Contextual validation of HEMLEM tool used for measuring clinical micro-learning environments

Area of Science:

• Medical Education Research
• Psychometric Validation
• Healthcare Professional Development

Background:

• A positive clinical learning environment is crucial for medical and dental student development.
• The original Healthcare Education Micro Learning Environment Measure (HEMLEM) lacked cross-cultural validation.
• This limits the global applicability of the original HEMLEM tool.

Purpose of the Study:

• To adapt and validate a revised version of HEMLEM (HEMLEM 2.0) for Pakistani medical and dental schools.
• To assess the factorial structure, measurement invariance, and psychometric robustness of HEMLEM 2.0.
• To ensure the tool's suitability for evaluating the clinical micro-learning environment in a new cultural context.

Main Methods:

• Cultural adaptation and validation of HEMLEM through expert review and pilot testing.
• Cross-sectional study with 628 Pakistani medical and dental students using a revised 12-item instrument.
• Confirmatory Factor Analysis (CFA) for construct validity and multi-group CFA for measurement invariance; reliability assessed via Cronbach's alpha and McDonald's omega.

Main Results:

• The revised 12-item HEMLEM 2.0, with factors 'Supervision,' 'Autonomy,' and 'Atmosphere,' showed a good fit in CFA.
• Full measurement invariance was confirmed across gender and academic discipline (MBBS/BDS).
• HEMLEM 2.0 demonstrated strong internal consistency with Cronbach's Alpha (0.897) and McDonald's Omega (0.929).

Conclusions:

• HEMLEM 2.0 is a culturally adapted and psychometrically robust tool for assessing the clinical micro-learning environment in Pakistani healthcare education.
• The tool's validity and reliability support its application in quality improvement initiatives, curriculum evaluation, and educational research.
• Future research should explore test-retest reliability and applicability in other LMICs.