Development of PATS: A tool to assess professionalism

Abstract Background: Professionalism has become a specific requirement for medical graduates because of dissatisfaction regarding their preparedness to adequately deal with the challenges of the medical world. It should be assessed as a competency in the final year of study using a valid and reliable instrument. The purpose was to develop and validate a tool to assess the development of professionalism in final year medical students in the local context to assess the readiness of medical graduates. Method: This was a mixed method study. Micro scenarios for the preliminary instrument were developed after a focus group meeting. These were validated using a 3-round modified Delphi technique by email. Twenty-four participants responded in the first round, and 15 in the second and third rounds. After the first round, relevance of the item was obtained. The content validity ratio was calculated after second round. Cut off value for items were approximated to be 0.6 and 0.73 for modification and 0.8 for item retention. The second round revised analysis was sent to participants for the third round and the content validity index average and universal agreement were calculated. Cognitive pretesting was performed. Cronbach’s Alpha for reliability and Confirmatory factor analysis were carried out. Results: The focus group produced 46 micro-scenarios using a manual qualitative analysis. The first round of Delphi produced 35 items. On calculation of Content validity ratio 12 items were retained, 18 were revised and 5 were removed. Content validity index (I-CVI) and content validity scale (S-CVI) were 0.94 and 0.64 respectively. Pre-cognitive testing resulted in the modification of 4 items. The Confirmatory factor analysis was 4.1. Cronbach’s Alpha was 0.96. Conclusion: The final instrument developed has a 27 item 5-point Likert scale. It has good content validity, reliability and acceptable construct validity. The strength of the instrument is in its process of development i.e. focus group discussion, the iterative Delphi rounds, cognitive pre-testing and piloting. It can be used to assess the development of professionalism in final year medical students. Keywords: Professionalism, respect, altruism, honor and integrity, accountability, content validity, construct validity, cognitive pre-testing, and confirmatory factor analysis