Development and Use of an Instrument Adapted to Assess the Clinical Skills Learning Environment in the Pre-clinical Years

Rebecca E. Rdesinski, Kathryn G. Chappelle, Diane L. Elliot, Debra K. Litzelman, Ryan T. Palmer, Frances E. Biagioli

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: The Communication, Curriculum, and Culture (C3) instrument is a well-established survey for measuring the professional learning climate or hidden curriculum in the clinical years of medical school. However, few instruments exist for assessing professionalism in the pre-clinical years. We adapted the C3 instrument and assessed its utility during the pre-clinical years at two U.S. medical schools. Methods: The ten-item Pre-clinical C3 survey was adapted from the C3 instrument. Surveys were administered at the conclusion of the first and second years of medical school using a repeated cross-sectional design. Factor analysis was performed and Cronbach’s alphas were calculated for emerging dimensions. Results: The authors collected 458 and 564 surveys at two medical schools during AY06-07 and AY07-09 years, respectively. Factor analysis of the survey data revealed nine items in three dimensions: “Patients as Objects”, “Talking Respectfully of Colleagues”, and “Patient-Centered Behaviors”. Reliability measures (Cronbach’s alpha) for the Pre-clinical C3 survey data were similar to those of the C3 survey for comparable dimensions for each school. Gender analysis revealed significant differences in all three dimensions. Conclusions: The Pre-clinical C3 instrument’s performance was similar to the C3 instrument in measuring dimensions of professionalism. As medical education moves toward earlier and more frequent clinical and inter-professional educational experiences, the Pre-clinical C3 instrument may be especially useful in evaluating the impact of curricular revisions.

Original languageEnglish (US)
Pages (from-to)285-291
Number of pages7
JournalMedical Science Educator
Issue number3
StatePublished - Sep 1 2015


  • Evaluation
  • Patient-centered care
  • Pre-clinical curriculum
  • Professionalism

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Education


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