Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
BMC Med Educ. 2010 Jan 27;10:8. doi: 10.1186/1472-6920-10-8.
Psychological distress is common among medical students but manifests in a variety of forms. Currently, no brief, practical tool exists to simultaneously evaluate these domains of distress among medical students. The authors describe the development of a subject-reported assessment (Medical Student Well-Being Index, MSWBI) intended to screen for medical student distress across a variety of domains and examine its preliminary psychometric properties.
Relevant domains of distress were identified, items generated, and a screening instrument formed using a process of literature review, nominal group technique, input from deans and medical students, and correlation analysis from previously administered assessments. Eleven experts judged the clarity, relevance, and representativeness of the items. A Content Validity Index (CVI) was calculated. Interrater agreement was assessed using pair-wise percent agreement adjusted for chance agreement. Data from 2248 medical students who completed the MSWBI along with validated full-length instruments assessing domains of interest was used to calculate reliability and explore internal structure validity.
Burnout (emotional exhaustion and depersonalization), depression, mental quality of life (QOL), physical QOL, stress, and fatigue were domains identified for inclusion in the MSWBI. Six of 7 items received item CVI-relevance and CVI-representativeness of >or=0.82. Overall scale CVI-relevance and CVI-representativeness was 0.94 and 0.91. Overall pair-wise percent agreement between raters was >or=85% for clarity, relevance, and representativeness. Cronbach's alpha was 0.68. Item by item percent pair-wise agreements and Phi were low, suggesting little overlap between items. The majority of MSWBI items had a >or=74% sensitivity and specificity for detecting distress within the intended domain.
The results of this study provide evidence of reliability and content-related validity of the MSWBI. Further research is needed to assess remaining psychometric properties and establish scores for which intervention is warranted.
心理困扰在医学生中很常见，但表现形式多种多样。目前，尚无一种简洁实用的工具可以同时评估医学生在这些困扰领域的情况。作者描述了一种被试报告评估工具（Medical Student Well-Being Index，MSWBI）的开发过程，该工具旨在筛查医学生在多种领域的困扰情况，并检验其初步心理测量学特性。
通过文献回顾、名义群体技术、院长和医学生的意见以及之前使用的评估方法的相关分析，确定了困扰的相关领域，生成了项目，并形成了一种筛选工具。11 名专家对项目的清晰度、相关性和代表性进行了评判。计算了内容效度指数（Content Validity Index，CVI）。采用配对百分比一致性来评估评分者间的一致性，并校正了一致性的机会因素。对 2248 名完成 MSWBI 以及评估感兴趣领域的完整长度工具的医学生的数据进行了可靠性和内部结构有效性的探索。
倦怠（情绪衰竭和去人格化）、抑郁、心理生活质量（QOL）、身体 QOL、压力和疲劳被确定为纳入 MSWBI 的领域。7 项中的 6 项获得了项目 CVI-相关性和 CVI-代表性的>0.82。总体量表 CVI-相关性和 CVI-代表性分别为 0.94 和 0.91。评分者之间的总体配对百分比一致性>0.85，适用于清晰度、相关性和代表性。克朗巴赫的α值为 0.68。项目间的百分比一致性和 Phi 值较低，表明项目之间的重叠较小。MSWBI 的大部分项目在预期领域检测到困扰的敏感性和特异性均>0.74%。
本研究结果为 MSWBI 的可靠性和内容相关效度提供了证据。需要进一步研究以评估其余的心理测量特性并建立需要干预的分数。
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