Open Access Research article

An instrument for evaluating clinical teaching in Japan: content validity and cultural sensitivity

Makoto Kikukawa1*, Renee E Stalmeijer2, Sei Emura3, Sue Roff4 and Albert JJA Scherpbier5

Author Affiliations

1 Department of Medical Education, Kyushu University, 3-1-1 Maidashi Higashi-ku Fukuoka, 81-8582 Kyushu, Japan

2 Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

3 Centre for Graduate Medical Education Development and Research, Saga University Hospital, Saga, Japan

4 The Centre for Medical Education, Dundee Medical School, Dundee, Scotland

5 Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands

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BMC Medical Education 2014, 14:179  doi:10.1186/1472-6920-14-179

Published: 28 August 2014



Many instruments for evaluating clinical teaching have been developed but almost all in Western countries. None of these instruments have been validated for the Asian culture, and a literature search yielded no instruments that were developed specifically for that culture. A key element that influences content validity in developing instruments for evaluating the quality of teaching is culture. The aim of this study was to develop a culture-specific instrument with strong content validity for evaluating clinical teaching in initial medical postgraduate training in Japan.


Based on data from a literature search and an earlier study we prepared a draft evaluation instrument. To ensure a good cultural fit of the instrument with the Asian context we conducted a modified Delphi procedure among three groups of stakeholders (five education experts, twelve clinical teachers and ten residents) to establish content validity, as this factor is particularly susceptible to cultural factors.


Two rounds of Delphi were conducted. Through the procedure, 52 prospective items were reworded, combined or eliminated, resulting in a 25-item instrument validated for the Japanese setting.


This is the first study describing the development and content validation of an instrument for evaluating clinical teaching specifically tailored to an East Asian setting. The instrument has similarities and differences compared with instruments of Western origin. Our findings suggest that designers of evaluation instruments should consider the probability that the content validity of instruments for evaluating clinical teachers can be influenced by cultural aspects.

Evaluation; Instrument; Clinical teaching; Japan; Culture; Modified Delphi method; Content validity