Development of a learning quality scale and associated factors among international medical students in China

The aims of this study were to develop and validate the International Medical Students' Learning Quality Scale (IMS-LQS) in China, and to examine student-related factors associated with learning quality.

A cross-sectional study was conducted among international students enrolled in clinical medicine programs in China. A multicenter convenience sampling strategy was applied at 16 medical universities located in selected regions of China. A preliminary IMS-LQS was developed through literature review, expert consultation, and student interviews. In total, 472 valid questionnaires were collected and randomly divided into an exploratory sample (n = 189) and confirmatory sample (n = 283). Exploratory factor analysis was conducted for item reduction and factor structure exploration, and confirmatory factor analysis was applied to examine model fit and construct validity. Internal consistency, convergent validity, and discriminant validity were assessed. Univariate and multivariate linear regression analyses were performed to identify factors associated with learning quality.

Nineteen items were retained in the final IMS-LQS covering five domains: professional knowledge, clinical skills and practice, professional literacy and ethics, Chinese communication and intercultural competence, and academic and self-directed development. The five-factor solution explained 73.37% of the total variance. The overall Cronbach's alpha coefficient was 0.889, and the domain-level coefficients ranged from 0.817 to 0.851. Confirmatory factor analysis showed that the model fit was acceptable (χ²/df = 2.26, comparative fit index = 0.927, Tucker-Lewis index = 0.913, root mean square error of approximation = 0.067, and standardized root mean square residual = 0.056), with adequate composite reliability, average variance extracted, and discriminant validity. Multivariate analysis showed that native English language, longer duration of study in China, motivation related to the cultural environment, and clinical internship experience were factors associated with higher learning quality scores.

The 19-item IMS-LQS had a clear five-domain structure and acceptable reliability and validity among international medical students in China. This scale may support learning quality assessment and targeted educational support in international medical education.