Psychometric Analysis of an Adapted Patient Care Ownership Scale for Medical Students

Patient care ownership (PCO) is a commitment to patient care with important implications for both patients and providers, and understanding PCO among trainees is an emerging area of study. Recently, Djulbegovic et al adapted a psychological ownership scale for graduate medical education (GME). Tailoring this scale for undergraduate medical education (UME) would strengthen the ability to measure and promote PCO among students, while directly linking this growth to the transition to GME.

Djulbegovic et al.'s PCO scale was adjusted through content expert input and cognitive interviews. This scale was administered to post-clerkship students at the University of Colorado School of Medicine after academic years 2020-21 and 2021-22. Exploratory factor analysis (EFA) was used to examine the underlying themes of the adapted scale in the 2020-21 sample. Confirmatory factor analysis (CFA) was performed in the 2021-22 sample to evaluate factors elucidated in EFA. Messick's validity framework was used to guide collection of content, response process, and internal structure validity evidence.

The final scale included 16, 7-point Likert-style items. EFA modeling in the first sample suggested either a four-factor structure or a two-factor structure that was a simplification of the four-factor structure. CFA modeling in the second sample supported a four-factor model of PCO in medical students, named Advocacy, Decision-making, Opportunity, and Responsibility.

This PCO scale demonstrated strong internal structure validity evidence and identified four factors contributing to PCO in medical students. Comparing these to Djulbegovic's work elucidates differences between UME and GME learners' experiences of PCO, chiefly in the opportunity of care ownership.