Psychometric characteristics of the Azerbaijan version of Medical Achievement Self-Efficacy Scale (MASS AZE)

Psychometric characteristics of the Azerbaijan version of Medical Achievement Self-Efficacy Scale (MASS AZE) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychometric characteristics of the Azerbaijan version of Medical Achievement Self-Efficacy Scale (MASS AZE) Samira Mammadova, Elyana Tahmazova, Sevgi Turan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6099391/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Self-efficacy is accepted as a mediator of behavioral change and has been shown to be related to achievement. Thus, self-efficacy is a vital variable in evaluating the overall curriculum. Methods : The MASS is an 18-item, five-point Likert-type scale. The minimum and maximum scores that can be obtained from the scale vary between 18–90 points. It was reported that Cronbach's alpha for the original form of the scale was 0.89, and item-total score correlations ranged between 0.39 and 0.64. The study was conducted with undergraduate military medical students at Azerbaijan Medical University (n = 250). A panel of experts translated the scale and then back-translated it. Cronbach alpha was calculated to determine the scale's reliability. Item-total correlation was calculated, and the scores of low-performing and high-performing groups were compared using a t-test. Exploratory factor analysis was conducted to determine the construct validity. Results : The original MASS based on the competency frameworks of CanMEDs and The Five Star Doctor indicated its content validity. The Azerbaijani form of the scale was examined by four experts for face validity and was found appropriate. The reliability of the scale was found to be high (Cronbach’s α = 0.95). Item-total correlation coefficients of the Turkish MASS ranged from 0.61 to 0.85. Lower and upper score groups were compared to indicate the discriminant validity. All items discriminated significantly between lowly and highly performing students. Factor analysis showed that the scale has a one-factor structure, which explains 56.26% of the variance. Factor loadings ranged from 0.59 to 0.84. Conclusions : The Azerbaijan adaptation of the MASS was found to be reliable and has construct validity. academic self-efficacy medical students scale development Introduction Self-efficacy, a concept introduced by Bandura (1997), refers to an individual's belief in their capacity to organize and execute actions required to achieve specific goals. It plays a crucial role in academic achievement, motivation, and psychological well-being. In medical education, where students face high cognitive and emotional demands, self-efficacy is particularly relevant as it influences learning processes, clinical performance, and resilience in stressful situations (Zimmerman, 2000; Mavis, 2001). Medical students with high self-efficacy demonstrate greater confidence in their clinical skills, are more likely to engage in problem-solving, and exhibit improved stress management (Tresolini & Stritter, 1994; Katz et al., 2005). Given its importance, assessing medical students' self-efficacy has become a focal focus in educational research. Various tools have been developed to measure self-efficacy in academic and clinical settings. One of the most widely used instruments is the Medical Achievement Self-Efficacy Scale (MASS), developed by Turan et al. (2013). The MASS’s content framework grounded in two well-established models: the Five-Star Doctor (Boelen, 1997) and was tested among Flemish medical students (Turan et al., 2013). The assessment demonstrated high internal consistency reliability (Cronbach’s α = 0.89) (Turan et al., 2013). Analyses of its discriminant and predictive validity showed that MASS scores differed between high- and low-achieving students, increased over years of study, and accounted for 10% of the variance in student performance on the Maastricht Progress Test (Turan et al., 2013). Designed to measure medical students' confidence in their academic and clinical abilities, the MASS has been validated in various cultural contexts, including Turkey (Turan et al., 2013) and Brazil (Bressa, 2023). Research confirms that the MASS is a reliable and valid tool for assessing self-efficacy across diverse populations. The development of the MASS-AZE is a significant step toward understanding self-efficacy in Azerbaijan’s medical education system. While previous studies have explored the role of self-efficacy in medical students from different countries (Frank & Danoff, 2007; Wright et al., 2006), research on this topic in Azerbaijan has been limited. Recognizing the need for culturally appropriate assessment tools, recent research has focused on adapting the MASS for Azerbaijani medical students. The adaptation process involves linguistic translation and validation to ensure that the scale maintains its psychometric properties in a new educational and cultural setting (Fraenkel & Wallen, 1996). This study addresses this gap by validating the MASS-AZE and examining its psychometric properties among Azerbaijani medical students. The findings will contribute to a broader understanding of self-efficacy in medical education and inform educational strategies to enhance student learning and medical curricula. Method Instrument The original MASS contained 18 items. It was rated on a five-point Likert scale. The scale score ranged from 18 to 90, with a higher score reflecting greater self-efficacy (Turan et al., 2013). In the first step of the adaptation process, two experts translated the scale, and then two others back-translated it. Native Azerbaijani speakers (four experts) also checked the translated version for the meaningfulness of items. The original structure was preserved when translating into Azerbaijani to ensure content validity. Subjects The study was conducted with undergraduate military medical students at Azerbaijan Medical University (n = 243). All the participants were male and enrolled from year 1 to 4 medical school (Table 1 ). Table 1 Percentages of gender, curriculum stream and grade of participants Frequency Percent Gender Female - - Male 243 100.0 Year 1 123 50,6 2 55 22,6 3 25 10,3 4 40 16,5 Total 243 100.0 Data Analysis Cronbach’s alpha was calculated to measure the scale’s internal consistency and reliability. Item-total correlation was calculated, and the scores of lowly (27% undermost) and highly performing groups (27% upmost) were compared using a t-test. Exploratory factor analysis was conducted to determine the construct validity. Ethical Considerations Participation was voluntary. The instrument included a brief cover letter informing students about the purpose of the study. Students were asked to read and complete the informed consent form before answering the scale. The completed forms were anonymous. Ethical approval was provided by Azerbaijan Medical School Ethical Committee Protocol No.22, 01.04.2022 Results Content and face validity During the adaptation process of the MASS, we conformed to the translation and back-translation procedures. The MASS items were based on the CanMEDS and the Five Stars Doctor. This structure was preserved when translating into Azerbaijani to ensure content validity (Table 2 ). Table 2 Description of CanMEDS roles and items of MASS CanMEDs Roles Description of CanMEDs Roles Items Items in Azerbaijan scale Medical Expert As Medical Experts, physicians integrate all of the roles, applying medical knowledge, clinical skills, and professional attitudes in their provision of patient-centered care. 1. I am able to perform the skills we learned thus far on a patient 4. I am able to adequately apply the subsequent steps of diagnosis and treatment on a clinical problem 7. I have adequate knowledge of basic medical sciences 1. İndiyə qədər öyrəndiyim bacarıqları xəstə üzərində tətbiq edə bilərəm. 4. Klinik bir situasiyada düzgün diaqnoz və müalicə addımlarını adekvat şəkildə tətbiq edə bilərəm. 7. Təməl tibb elmləri üzrə kifayət qədər məlumata sahibəm. Communicator As Communicators, physicians effectively facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter. 5. I am able to react in a conflict situation with a patient in a communicatively adequate way 15. In a consultation I am able to structure the information I obtain from a patient 5. Fikir ayrılığı olarsa, xəstəyə ünsiyyət baxımından adekvat reaksiya verə bilərəm. 15. Xəstə qəbulu (konsultasiya) zamanı xəstədən aldığım məlumatları strukturlaşdıra bilərəm. Collaborator As Collaborators, physicians effectively work within a healthcare team to achieve optimal patient care. 8. I am able to analyze a health problem of a patient in a group 12. I feel able to collaborate on a basis of equality with colleagues from other health care disciplines 8. Bir xəstənin sağlamlıq problemini qrup daxilində təhlil edə bilərəm. 12. Digər səhiyyə sahələrindən olan həmkarlarımla eyni səviyyədə əməkdaşlıq edə bilərəm. Manager As Managers, physicians are integral participants in healthcare organizations, organizing sustainable practices, making decisions about allocating resources, and contributing to the effectiveness of the healthcare system. 16. I am able to make a cost-effective choice when using technical means for diagnosis or therapy 18. I am able to deal with critical incidents (unexpected, stressful events) when providing health care 16. Diaqnoz və müalicə üçün texniki vasitələrin istifadəsində sərfəli olanı seçə bilərəm. 18. Səhiyyə xidməti göstərərkən kritik vəziyyətlərin (gözlənilməz, stresli hadisələr) öhdəsindən gələ bilərəm. Table 2 continued. CanMEDs Roles Description of CanMEDs Roles Items Items in Azerbaijan scale Health Advocate As Health Advocates, physicians responsibly use their expertise and influence to advance the health and well-being of individual patients, communities, and populations 2. I have sufficient insight in the social factors that influence the health problems of patients 14. I am able to handle a health problem in society preventatively 2. Xəstələrin sağlamlıq problemlərinə təsir edən sosial amillər haqqında kifayət qədər fikrim var. 14. Cəmiyyətdəki hər hansısa bir sağlamlıq problemini profilaktik (önləyici) şəkildə ələ ala bilərəm. Scholar As Scholars, physicians demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge 3. I am able to search literature relevant to a health problem electronically 6. I master the medical aspects that have been dealt with in the Studium generale or Medical Humanities (e.g. philosophy, art, …) 9. I am able to write a sound scientific paper on a health related subject 10. I am able to choose/to draw a scientific set up for the solution of a medical research problem 3. Hər hansısa bir sağlamlıq problemi ilə bağlı tibbi ədəbiyyatı elektron şəkildə araşdıra bilərəm. 6. Tibb fakültəsi proqramında olan sosial elmlərin (fəlsəfə, etika,tarix və s.) mənə qazandırdığı tibbi baxışa sahibəm. 9. Hər hansısa bir sağlamlıq mövzusunda etibarlı elmi məqalə yaza bilərəm. 10. Tibbi tədqiqatın əsas məsələsini həll etmək üçün elmi tədqiqat dizaynını seçə bilərəm. Professional As Professionals, physicians are committed to the health and well-being of individuals and society through ethical practice, profession-led regulation, and high personal standards of behaviour. 11. I am able to take an underpinned personal point of view related to the ethical aspects when a patient asks for euthanasia 13. I am able to handle my feelings of anxiety when they appear in certain clinical situations 17. I am able to recognize signs and symptoms of burnout in my professional functioning 11. Bir xəstə evtanaziya tələb etdikdə, mən etik cəhətdən dəstəklənən fikirlərimlə öz mövqeyimi sərgiləyə bilərəm. 13. Müəyyən klinik vəziyyətlərdə meydana gələn narahatlıq hisslərimin öhdəsindən gələ bilərəm. 17. İş həyatımda (vəzifələrimdə) tükənmə əlamətlərini və işarələrini tanıya bilərəm. Item analysis and internal consistency reliability Item-total correlation coefficients of the MASS AZE ranged from 0.61 to 0.83 (Table 3 ). The scores of lowly and highly performing groups scores were compared: it was found that all items discriminated significantly (p < 0.001) (Table 4 ). The reliability of the scale was high (Cronbach’s α = 0.95). Table 3 Item-Total Statistics of MASS Original study (n = 1060) (Turan et al., 2013) Turkish students (n = 547) Azerbaijan students (n = 243) Item number Item-Total Correlation Item-Total Correlation Item-Total Correlation 1 0.40 0.53 0.76 2 0.52 0.56 0.76 3 0.41 0.53 0.62 4 0.63 0.66 0.78 5 0.57 0.59 0.61 6 0.39 0.55 0.69 7 0.56 0.59 0.71 8 0.64 0.69 0.79 9 0.55 0.57 0.75 10 0.60 0.66 0.80 11 0.45 0.53 0.74 12 0.43 0.62 0.76 13 0.49 0.65 0.73 14 0.63 0.70 0.83 15 0.61 0.69 0.81 16 0.57 0.60 0.82 17 0.51 0.63 0.75 18 0.58 0.67 0.74 Table 4 The comparison of lower and upper score groups of MASS-AZE Item number Lower Group Upper Group t- value p< Mean SS Mean SS 1 1.85 0.82 4.93 0.27 -18.55 0.001 2 2.22 1.01 4.93 0.27 -13.41 0.001 3 2.89 1.07 4.85 0.77 -7.66 0.001 4 1.59 0.57 4.78 0.51 -21.66 0.001 5 2.52 1.09 4.85 0.46 -10.28 0.001 6 2.15 1.06 4.93 0.39 -12.76 0.001 7 2.30 0.87 4.89 0.42 -13.94 0.001 8 2.41 0.84 5.00 0.00 -15.96 0.001 9 1.63 0.74 4.85 0.53 -18.33 0.001 10 2.00 0.88 5.00 0.00 -17.77 0.001 11 2.48 1.16 5.00 0.00 -11.32 0.001 12 2.30 0.99 5.00 0.00 -14.15 0.001 13 2.85 1.29 5.00 0.00 -8.64 0.001 14 2.33 0.78 5.00 0.00 -17.66 0.001 15 2.30 0.78 5.00 0.00 -18.12 0.001 16 2.15 0.77 5.00 0.00 -19.25 0.001 17 2.48 0.93 5.00 0.00 -13.99 0.001 18 2.63 1.12 5.00 0.00 -11.05 0.001 Discriminant validity Lower and upper score groups were compared as an indicator of discriminant validity. All items discriminated significantly between lowly and highly performing students (p < 0.001) (Table 4 ). The construct of the scale Exploratory factor analysis was used to obtain information about the structure of the scale. The Kaiser-Meyer-Olkin coefficient (KMO) was 0.95, and Bartlett’s test reached statistical significance (p < 0.001). Factor analysis produced two factors. All items were loaded on one factor, which explained 56.26% of the variance. Factor loadings ranged from 0.59 to 0.84. The high loads and the high percentage of explained variance on one factor showed that all items of the instrument indicated the same dimension (Table 5 ). Table 5 Summary of Exploratory Factor Analysis Results Item Communalities Component 1 2 Item 14 0.772 0,844 -0,242 Item 16 0.743 0,830 -0,232 Item 15 0.740 0,823 -0,249 Item 10 0.644 0,798 0,086 Item 8 0.656 0,796 0,152 Item 4 0.721 0,771 0,356 Item 12 0.617 0,767 -0,170 Item 17 0.653 0,763 -0,266 Item 18 0.715 0,754 -0,382 Item 2 0.618 0,754 0,222 Item 1 0.708 0,750 0,382 Item 13 0.646 0,739 -0,317 Item 11 0.542 0,736 0,017 Item 9 0.616 0,736 0,274 Item 7 0.578 0,705 0,283 Item 6 0.512 0,673 0,241 Item 3 0.375 0,612 -0,004 Item 5 0.361 0,599 -0,056 % of Total Variance Explained 56.265 6.053 Extraction Method: Principal Component Analysis. Discussion Validity refers to the degree to which the scale measures what it is intended to measure (Fraenkel & Wallen, 1996). Since the items of the MASS were based on the CanMEDS and the Five-Star Doctor frameworks (Turan et al., 2013), the MASS demonstrated good content validity. The structure of the MASS scale was preserved in its Azerbaijani translation. Additionally, the translation and back-translation process was conducted with the support of experts in the field and linguists, ensuring accuracy and fidelity to the original framework. The MASS-AZE showed high internal consistency reliability. The high item-total correlation coefficients of all items of the MASS-AZE revealed that they measured the same general construct. Previous studies have also demonstrated the reliability and validity of the MASS in different cultural and educational contexts. The original study with Flemish students (Turan et al., 2013) established its strong psychometric properties, including a high-reliability coefficient (Cronbach’s α = 0.89). The Turkish adaptation (Turan, Elcin, & Derese, 2018) confirmed the one-dimensional structure and cross-cultural applicability of the scale. Similarly, the Brazilian adaptation (Bressa, 2023) validated the scale in Portuguese and highlighted its role in assessing self-efficacy in professional competency development. The study reported Cronbach’s alpha of 0.936 for internal consistency, confirming the scale’s reliability. In this study, the Azerbaijani adaptation further reinforced the reliability and construct validity of MASS-AZE, aligning with previous adaptations. The findings of this study support the reliability and validity of the Azerbaijani adaptation of the Medical Achievement Self-Efficacy Scale (MASS-AZE). Our analysis demonstrated strong internal consistency (Cronbach's α = 0.95) and significant item-total correlations ranging from 0.61 to 0.83, confirming that the scale consistently measures the same construct across items. The discriminant validity was evident, as all items significantly differentiated between low-performing and high-performing students (p < 0.001). These results are consistent with the findings from previous studies (Turan et al., 2013; Turan, Elcin, & Derese, 2018; Bressa, 2023), including the original MASS study, and provide strong evidence of the scale’s ability to assess medical achievement self-efficacy reliably in Azerbaijani students. A comparison of our findings with the Portuguese adaptation of the MASS reveals similarities. Like the MASS-AZE, the Portuguese version of the scale also demonstrated strong internal consistency (Cronbach’s α = 0.936), with item-total correlations ranging from 0.488 to 0.816 (p < 0.001) and the ability to discriminate between low and high-performing student groups. These results underscore the cross-cultural reliability and applicability of the MASS scale, reinforcing that the MASS-AZE is a valid tool for use in Azerbaijan. One of the key similarities between the two studies is the unidimensional nature of the scale. In both the MASS-AZE and the Portuguese adaptation, exploratory factor analysis (EFA) yielded a one-factor solution. The factor analysis in our study explained 56.26% of the variance, with factor loadings ranging from 0.59 to 0.84, which aligns with the findings from Portugal, where a similar one-factor structure was identified, explaining 52.1% of the variance (Bressa, 2023). Both studies support the unidimensionality of the scale, which is consistent with the theoretical underpinnings of the original MASS, as well as the CanMEDS and Five-Star Doctor frameworks. While both studies employed exploratory factor analysis to assess construct validity, the Portuguese study further utilized confirmatory factor analysis (CFA) to confirm the fit of the one-factor model. In the Portuguese study, CFA results showed excellent fit indices (CFI = 0.988, TLI = 0.986, RMSEA = 0.110), which was later improved upon with a re-specified model (CFI = 0.999, TLI = 0.999, RMSEA = 0.027) (Bressa, 2023). These results suggest a stronger model fit and provide additional support for the structural validity of the Portuguese version of the scale (Bressa, 2023). Although we did not include CFA in our analysis, the EFA results in our study, with the KMO value of 0.95 and Bartlett’s test of sphericity (p < 0.001), suggest that the MASS-AZE also has a well-supported factor structure. When comparing our findings to the earlier study with Flemish students using the original MASS, we found additional similarities. Like the MASS-AZE, the Flemish version of the scale also demonstrated strong internal consistency, with Cronbach’s α = 0.89. The Flemish study’s item-total correlations ranged from 0.39 to 0.64 (Turan et al., 2013), which is consistent with the range observed in our study (0.34 to 0.61). Moreover, the Flemish study also reported strong discriminant validity, with significant differences between low and high-performing students (p < 0.001), aligning with our findings where all items significantly discriminated between students (p < 0.001). The Flemish study provides additional validation for the original scale by comparing it to the Maastricht Progress Test. - While this study offers compelling evidence of the MASS-AZE's reliability and validity, some limitations should be considered. The study was conducted exclusively with military medical students in Azerbaijan, which may limit the findings' generalizability to students from other educational settings or medical curricula. To enhance the MASS's generalizability, future research should test it in various medical schools, particularly those using different curricula and explore its performance across diverse student populations. Furthermore, while our study provides evidence of the internal consistency and discriminant validity of the MASS-AZE, test-retest reliability could be assessed to determine the stability of the scale over time. Additionally, future research on MASS-AZE could benefit from incorporating CFA to confirm its structural validity further, as was done in the Portuguese study. Given the promising results from EFA and the strong alignment with the Portuguese findings, CFA could offer additional insights into the robustness of the scale’s construct validity. Conclusion This study provides compelling evidence that the Azerbaijani adaptation of the MASS is a psychometrically sound instrument for assessing medical achievement self-efficacy among military medical students. The scale demonstrated high internal consistency, strong item-total correlations, and robust construct validity, as evidenced by its unidimensional factor structure. The findings are consistent with previous research on the MASS, supporting its cross-cultural applicability. Future research should integrate confirmatory factor analysis and extend validation efforts to diverse medical student populations to enhance the generalizability of these results. Overall, the MASS-AZE represents a valuable tool for evaluating self-efficacy in medical education, contributing to the assessment and improvement of competency-based learning and academic achievement. Declarations Ethics approval and consent to participate Participation in this study was voluntary. The instrument included a brief cover letter informing students about the purpose of the study. Before completing the questionnaire, students were required to read and sign the informed consent form. All responses were anonymous. Ethical approval for this study was obtained from the Azerbaijan Medical School Ethical Committee (Protocol No. 22). Consent for publication Not applicable. Availability of data and materials The data generated and analyzed during this study contain personal information and must remain confidential according to ethical guidelines in scientific research. The informed consent form explicitly stated that these data would only be used by researchers, and sharing identifiable information would violate the terms of consent. However, anonymized datasets can be made available upon reasonable request. Competing interests The authors declare that they have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Funding Not applicable. Authors’ contributions Conceptualization: Samira Mammadova, Elyana Tahmazova, Sevgi Turan. Methodology: Sevgi Turan. Data acquisition: Samira Mammadova, Elyana Tahmazova. Data analysis: Samira Mammadova, Sevgi Turan. Writing – original draft preparation: Samira Mammadova, Elyana Tahmazova, Sevgi Turan. 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Zeidner (Eds.), Handbook of Self-Regulation (pp. 13–39). San Diego, CA: Academic Press. BRESSA, Rebeca Carvalho. Autoeficácia acadêmica, motivação e autorregulação da aprendizagem no desenvolvimento de competências profissionais na formação médica. 2023. 214 f. Tese (Doutorado em Educação) - Universidade do Oeste Paulista, Presidente Prudente, 2023. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6099391","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":447077940,"identity":"4177ee51-f1a6-4336-9cd2-56797340bfab","order_by":0,"name":"Samira Mammadova","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYPACZiBmP/gAwkkgWgtPsgGpWhjMJIjSIj/t8NFNNyqs5QyOH0ir+JlzmIGfPceA4ccf3FoMbqel3c45k25scCbx2M3ebYcZJHveGDD28ODRIp1jdju37XDizIaEtBu8QC0GN4C28Ejgcdjs/G+3c/8BtfQ/MCv8C9RiD9TC+McAj2du57Ddzm04nNgvkWDGDLZFIseAmQdPEAD9YnY751i6Mb/Em2Rp2W3pPBJnnhUcljmAz2HJz27n1FjLsfGnH/z4dpu1HH978saHb/CEGAYABxUeO0bBKBgFo2AUEAMATOJT5F7m2HwAAAAASUVORK5CYII=","orcid":"","institution":"Azerbaijan Medical University","correspondingAuthor":true,"prefix":"","firstName":"Samira","middleName":"","lastName":"Mammadova","suffix":""},{"id":447077941,"identity":"cac06bb2-c3a2-4047-98cc-4cf42d6abaaa","order_by":1,"name":"Elyana Tahmazova","email":"","orcid":"","institution":"Azerbaijan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Elyana","middleName":"","lastName":"Tahmazova","suffix":""},{"id":447077942,"identity":"0716c4f2-ad0e-42bf-ba3b-0416781dfe2b","order_by":2,"name":"Sevgi Turan","email":"","orcid":"","institution":"ADA University School of Education","correspondingAuthor":false,"prefix":"","firstName":"Sevgi","middleName":"","lastName":"Turan","suffix":""}],"badges":[],"createdAt":"2025-02-24 18:53:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6099391/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6099391/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84008678,"identity":"6c447e68-b7f2-4fc7-9269-116223fe9832","added_by":"auto","created_at":"2025-06-05 16:01:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":974312,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6099391/v1/9cd85342-4b3e-4cc1-a613-c6ffc6d2fb9c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychometric characteristics of the Azerbaijan version of Medical Achievement Self-Efficacy Scale (MASS AZE)","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSelf-efficacy, a concept introduced by Bandura (1997), refers to an individual's belief in their capacity to organize and execute actions required to achieve specific goals. It plays a crucial role in academic achievement, motivation, and psychological well-being. In medical education, where students face high cognitive and emotional demands, self-efficacy is particularly relevant as it influences learning processes, clinical performance, and resilience in stressful situations (Zimmerman, 2000; Mavis, 2001). Medical students with high self-efficacy demonstrate greater confidence in their clinical skills, are more likely to engage in problem-solving, and exhibit improved stress management (Tresolini \u0026amp; Stritter, 1994; Katz et al., 2005).\u003c/p\u003e \u003cp\u003eGiven its importance, assessing medical students' self-efficacy has become a focal focus in educational research. Various tools have been developed to measure self-efficacy in academic and clinical settings. One of the most widely used instruments is the Medical Achievement Self-Efficacy Scale (MASS), developed by Turan et al. (2013). The MASS\u0026rsquo;s content framework grounded in two well-established models: the Five-Star Doctor (Boelen, 1997) and was tested among Flemish medical students (Turan et al., 2013). The assessment demonstrated high internal consistency reliability (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.89) (Turan et al., 2013). Analyses of its discriminant and predictive validity showed that MASS scores differed between high- and low-achieving students, increased over years of study, and accounted for 10% of the variance in student performance on the Maastricht Progress Test (Turan et al., 2013). Designed to measure medical students' confidence in their academic and clinical abilities, the MASS has been validated in various cultural contexts, including Turkey (Turan et al., 2013) and Brazil (Bressa, 2023). Research confirms that the MASS is a reliable and valid tool for assessing self-efficacy across diverse populations.\u003c/p\u003e \u003cp\u003eThe development of the MASS-AZE is a significant step toward understanding self-efficacy in Azerbaijan\u0026rsquo;s medical education system. While previous studies have explored the role of self-efficacy in medical students from different countries (Frank \u0026amp; Danoff, 2007; Wright et al., 2006), research on this topic in Azerbaijan has been limited. Recognizing the need for culturally appropriate assessment tools, recent research has focused on adapting the MASS for Azerbaijani medical students. The adaptation process involves linguistic translation and validation to ensure that the scale maintains its psychometric properties in a new educational and cultural setting (Fraenkel \u0026amp; Wallen, 1996). This study addresses this gap by validating the MASS-AZE and examining its psychometric properties among Azerbaijani medical students. The findings will contribute to a broader understanding of self-efficacy in medical education and inform educational strategies to enhance student learning and medical curricula.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInstrument\u003c/h2\u003e \u003cp\u003eThe original MASS contained 18 items. It was rated on a five-point Likert scale. The scale score ranged from 18 to 90, with a higher score reflecting greater self-efficacy (Turan et al., 2013). In the first step of the adaptation process, two experts translated the scale, and then two others back-translated it. Native Azerbaijani speakers (four experts) also checked the translated version for the meaningfulness of items. The original structure was preserved when translating into Azerbaijani to ensure content validity.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSubjects\u003c/h3\u003e\n\u003cp\u003eThe study was conducted with undergraduate military medical students at Azerbaijan Medical University (n\u0026thinsp;=\u0026thinsp;243). All the participants were male and enrolled from year 1 to 4 medical school (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentages of gender, curriculum stream and grade of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eYear\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50,6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22,6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10,3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16,5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e243\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eCronbach\u0026rsquo;s alpha was calculated to measure the scale\u0026rsquo;s internal consistency and reliability. Item-total correlation was calculated, and the scores of lowly (27% undermost) and highly performing groups (27% upmost) were compared using a t-test. Exploratory factor analysis was conducted to determine the construct validity.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003eParticipation was voluntary. The instrument included a brief cover letter informing students about the purpose of the study. Students were asked to read and complete the informed consent form before answering the scale. The completed forms were anonymous. Ethical approval was provided by Azerbaijan Medical School Ethical Committee Protocol No.22, 01.04.2022\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eContent and face validity\u003c/h2\u003e \u003cp\u003eDuring the adaptation process of the MASS, we conformed to the translation and back-translation procedures. The MASS items were based on the CanMEDS and the Five Stars Doctor. This structure was preserved when translating into Azerbaijani to ensure content validity (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescription of CanMEDS roles and items of MASS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanMEDs Roles\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription of CanMEDs Roles\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eItems in Azerbaijan scale\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical Expert\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAs Medical Experts, physicians integrate all of the roles, applying medical knowledge, clinical skills, and professional attitudes in their provision of patient-centered care.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. I am able to perform the skills we learned thus far on a patient\u003c/p\u003e \u003cp\u003e4. I am able to adequately apply the subsequent steps of diagnosis and treatment on a clinical problem\u003c/p\u003e \u003cp\u003e7. I have adequate knowledge of basic medical sciences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1. İndiyə qədər \u0026ouml;yrəndiyim bacarıqları xəstə \u0026uuml;zərində tətbiq edə bilərəm.\u003c/p\u003e \u003cp\u003e4. Klinik bir situasiyada d\u0026uuml;zg\u0026uuml;n diaqnoz və m\u0026uuml;alicə addımlarını adekvat şəkildə tətbiq edə bilərəm.\u003c/p\u003e \u003cp\u003e7. Təməl tibb elmləri \u0026uuml;zrə kifayət qədər məlumata sahibəm.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunicator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAs Communicators, physicians effectively facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5. I am able to react in a conflict situation with a patient in a communicatively adequate way\u003c/p\u003e \u003cp\u003e15. In a consultation I am able to structure the information I obtain from a patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5. Fikir ayrılığı olarsa, xəstəyə \u0026uuml;nsiyyət baxımından adekvat reaksiya verə bilərəm.\u003c/p\u003e \u003cp\u003e15. Xəstə qəbulu (konsultasiya) zamanı xəstədən aldığım məlumatları strukturlaşdıra bilərəm.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollaborator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAs Collaborators, physicians effectively work within a healthcare team to achieve optimal patient care.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8. I am able to analyze a health problem of a patient in a group\u003c/p\u003e \u003cp\u003e12. I feel able to collaborate on a basis of equality with colleagues from other health care disciplines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8. Bir xəstənin sağlamlıq problemini qrup daxilində təhlil edə bilərəm.\u003c/p\u003e \u003cp\u003e12. Digər səhiyyə sahələrindən olan həmkarlarımla eyni səviyyədə əməkdaşlıq edə bilərəm.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAs Managers, physicians are integral participants in healthcare organizations, organizing sustainable practices, making decisions about allocating resources, and contributing to the effectiveness of the healthcare system.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16. I am able to make a cost-effective choice when using technical means for diagnosis or therapy\u003c/p\u003e \u003cp\u003e18. I am able to deal with critical incidents (unexpected, stressful events) when providing health care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16. Diaqnoz və m\u0026uuml;alicə \u0026uuml;\u0026ccedil;\u0026uuml;n texniki vasitələrin istifadəsində sərfəli olanı se\u0026ccedil;ə bilərəm.\u003c/p\u003e \u003cp\u003e18. Səhiyyə xidməti g\u0026ouml;stərərkən kritik vəziyyətlərin (g\u0026ouml;zlənilməz, stresli hadisələr) \u0026ouml;hdəsindən gələ bilərəm.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003econtinued.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCanMEDs Roles\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription of CanMEDs Roles\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eItems in Azerbaijan scale\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth Advocate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAs Health Advocates, physicians responsibly use their expertise and influence to advance the health and well-being of individual patients, communities, and populations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2. I have sufficient insight in the social factors that influence the health problems of patients\u003c/p\u003e \u003cp\u003e14. I am able to handle a health problem in society preventatively\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2. Xəstələrin sağlamlıq problemlərinə təsir edən sosial amillər haqqında kifayət qədər fikrim var.\u003c/p\u003e \u003cp\u003e14. Cəmiyyətdəki hər hansısa bir sağlamlıq problemini profilaktik (\u0026ouml;nləyici) şəkildə ələ ala bilərəm.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScholar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAs Scholars, physicians demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3. I am able to search literature relevant to a health problem electronically\u003c/p\u003e \u003cp\u003e6. I master the medical aspects that have been dealt with in the Studium generale or Medical Humanities (e.g. philosophy, art, \u0026hellip;)\u003c/p\u003e \u003cp\u003e9. I am able to write a sound scientific paper on a health related subject\u003c/p\u003e \u003cp\u003e10. I am able to choose/to draw a scientific set up for the solution of a medical research problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3. Hər hansısa bir sağlamlıq problemi ilə bağlı tibbi ədəbiyyatı elektron şəkildə araşdıra bilərəm.\u003c/p\u003e \u003cp\u003e6. Tibb fak\u0026uuml;ltəsi proqramında olan sosial elmlərin (fəlsəfə, etika,tarix və s.) mənə qazandırdığı tibbi baxışa sahibəm.\u003c/p\u003e \u003cp\u003e9. Hər hansısa bir sağlamlıq m\u0026ouml;vzusunda etibarlı elmi məqalə yaza bilərəm.\u003c/p\u003e \u003cp\u003e10. Tibbi tədqiqatın əsas məsələsini həll etmək \u0026uuml;\u0026ccedil;\u0026uuml;n elmi tədqiqat dizaynını se\u0026ccedil;ə bilərəm.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAs Professionals, physicians are committed to the health and well-being of individuals and society through ethical practice, profession-led regulation, and high personal standards of behaviour.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11. I am able to take an underpinned personal point of view related to the ethical aspects when a patient asks for euthanasia\u003c/p\u003e \u003cp\u003e13. I am able to handle my feelings of anxiety when they appear in certain clinical situations\u003c/p\u003e \u003cp\u003e17. I am able to recognize signs and symptoms of burnout in my professional functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11. Bir xəstə evtanaziya tələb etdikdə, mən etik cəhətdən dəstəklənən fikirlərimlə \u0026ouml;z m\u0026ouml;vqeyimi sərgiləyə bilərəm.\u003c/p\u003e \u003cp\u003e13. M\u0026uuml;əyyən klinik vəziyyətlərdə meydana gələn narahatlıq hisslərimin \u0026ouml;hdəsindən gələ bilərəm.\u003c/p\u003e \u003cp\u003e17. İş həyatımda (vəzifələrimdə) t\u0026uuml;kənmə əlamətlərini və işarələrini tanıya bilərəm.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003e\u003cb\u003eItem analysis and internal consistency reliability\u003c/b\u003e\u003c/div\u003e \u003cp\u003eItem-total correlation coefficients of the MASS AZE ranged from 0.61 to 0.83 (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The scores of lowly and highly performing groups scores were compared: it was found that all items discriminated significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The reliability of the scale was high (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.95).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eItem-Total Statistics of MASS\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOriginal study (n\u0026thinsp;=\u0026thinsp;1060) (Turan et al., 2013)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTurkish students (n\u0026thinsp;=\u0026thinsp;547)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAzerbaijan students (n\u0026thinsp;=\u0026thinsp;243)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem number\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItem-Total\u003c/p\u003e \u003cp\u003eCorrelation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eItem-Total Correlation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eItem-Total Correlation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe comparison of lower and upper score groups of MASS-AZE\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem number\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eLower Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003eUpper Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c9\" namest=\"c8\" rowspan=\"2\"\u003e \u003cp\u003et- value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c11\" namest=\"c10\" rowspan=\"2\"\u003e \u003cp\u003ep\u0026lt;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eSS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c12\" namest=\"c12\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-18.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-13.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-7.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-21.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-10.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-12.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-13.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-15.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-18.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-17.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-11.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-14.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-8.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-17.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-18.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-19.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-13.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e-11.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eDiscriminant validity\u003c/h3\u003e\n\u003cp\u003eLower and upper score groups were compared as an indicator of discriminant validity. All items discriminated significantly between lowly and highly performing students (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eThe construct of the scale\u003c/h2\u003e \u003cp\u003eExploratory factor analysis was used to obtain information about the structure of the scale. The Kaiser-Meyer-Olkin coefficient (KMO) was 0.95, and Bartlett\u0026rsquo;s test reached statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eFactor analysis produced two factors. All items were loaded on one factor, which explained 56.26% of the variance. Factor loadings ranged from 0.59 to 0.84. The high loads and the high percentage of explained variance on one factor showed that all items of the instrument indicated the same dimension (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of Exploratory Factor Analysis Results\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCommunalities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eComponent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,844\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,242\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,830\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,232\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.740\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,823\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,249\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.644\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,798\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,086\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.656\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,796\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,771\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,767\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.653\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,763\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,266\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,382\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.618\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,222\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,382\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.646\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,317\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,736\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,736\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,274\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.578\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,705\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,283\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,673\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,241\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,612\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.361\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,599\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0,056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e% of Total\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eVariance Explained\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e56.265\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e6.053\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eExtraction Method: Principal Component Analysis.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eValidity refers to the degree to which the scale measures what it is intended to measure (Fraenkel \u0026amp; Wallen, 1996). Since the items of the MASS were based on the CanMEDS and the Five-Star Doctor frameworks (Turan et al., 2013), the MASS demonstrated good content validity. The structure of the MASS scale was preserved in its Azerbaijani translation. Additionally, the translation and back-translation process was conducted with the support of experts in the field and linguists, ensuring accuracy and fidelity to the original framework.\u003c/p\u003e \u003cp\u003eThe MASS-AZE showed high internal consistency reliability. The high item-total correlation coefficients of all items of the MASS-AZE revealed that they measured the same general construct. Previous studies have also demonstrated the reliability and validity of the MASS in different cultural and educational contexts. The original study with Flemish students (Turan et al., 2013) established its strong psychometric properties, including a high-reliability coefficient (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.89). The Turkish adaptation (Turan, Elcin, \u0026amp; Derese, 2018) confirmed the one-dimensional structure and cross-cultural applicability of the scale. Similarly, the Brazilian adaptation (Bressa, 2023) validated the scale in Portuguese and highlighted its role in assessing self-efficacy in professional competency development. The study reported Cronbach\u0026rsquo;s alpha of 0.936 for internal consistency, confirming the scale\u0026rsquo;s reliability. In this study, the Azerbaijani adaptation further reinforced the reliability and construct validity of MASS-AZE, aligning with previous adaptations.\u003c/p\u003e \u003cp\u003eThe findings of this study support the reliability and validity of the Azerbaijani adaptation of the Medical Achievement Self-Efficacy Scale (MASS-AZE). Our analysis demonstrated strong internal consistency (Cronbach's α\u0026thinsp;=\u0026thinsp;0.95) and significant item-total correlations ranging from 0.61 to 0.83, confirming that the scale consistently measures the same construct across items. The discriminant validity was evident, as all items significantly differentiated between low-performing and high-performing students (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These results are consistent with the findings from previous studies (Turan et al., 2013; Turan, Elcin, \u0026amp; Derese, 2018; Bressa, 2023), including the original MASS study, and provide strong evidence of the scale\u0026rsquo;s ability to assess medical achievement self-efficacy reliably in Azerbaijani students.\u003c/p\u003e \u003cp\u003eA comparison of our findings with the Portuguese adaptation of the MASS reveals similarities. Like the MASS-AZE, the Portuguese version of the scale also demonstrated strong internal consistency (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.936), with item-total correlations ranging from 0.488 to 0.816 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and the ability to discriminate between low and high-performing student groups. These results underscore the cross-cultural reliability and applicability of the MASS scale, reinforcing that the MASS-AZE is a valid tool for use in Azerbaijan.\u003c/p\u003e \u003cp\u003eOne of the key similarities between the two studies is the unidimensional nature of the scale. In both the MASS-AZE and the Portuguese adaptation, exploratory factor analysis (EFA) yielded a one-factor solution. The factor analysis in our study explained 56.26% of the variance, with factor loadings ranging from 0.59 to 0.84, which aligns with the findings from Portugal, where a similar one-factor structure was identified, explaining 52.1% of the variance (Bressa, 2023). Both studies support the unidimensionality of the scale, which is consistent with the theoretical underpinnings of the original MASS, as well as the CanMEDS and Five-Star Doctor frameworks.\u003c/p\u003e \u003cp\u003eWhile both studies employed exploratory factor analysis to assess construct validity, the Portuguese study further utilized confirmatory factor analysis (CFA) to confirm the fit of the one-factor model. In the Portuguese study, CFA results showed excellent fit indices (CFI\u0026thinsp;=\u0026thinsp;0.988, TLI\u0026thinsp;=\u0026thinsp;0.986, RMSEA\u0026thinsp;=\u0026thinsp;0.110), which was later improved upon with a re-specified model (CFI\u0026thinsp;=\u0026thinsp;0.999, TLI\u0026thinsp;=\u0026thinsp;0.999, RMSEA\u0026thinsp;=\u0026thinsp;0.027) (Bressa, 2023). These results suggest a stronger model fit and provide additional support for the structural validity of the Portuguese version of the scale (Bressa, 2023). Although we did not include CFA in our analysis, the EFA results in our study, with the KMO value of 0.95 and Bartlett\u0026rsquo;s test of sphericity (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), suggest that the MASS-AZE also has a well-supported factor structure.\u003c/p\u003e \u003cp\u003eWhen comparing our findings to the earlier study with Flemish students using the original MASS, we found additional similarities. Like the MASS-AZE, the Flemish version of the scale also demonstrated strong internal consistency, with Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.89. The Flemish study\u0026rsquo;s item-total correlations ranged from 0.39 to 0.64 (Turan et al., 2013), which is consistent with the range observed in our study (0.34 to 0.61). Moreover, the Flemish study also reported strong discriminant validity, with significant differences between low and high-performing students (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), aligning with our findings where all items significantly discriminated between students (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The Flemish study provides additional validation for the original scale by comparing it to the Maastricht Progress Test. -\u003c/p\u003e \u003cp\u003eWhile this study offers compelling evidence of the MASS-AZE's reliability and validity, some limitations should be considered. The study was conducted exclusively with military medical students in Azerbaijan, which may limit the findings' generalizability to students from other educational settings or medical curricula. To enhance the MASS's generalizability, future research should test it in various medical schools, particularly those using different curricula and explore its performance across diverse student populations.\u003c/p\u003e \u003cp\u003eFurthermore, while our study provides evidence of the internal consistency and discriminant validity of the MASS-AZE, test-retest reliability could be assessed to determine the stability of the scale over time. Additionally, future research on MASS-AZE could benefit from incorporating CFA to confirm its structural validity further, as was done in the Portuguese study. Given the promising results from EFA and the strong alignment with the Portuguese findings, CFA could offer additional insights into the robustness of the scale\u0026rsquo;s construct validity.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides compelling evidence that the Azerbaijani adaptation of the MASS is a psychometrically sound instrument for assessing medical achievement self-efficacy among military medical students. The scale demonstrated high internal consistency, strong item-total correlations, and robust construct validity, as evidenced by its unidimensional factor structure. The findings are consistent with previous research on the MASS, supporting its cross-cultural applicability. Future research should integrate confirmatory factor analysis and extend validation efforts to diverse medical student populations to enhance the generalizability of these results. Overall, the MASS-AZE represents a valuable tool for evaluating self-efficacy in medical education, contributing to the assessment and improvement of competency-based learning and academic achievement.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipation in this study was voluntary. The instrument included a brief cover letter informing students about the purpose of the study. Before completing the questionnaire, students were required to read and sign the informed consent form. All responses were anonymous. Ethical approval for this study was obtained from the Azerbaijan Medical School Ethical Committee (Protocol No. 22).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data generated and analyzed during this study contain personal information and must remain confidential according to ethical guidelines in scientific research. The informed consent form explicitly stated that these data would only be used by researchers, and sharing identifiable information would violate the terms of consent. However, anonymized datasets can be made available upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: Samira Mammadova, Elyana Tahmazova, Sevgi Turan.\u003c/p\u003e\n\u003cp\u003eMethodology: Sevgi Turan.\u003c/p\u003e\n\u003cp\u003eData acquisition: Samira Mammadova, Elyana Tahmazova.\u003c/p\u003e\n\u003cp\u003eData analysis: Samira Mammadova, Sevgi Turan.\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; original draft preparation: Samira Mammadova, Elyana Tahmazova, Sevgi Turan.\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; review and editing: Samira Mammadova, Sevgi Turan.\u003c/p\u003e\n\u003cp\u003eSupervision: Sevgi Turan.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e Bandura, A. (1997). \u003cem\u003eSelf-efficacy: The exercise of control\u003c/em\u003e. Freeman.Frank, J. R., \u0026amp; Danoff, D. (2007). The CanMEDS initiative: Implementing an outcomes-based framework of physician competencies. \u003cem\u003eMedical Teacher, 29\u003c/em\u003e, 642\u0026ndash;647.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Fraenkel JR, Wallen NE. Valididity and reliability. How to design and research in education. New York: McGraw-Hill, INC. 1996; 3: 153\u0026ndash;171.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Katz S, Feigenbaum A, Pasternak S, Vinker S. An interactive course to enhance self-efficacy of family practitioners to treat obesity. BMC Medical Education. 2005; 5: 4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Mavis B. Self-Efficacy and OSCE performance among second year medical students. Advances in Health Sciences Education. 2001; 6: 93\u0026ndash;102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Tresolini CP, Stritter FT. An analysis of learning experiences contributing to medical students\u0026rsquo; self-efficacy in conducting patient education for health promotion. Teaching and Learning in Medicine: An International Journal. 1994; 6 (4): 247\u0026ndash;254.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Turan, S., Valcke, M., De Maeseneer, J., Aper, L., Koole, S., De Wispelaere, C., Deketelaere, A., \u0026amp; Derese, A. (2013). A novel Medical Achievement Self-efficacy Scale (MASS): A valid and reliable tool. \u003cem\u003eMedical Teacher, 35\u003c/em\u003e(7), 575\u0026ndash;580.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Туран Севги, Эльчин Мелих, \u0026amp; Дересе Анселме (2018). Адаптация шкалы самоэффективности медицинских достижений (mass) для Турции. Вестник современной клинической медицины, 11 (2), 41\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Wright SW, Lindsell CJ, Hinckley WR, Williams A, Holland C, Lewis CH, Heimburger G. High fidelity medical simulation in the difficult environment of a helicopter: feasibility, self-efficacy and cost. BMC Medical Education. 2006; 6: 49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e Zimmerman, B. J. (2000). Attaining Self-Regulation: A Social Cognitive Perspective. In M. Boekaerts, P. R. Pintrich, \u0026amp; M. Zeidner (Eds.), Handbook of Self-Regulation (pp. 13\u0026ndash;39). San Diego, CA: Academic Press.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e BRESSA, Rebeca Carvalho. Autoefic\u0026aacute;cia acad\u0026ecirc;mica, motiva\u0026ccedil;\u0026atilde;o e autorregula\u0026ccedil;\u0026atilde;o da aprendizagem no desenvolvimento de compet\u0026ecirc;ncias profissionais na forma\u0026ccedil;\u0026atilde;o m\u0026eacute;dica. 2023. 214 f. Tese (Doutorado em Educa\u0026ccedil;\u0026atilde;o) - Universidade do Oeste Paulista, Presidente Prudente, 2023.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"academic self-efficacy, medical students, scale development","lastPublishedDoi":"10.21203/rs.3.rs-6099391/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6099391/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eIntroduction\u003c/b\u003e: Self-efficacy is accepted as a mediator of behavioral change and has been shown to be related to achievement. Thus, self-efficacy is a vital variable in evaluating the overall curriculum.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e: The MASS is an 18-item, five-point Likert-type scale. The minimum and maximum scores that can be obtained from the scale vary between 18\u0026ndash;90 points. It was reported that Cronbach's alpha for the original form of the scale was 0.89, and item-total score correlations ranged between 0.39 and 0.64.\u003c/p\u003e \u003cp\u003eThe study was conducted with undergraduate military medical students at Azerbaijan Medical University (n\u0026thinsp;=\u0026thinsp;250). A panel of experts translated the scale and then back-translated it. Cronbach alpha was calculated to determine the scale's reliability. Item-total correlation was calculated, and the scores of low-performing and high-performing groups were compared using a t-test. Exploratory factor analysis was conducted to determine the construct validity.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e: The original MASS based on the competency frameworks of CanMEDs and The Five Star Doctor indicated its content validity. The Azerbaijani form of the scale was examined by four experts for face validity and was found appropriate. The reliability of the scale was found to be high (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.95). Item-total correlation coefficients of the Turkish MASS ranged from 0.61 to 0.85. Lower and upper score groups were compared to indicate the discriminant validity. All items discriminated significantly between lowly and highly performing students. Factor analysis showed that the scale has a one-factor structure, which explains 56.26% of the variance. Factor loadings ranged from 0.59 to 0.84.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusions\u003c/b\u003e: The Azerbaijan adaptation of the MASS was found to be reliable and has construct validity.\u003c/p\u003e","manuscriptTitle":"Psychometric characteristics of the Azerbaijan version of Medical Achievement Self-Efficacy Scale (MASS AZE)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-25 11:57:36","doi":"10.21203/rs.3.rs-6099391/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6989f3f5-9d91-4d10-97f6-3a1d0e4e9a0b","owner":[],"postedDate":"April 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-05T15:53:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-25 11:57:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6099391","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6099391","identity":"rs-6099391","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}