Beyond The Checkbox: Development And Validation Of A Scale Measuring MBBS Students’ Attitudes, Barriers, And Preferences Toward Academic And Clinical Documentation
TL;DR
The AACDS's 40-item attitude/barrier core demonstrates robust, multi-method psychometric validation for assessing MBBS students' engagement with CBME documentation requirements, and is, to the authors' knowledge, the first instrument to jointly capture attitudes, barriers, and preferences across assignments, SDL, and logbook documentation while linking self-report data to objective institutional records.
Abstract
Background: Competency-Based Medical Education (CBME) in India relies on assignments, Self-Directed Learning (SDL) record book entries, and clinical logbook documentation as core mechanisms for developing self-regulated, lifelong learners. Prior survey work suggests these elements are inconsistently well received by MBBS students, yet no validated, multi-domain instrument exists to assess attitudes, perceived barriers, and preferences across all three tasks within a single framework, nor to link self-report data with objective compliance records. Objective: To develop and psychometrically validate the Attitude, Barriers, and Preferences towards Academic and Clinical Documentation Scale (AACDS), including an item assessing preference for extending the National Medical Commission’s (NMC) postgraduate e-logbook mandate to undergraduate level. Methods: The 48-item AACDS (40 Likert-scaled attitude/barrier items across four subscales, plus 8 preference/opportunity items) was evaluated across six validation strands: content validity (10-expert panel), face validity (pilot, n=15), internal consistency reliability (pilot, n=35), exploratory factor analysis (n=300), test–retest reliability (n=50, 2-week interval), and inter-rater reliability of a linked objective Entry Quality Rubric (2 raters, 20 entries). Results: Content validity was excellent (S-CVI/Ave = 0.902; all 48 items I-CVI ≥ 0.78). Face validity was strong (mean clarity = 87.8%; 0/48 items flagged). Internal consistency was acceptable to good across subscales (α = 0.783–0.824). Exploratory factor analysis (KMO = 0.85; Bartlett's χ²(435) = 2217.67, p < .001) supported by parallel analysis confirmed the hypothesized three-factor structure (Assignments, SDL Record Book, Clinical Logbook) with small cross-loadings (< .15 in magnitude), explaining 37.68% of variance. Test–retest reliability was good (ICC = 0.78). Inter-rater reliability for the objective Entry Quality Rubric was almost perfect (pooled κ = 0.90; ICC = 0.88). Conclusion: The AACDS's 40-item attitude/barrier core demonstrates robust, multi-method psychometric validation for assessing MBBS students' engagement with CBME documentation requirements; validation of the 8 Section E preference items remains pending. It is, to our knowledge, the first instrument to jointly capture attitudes, barriers, and preferences across assignments, SDL, and logbook documentation while linking self-report data to objective institutional records, positioning it as a practical tool for curriculum evaluation and for informing undergraduate digital documentation policy.