Abstract
Introduction: The Clinical Learning Evaluation Questionnaire (CLEQ) is a multidimensional, reliable instrument designed to measure the effectiveness of the clinical learning environment for undergraduate medical students. This study seeks to measure and examine the underlying construct along with the latent variables by conducting a confirmatory factor analysis, using structural equation modeling (SEM) so that the instrument can be utilized as an evaluation tool for the continuous improvement of educational environments and curricula.
Methods: A cross-sectional study was carried out on 185 third- and fourth-year medical students. A confirmatory factor analysis was conducted, beginning with principal component analysis for standardized factor loadings, using varimax rotation in SPSS to explore the underlying construct of items. The constructs to which each item was tied were determined, and then the data were run through AMOS to assess construct validity through item reduction based on the modification indices, and estimates were made of the standardized residual covariance of each item in order to determine the best model fit.
Results: A total of 185 students completed the CLEQ Inventory. The original six-factor structure of the CLEQ did not achieve model fit (X-2=1587.475, RMSEA=0.092, RMR=0.146, GFI=0.651, AGFI=0.601, CFI=0.728, NFI=0.626). However, the suggested four-factor model of CLEQ displayed good model fit with the improvement of values (X-2=86.184, RMSEA=0.052, RMR=0.062, GFI=0.903, AGFI=0.865, CFI=0.951, NFI=0.871). Internal consistency analysis showed that Cronbach's alpha values of the original six-factor model ranged from 0.68 to 0.88, while four-factor model ranged from 0.72 to 0.87.
Conclusion: This study did not support the proposed six-factor structure of the CLEQ tool. However, the four-factor CLEQ structure demonstrated an adequate degree of good fit and was found to be as reliable as the original structure. Further research on the predictive validity of CLEQ is required as well as a comparison of the psychometric properties across different institutions and countries.