of sphericity was statistically significant (χ²(153) = 4098.257, p < 0.001). Exploratory factor analysis supported a three-factor structure explaining 68.10% of the total variance, comprising learning preparation, participation, and motivation challenges; interpersonal and social conflict challenges; and learning benefit and team harmony challenges. Overall, the CTBLQ demonstrated satisfactory psychometric properties and provides a standardized diagnostic instrument for identifying barriers to Team-Based Learning implementation. The instrument may support evidence-informed curriculum evaluation, educational planning, and future research in nursing education while contributing to the advancement of health workforce education through improved implementation of collaborative learning.
Objective: Curriculum integration is increasingly used in medical and dental education, yet validated tools to objectively measure integration are limited. Existing frameworks, such as Harden’s ladder, are mostly descriptive and difficult to implement for systematic evaluation. Therefore, this study aimed to develop a valid and reliable tool to assess the level of integration in medical and dental curricula.
Methodology: A multiphase mixed-method approach was employed for instrument development. Eight domains representing the integrated curriculum were initially identified through a literature review, each structured on a 5-point scale based on Harden’s integration ladder. Content validity was established via expert review (n = 17), followed by cognitive interviews with faculty (n = 6), and pilot testing with medical and dental faculty (n = 150). Reliability was assessed using Cronbach’s alpha.
Results: Content validity resulted in seven domains with a mean content validity index of 0.89 and an average content clarity score of 3.46. Cognitive interviews led to minor adjustments in four items. The final tool demonstrated good reliability (Cronbach's alpha = 0.88). EFA supported a one-factor model, confirmed by CFA (GFI = 0.96, RMSEA = 0.052, normed χ² = 1.4), indicating a good model fit.
Conclusion: The Tool of Integration Practices (TIP) demonstrated adequate validity and reliability. It provides a practical, psychometrically sound framework for assessing and comparing curriculum integration practices based on faculty perceptions at the course and program levels in health professions education.
Syeda Rabbab Hasan, Madiha Sajjad, Rehan Ahmed Khan· Pakistan Journal of Medical...· 0 citations
Background Clinical teaching is essential in high-risk disciplines such as anesthesia. MSc students in Anesthesia Education require validated tools to assess their instructional performance during clinical internships. This study aimed to design and validate a clinical teaching performance checklist for MSc students in Anesthesia Education using Kane’s argument-based validation framework. Methods This descriptive-analytical, cross-sectional, single-center study was conducted at Iran University of Medical Sciences (2023–2025) with 11 fourth-semester MSc students. The checklist was developed using curriculum objectives, Entrustable Professional Activities (EPAs), focus groups, and a two-round Delphi process with 10 experts. Face and content validity (Impact Score, CVR, CVI), reliability (Cronbach’s alpha, ICC across two settings), and extrapolation evidence (Spearman correlation with global ratings) were evaluated. Results Seven EPAs yielded a 20-item checklist. Content validity was acceptable (CVI≥0.79 for most items; two retained via expert consensus). The instrument showed high internal consistency (Cronbach’s α=0.88) and excellent inter-rater reliability (ICC≥0.98). Extrapolation inference was supported by a strong correlation with faculty global ratings (rs=0.81). Faculty and students reported high satisfaction with the tool. Conclusion This study offers promising preliminary evidence supporting the feasibility, validity, and reliability of the EPA-based checklist for clinical teaching assessment. Integrating Kane’s framework with EPAs provides a structured approach for formative evaluation; however, broader confirmation through larger, multicenter studies is required prior to widespread implementation.
A. S. Sajadi, N. Hamidi, Shahnam Sedigh-Maroufi et al.· Advances in Medical Educatio...· 0 citations
AIM
To develop and validate the Learning Flow Scale for Thai nursing students.
BACKGROUND
Learning flow is a key psychological state that promotes deep engagement, skill development and optimal learning outcomes in nursing education. However, standardized instruments specifically designed to assess learning flow among Thai nursing students remain limited.
DESIGN
A descriptive cross-sectional design was employed.
METHODS
A total of 471 undergraduate nursing students across multiple public nursing colleges in Thailand participated in the scale development and validation process. Scale items were generated using both inductive and deductive approaches based on literature review, qualitative insights and theoretical frameworks of flow in learning contexts. The underlying factor structure was explored using exploratory factor analysis (EFA) and subsequently confirmed through confirmatory factor analysis (CFA).
RESULTS
A 23-item Learning Flow Scale with a four-factor structure was identified. The four dimensions were labeled 'Goal-Activity Alignment', 'Real-Time Reflective Clarity', 'Autonomous Learning Experience' and 'Deep Concentration and Immersion'. The overall scale demonstrated excellent internal consistency (Cronbach's α = 0.958), with subscale reliability coefficients ranging from 0.802 to 0.926. Model fit indices from CFA supported the adequacy of the proposed measurement model.
CONCLUSION
The Learning Flow Scale for Thai nursing students demonstrates strong psychometric properties and provides a valid and reliable tool for assessing learning flow in nursing education. The scale may support educators in identifying students' engagement patterns and designing pedagogical strategies that enhance meaningful and effective learning experiences.
BACKGROUND
Competency training is essential for cultivating qualified anaesthesia Master of Nursing Specialist (MNS) graduates. Although a previous study has established relevant competency dimensions for anaesthesia nursing, no refined framework with operationalized indicators is currently available for Chinese MNS anaesthesia students.
OBJECTIVE
To construct an index system for the core clinical competencies of MNS anaesthesia students.
METHODS
Following literature screening, 26 eligible publications were selected to draft preliminary indicators. Semi-structured interviews with 15 participants were performed, and interview data were analysed via thematic coding.21 experts from 11 regions across China completed two rounds of Delphi surveys. Indicators were rated on a 5-point Likert scale, with expert consensus determined by predefined statistical cut-offs (mean importance score ≥ 3.5, coefficient of variation (CV) ≤ 0.25, ≥ 75% ratings ≥ 4) combined with comprehensive expert revision opinions.
RESULTS
The response rates of the two Delphi rounds were 100% and 95.24%, respectively. The expert authority coefficients (Cr) were 0.95 and 0.96, indicating high reliability of the consultation results. In the second round, Kendall's concordance coefficients (W) for the first, second, and third-level indicators were 0.552 (strong consensus), 0.324 (moderate consensus), and 0.254 (weak-moderate consensus) respectively (P < 0.01), which indicated that the consistency of expert opinions was statistically significant and the consultation results were valid. The range of coefficient of variation was from 0.05 to 0.25. The final indicator system included 8 first-level indicators, 39 s-level indicators, and 109 third-level indicators.
CONCLUSION
Core clinical competency indicators for MNS anaesthesia students, established in this study, achieved expert consensus validity. These competency indicators can serve as a theoretical reference for the future training and assessment of MNS postgraduates in this field.
Xueyan Xing, Cong Jiang, Tingting Yang et al.· BMC Nursing· 0 citations
Aim To develop and psychometrically validate an instrument to assess the competencies (knowledge, skills, and attitudes) of nurses and nursing students regarding the effects of climate change on the health of older people. Methods Cross‐sectional descriptive study of questionnaire construction and validation developed in four phases: creation and elaboration of the initial items, content validation by an expert panel, pilot test, and psychometric validation. A tool was developed consisting of a knowledge questionnaire, a skills scale, and an attitude scale. Data were collected from a convenience sample of 708 individuals (210 nurses and 498 nursing students) between January and April 2024. Content validation was carried out by consulting a panel of 13 experts and a pilot test. Psychometric validation was carried out using Item Response Theory, specifically the Rasch model for the knowledge questionnaire and Andrich’s rating scale model for the skills and attitude scales. The STROBE checklist for cross‐sectional studies was followed. Results Reliability for the set of items and for individuals was excellent (0.99 and 0.90, respectively). Item separation index was above 2 in all three parts of the instrument, although somewhat more limited for people. Internal consistency was acceptable in the knowledge questionnaire (11 items, Cronbach’s α 0.68) and excellent in the skills (13 items, Cronbach’s α 0.91) and attitudes (11 items, Cronbach’s α 0.93) scales. Conclusion Nursing Competencies Questionnaire on Older People’s Environmental Health is a useful and reliable instrument for measuring knowledge, skills, and attitudes in nurses and nursing students.
E. M. Montoro-Ramírez, Laura Parra-Anguita, Carmen Álvarez-Nieto et al.· Nursing Research and Practic...· 0 citations
Introduction The Objective Structured Clinical Examination (OSCE) is a well-known clinical skill evaluation tool that has been applied worldwide to teach and assess learners’ competencies in healthcare disciplines. Poor implementation of OSCE can lead to inaccurate assessments and ultimately result in the production of incompetent professionals. However, there is no evidence of the implementation status and factors that limit the much-needed OSCE practice in the study area. Objective To assess OSCE implementation among midwifery and nursing educators in the South and Central region of Ethiopian universities, 2023. Methods An institution-based cross-sectional study with a mixed approach was used among 269 midwifery and nursing educators and 15 key informants from 8 May to 10 June 2023. All midwifery and nursing educators were included from randomly selected 4 universities in southern and central Ethiopia. Quantitative data were collected using pretested self-administered questionnaires and were analyzed using descriptive statistics and logistic regression. With a p-value of less than 0.05, which denotes statistical significance, a corresponding 95% confidence interval (CI) was calculated. Qualitative data was collected through in-depth interviews and analyzed using open-code software Version 4.02, and findings were used to support quantitative findings. Results A total of 260 (97%) educators participated in this study, and 43.5% (95% CI 37.4–49.5) of them had a good OSCE implementation. Training in OSCE (AOR = 2.07, 95% CI 1.03–4.17), having an OSCE checklist (AOR = 1.89, 95% CI 1.05–3.42), having equipment (AOR = 2.36, 95% CI 1.03–5.39) and negative perceptions toward OSCE (AOR = 0.53, 95% CI 0.31–0.92) were significantly associated, and poor organization and planning, perceptions towards OSCE, shortage of resources and insufficient number and duration of the station were found by qualitative study. Conclusions Less than half of educators have had a good OSCE implementation. Training, equipment, checklists, and perceptions highlight issues such as poor organization and planning, resource, and time allocation stations found as influencing factors. In addition to improving in-service and ongoing OSCE training, it is preferable to ensure the availability and accessibility of resources in the facilities to improve OSCE implementation.