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Open Access Research article

Development and preliminary psychometric properties of a well-being index for medical students

Liselotte N Dyrbye1*, Daniel W Szydlo2, Steven M Downing3, Jeff A Sloan2 and Tait D Shanafelt1

Author Affiliations

1 Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA

2 Mayo Clinic Department of Health Sciences Research, 200 First Street SW, Rochester, MN 55905, USA

3 Department of Medical Education (MC 591), University of Illinois-Chicago College of Medicine, College of Medicine, 986 CME, 808 S Wood Street, Chicago IL, 60612, USA

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BMC Medical Education 2010, 10:8  doi:10.1186/1472-6920-10-8

Published: 27 January 2010

Abstract

Background

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.

Methods

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.

Results

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 ≥0.82. Overall scale CVI-relevance and CVI-representativeness was 0.94 and 0.91. Overall pair-wise percent agreement between raters was ≥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 ≥74% sensitivity and specificity for detecting distress within the intended domain.

Conclusions

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.