Development of a self-reported clinical decision-making competence scale for medical students

Clinical decision-making (CDM) is a multifaceted competency encompassing cognitive, ethical, and interpersonal dimensions. Despite its importance in medical education, there remains a lack of psychometrically sound instruments for assessing medical students' self-reported clinical decision-making competence.

To develop and validate a Self-Reported Clinical Decision-Making Competence Scale for clinical-phase medical students.

A methodological scale-development study was conducted with 243 clinical-phase medical students at Karadeniz Technical University. An initial 30-item pool was generated through a literature review and expert consultation. Following expert review, a 27-item Likert-type scale was finalized and administered online. Construct validity was examined using exploratory factor analysis with robust estimation, the Robust MORGANA approach, and PROMIN rotation. Reliability was evaluated using Cronbach's α and McDonald's ω coefficients.

Exploratory factor analysis supported an essentially unidimensional structure explaining 57.6% of the total variance. Factor loadings ranged from 0.44 to 0.85, and model fit indices demonstrated excellent fit. Item discrimination was high across all items (Cohen's d = 1.30-3.18; p < .001). Reliability was excellent (Cronbach's α = 0.971; McDonald's ω = 0.973), supporting the internal consistency of the instrument.

The 27-item Self-Reported Clinical Decision-Making Competence Scale demonstrated strong psychometric properties and provides a standardized self-report instrument for assessing medical students' clinical decision-making competence. The scale is intended to complement, rather than replace, performance-based assessment methods within competency-based medical education.