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This paper makes available to the broader educational community the instruments which have been originally designed and validated within the European project "CLIL for all: Attention to diversity in bilingual education" ("ADiBE") to determine how diversity is being catered to across a broad array of CLIL contexts in European Secondary Education (Austria, Finland, Germany, Italy, Spain, and the United Kingdom). They include three sets of questionnaires, interviews, and observation protocols and are qualitative and quantitative instruments whose design has been based on the latest research and which have undergone a carefully controlled double-fold pilot process for their validation (external ratings approach and pilot phase with a representative sample of 264 subjects). The questions included in the three sets of instruments are initially characterized, together with their format and main categories. The paper then details the steps undertaken for their research-based design and the double-fold pilot process followed for their validation. The questionnaires and interview and observation protocols are then presented in a format which is directly applicable in any CLIL classroom in order to determine the accessibility of bilingual programs for all types of achievers and to identify the chief difficulties and best practices in promoting inclusion in bilingual education.

Research on learning environments at the higher-education level has been quite sparse compared with studies at other educational levels. Because statistics is perceived as a difficult subject across disciplines, it suffers from low passing rates in many universities. This study involved validating questionnaires for assessing the psychosocial environment and student attitudes associated with learning business statistics in computing laboratory workshops. The Business Statistics Computer Learning Environment Inventory (BSCLEI) and Attitude to Business Analytics instrument were validated with 275 students enrolled across various business degree programs in the United Kingdom over two academic years. Various data analyses (including exploratory and confirmatory factor analyses) supported the validity of these two questionnaires, thereby paving the way for their future use in research and practical applications relevant to learning environments in higher-education statistics workshop classrooms.

The project examined the predictive validity of the "TOEFL iBT"® test with a focus on the relationship between TOEFL iBT scores and students' subsequent academic success in postgraduate studies in one leading university in the United Kingdom, paying specific attention to the role of linguistic preparedness as perceived by students and tutors. We employed a mixed-methods approach to enrich traditionally quantitatively oriented studies with a qualitative perspective. For the sample of 504 students who entered the university for postgraduate studies in the years 2011-2013 on the basis of a TOEFL iBT score, we analyzed the relation between TOEFL iBT scores and final academic award by correlation and regression analyses, taking into consideration discipline, nationality, and additional language support. For the qualitative strand, students entering the university in 2013 on the basis of a TOEFL iBT score were invited to complete questionnaires and interviews, as were their English for academic purposes and academic tutors. A total 48 students and 58 tutors participated, with 25 students and 36 tutors being interviewed at 3 points over the course of the year. Our findings show that students entering the university on the basis of TOEFL iBT scores feel well prepared and generally regard the test as an effective means of preparation for their academic studies in a U.K. setting. They cope well with linguistic demands, and a vast majority graduate successfully. Our findings support the appropriateness of the university's entrance policy with regard to setting minimum test score requirements, thus underpinning the predictive validity of TOEFL iBT in a U.K. setting.

The Me and My School Questionnaire (M&MS) is a brief self-report measure of elementary school students' (ages 8-12) social, emotional, and behavioral challenges. As there is a need for brief self-report screening measures for students in elementary, or primary, school, this study examined the factor structure and measurement invariance of the M&MS for elementary school students in the United States (U.S.; N = 784) and the U.K. (N = 538). Results replicated its two-factor structure (emotional difficulties and behavioral difficulties) with both samples. Convergent and discriminant validity, test-retest reliability, and measurement invariance for girls and boys were examined in the U.S. sample. Partial measurement invariance was established when comparing factor structures of the U.S. and U.K. samples. Implications for mental health monitoring, and for comparative international research are discussed. [For the corresponding grantee submission, see ED603450.]

Social and emotional development in early childhood has been shown to predict long-term outcomes, including school readiness and academic achievement. Early years practitioners need robust assessment tools to adequately identify early signs of social, emotional, behavioural and mental health (SEMH) difficulties. The current study aimed to develop and validate the Early Years Boxall Profile (EYBP). A total of 510 children were assessed by preschool practitioners using the EYBP and the Strengths and Difficulties Questionnaire. We found that the EYBP showed limited accuracy in screening children with SEMH difficulties. However, the EYBP had good internal consistency and excellent convergent and concurrent validity. Results suggest that the tool may be helpful to identify early signs of SEMH needs. Future research is needed to explore the structural validity of the assessment tool and to improve its diagnostic abilities.

To assist higher education institutions in meeting the challenge of limited student engagement in the implementation of Learning Analytics services, the Questionnaire for Student Expectations of Learning Analytics (SELAQ) was developed. This instrument contains 12 items, which are explained by a purported two-factor structure of "Ethical and Privacy Expectations" and "Service Feature Expectations." As it stands, however, the SELAQ has only been validated with students from UK university, which is problematic on account of the interest in Learning Analytics extending beyond this context. Thus, the aim of the current work was to assess whether the translated SELAQ can be validated in three contexts (an Estonian, a Spanish, and a Dutch University). The findings show that the model provided acceptable fits in both the Spanish and Dutch samples, but was not supported in the Estonian student sample. In addition, an assessment of local fit is undertaken for each sample, which provides important points that need to be considered in future work. Finally, a general comparison of expectations across contexts is undertaken, which are discussed in relation to the General Data Protection Regulation (2018).

The Boxall Profile is one of the most frequently used tools to measure the social, emotional, behavioural and/or mental health difficulties (SEMH) of children and young people in schools across the UK. However, limited evidence exists regarding the norms and psychometric properties of the tool. The current study used data from 487 primary school-aged children to carry out a re-standardisation and explore a range of psychometric properties of the Boxall Profile. Updated norms were established for 4- to 11-year-old children using a Receiver Operating Characteristic approach and the Strengths and Difficulties Questionnaire as gold standard measure for SEMH difficulties. Psychometric analyses indicated good internal consistency, concurrent validity and convergent validity but also highlighted the need for further research into the structural validity of the tool. To our knowledge, this is the first study providing substantial evidence for the reliability and validity of the Boxall Profile since its publication in 1984.

Low-level classroom disruption (LLCD) is characterised by pupils swinging on chairs, whispering or fidgeting in class. This paper provides initial data on the development and validation of the teacher-rated Low-Level Classroom Disruption Scale (LLCD-S), with two samples of primary school pupils. Exploratory factor analysis in Study 1 (N= 120) revealed one factor accounting for 61% of the variance; supported by confirmatory factor analysis in Study 2 (N= 274), with one factor accounting for 63% of the variance. Both studies reported high Cronbach's alpha values of.82 and.93 respectively. The evidence supports LLCD being a unidimensional construct, measured by the eight item LLCD-S. Weak convergence validity was found between the LLCD-S and the Strengths and Difficulties Questionnaire's (SDQ) externalising behaviours: conduct problems and hyperactivity. This preliminary evidence indicates that LLCD-S is a valid and reliable measure of low-level classroom disruption. Further research is needed to test the utility of the LLCD-S across different levels of education, cultures and as a pupil-reported measure.

Objective: The evaluation of individual and organizational quality of life through the Guide to Quality-of-Life Indicators and its promotion in English-speaking areas. This guide was initially designed for people living with Autism Spectrum Disorder in specialist autism centers in Spanish and Italian-speaking areas where its effectiveness has been validated. Method: The Delphi technique is applied to the design of a qualitative investigation, with expert validation for the adaptation to English-speaking areas. Results: The results have facilitated the adaptation and validation of the tool, which has 68 indicators grouped into six areas, for its application in both the planning and the evaluation processes of organizations and support services in English-speaking areas. Conclusion: The adaptation of the questionnaire on QoL indicators for people with ASD is a reliable service-provision tool intended to assess integrated programs and to improve them throughout their life-cycles; this aim is approached from the objective perspective and through a subjective evaluation. The Guide will require further updating and review procedures as new needs and contexts emerge.

Many countries use national-level surveys to capture student opinions about their university experiences. It is necessary to interpret survey results in an appropriate context to inform decision-making at many levels. To provide context to national survey outcomes, we describe patterns in the ratings of science and engineering subjects from the UK's National Student Survey (NSS). New, robust statistical models describe relationships between the Overall Satisfaction' rating and the preceding 21 core survey questions. Subjects exhibited consistent differences and ratings of "Teaching", "Organisation" and "Support" were thematic predictors of "Overall Satisfaction" and the best single predictor was "The course was well designed and running smoothly". General levels of satisfaction with feedback were low, but questions about feedback were ultimately the weakest predictors of "Overall Satisfaction". The UK's universities affiliated groupings revealed that more traditional "1994" and "Russell" groups over-performed in a model using the core 21 survey questions to predict "Overall Satisfaction", in contrast to the under-performing newer universities in the Million+ and Alliance groups. Findings contribute to the debate about "level playing fields" for the interpretation of survey outcomes worldwide in terms of differences between subjects, institutional types and the questionnaire items.

A large number of studies document that children differ in the degree they are shaped by their developmental context with some being more sensitive to environmental influences than others. Multiple theories suggest that "Environmental Sensitivity" is a common trait predicting the response to negative as well as positive exposures. However, most research to date has relied on more or less proximal markers of Environmental Sensitivity. In this paper we introduce a new questionnaire--the "Highly Sensitive Child" (HSC) scale--as a promising self-report measure of Environmental Sensitivity. After describing the development of the short 12-item HSC scale for children and adolescents, we report on the psychometric properties of the scale, including confirmatory factor analysis and test-retest reliability. After considering bivariate and multivariate associations with well-established temperament and personality traits, we apply Latent Class Analysis to test for the existence of hypothesized sensitivity groups. Analyses are conducted across 5 studies featuring 4 different U.K.-based samples ranging in age from 8-19 years and with a total sample size of N = 3,581. Results suggest the 12-item HSC scale is a psychometrically robust measure that performs well in both children and adolescents. Besides being relatively independent from other common traits, the Latent Class Analysis suggests that there are 3 distinct groups with different levels of Environmental Sensitivity--low (approx. 25-35%), medium (approx. 41-47%), and high (20-35%). Finally, we provide exploratory cut-off scores for the categorization of children into these different groups which may be useful for both researchers and practitioners.

Schools have an obligation to assess the literacy skills of their students, and the provision of reading instruction to students includes the ability to measure progress in this area. However, the design of reading tests includes the ability not only to read words, but also the ability to verbalise them. This presents a particular challenge for practitioners working with students with autism spectrum disorders (ASD) who can be nonverbal in many cases. How this issue is generally overcome is currently unknown. A survey was developed, in the form of an online multiple-choice questionnaire, in order to determine which tests are currently being used in the UK to assess the reading abilities of nonverbal students, and to examine the opinions of the education practitioners who use them, in relation to their suitability. Using the schools web directory, e-mail invitations were sent to 1,050 special educational needs schools across the UK, and 70 schools responded to the invitation. Respondents suggested that the majority of practitioners hold little faith in the ability of current reading assessments to provide an accurate picture of reading ability for students with ASD, and this holds particularly true for nonverbal pupils with ASD. One purpose of education assessment is to establish a baseline of students' ability in order to plan for lifelong learning and achievement. If there is an inability on the part of schools accurately to assess the reading abilities of nonverbal students with ASD, then it would be fair to assume that this could have a negative impact on the provision of learning opportunities for this population.

The Learning Disability Screening Questionnaire (LDSQ), a brief screening tool for intellectual disability, was originally validated against the Weschler Adult Intelligence Scale, Third Edition (WAIS-III), which was superseded by the Weschler Adult Intelligence Scale, Fourth Edition (WAIS-IV) in the United Kingdom in 2010. This study examines the performance of the LDSQ using the WAIS-IV as the diagnostic intellectual assessment. Based on the original optimal cut-off score, the LDSQ sensitivity value was equivalent (91%) to that obtained in the original validation study, and the specificity value was higher at 92%. This suggests that the LDSQ remains valid when using the WAIS-IV as the comparative intellectual assessment.

The aim of the present study was to develop and provide psychometric evidence in support of the groupwork skills questionnaire (GSQ) for measuring task and interpersonal groupwork skills. A 46-item version of the GSQ was initially completed by 672 university students. The number of items was reduced to 15 following exploratory factor analyses, and a two-factor model consisting of task and interpersonal groupwork skills was revealed. Confirmatory factor analyses with model re-specification on new data (n = 275 students) established that the best fitting model consisted of 10 items and the same two factors (task and interpersonal). Concurrent validity of the GSQ was then determined with 145 participants by demonstrating significant relationships (p < 0.05) with attitudes towards groupwork and groupwork self-efficacy. Test-retest reliability was examined over a one-week interval. Overall, the GSQ demonstrates good validity and reliability, and has potential for both research and pedagogical application.

Despite the limitations of overgeneralizing cutoff values for confirmatory factor analysis (CFA; e.g., Marsh, Hau, & Wen, 2004), they are still often employed as golden rules for assessing factorial validity in sport and exercise psychology. The purpose of this study was to investigate the appropriateness of using the CFA approach with these cutoff values for typical multidimensional measures. Furthermore, we ought to examine how a model could be respecified to achieve acceptable fit and explored whether exploratory structural equation modeling (ESEM) provides a more appropriate assessment of model fit. Six multidimensional measures commonly used in sport and exercise psychology research were examined using CFA and ESEM. Despite demonstrating good validity in previous research, all eight failed to meet the cutoff values proposed by Hu and Bentler. ESEM improved model fit in all measures. In conclusion, we suggest that model misfit in this study demonstrates the problem with interpreting cutoff values rigidly. Furthermore, we recommend ESEM as a preferred approach to examining model fit in multidimensional measures.

There has long been the suspicion amongst staff in Art & Design that the ratings given to their subject disciplines in the UK's National Student Survey are adversely affected by a combination of circumstances--a "perfect storm". The "perfect storm" proposition is tested by comparing ratings for Art & Design with those for a selection of other subjects chosen because they share some features that might lead to lower ratings on the survey. Data from a small-scale qualitative study are used to throw light on what might lie behind the sector-wide statistics. The comparisons suggest that there is some validity in the "perfect storm" proposition. More broadly, the article points to the need for sophistication in interpreting findings from the survey, irrespective of the subject area.

Little research has been published on the need for sexual education for women in secure psychiatric facilities when patients present with a combination of learning disability, mental illness and personality disorder. The development of a brief, feasible, gender-speci?c sexual knowledge questionnaire is described, which has validity and reliability and which is comprehensible by 95% of adults. Results of a pilot study show signi?cant sexual knowledge de?cits in learning disability and mentally ill women along with risk and vulnerability factors. Ways of addressing these issues are discussed.

A consistent message emerges from research on undergraduate students' perceptions of assessment which describes traditional assessment as detrimental to learning. However this literature has not included students in the pure sciences. Mathematics education literature advocates the introduction of innovative assessment at university. In this literature however students' voices tend to be unheard. We investigate mathematics students' perceptions of assessment at one high-ranking UK University. We find that, in contrast to the message from the general literature, students perceive traditional assessment as the best discriminator of ability. We suggest that the drive towards the introduction of innovative assessment in mathematics should be considered in the light of students' perceptions and that further research is needed to investigate the origins of those perceptions as well as how those perceptions may be influenced by the subject of study.

The present study is aimed to translate 3 widely used clinical assessment measures into British Sign Language (BSL), to pilot the BSL versions, and to establish their validity and reliability. These were the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, and the Work and Social Adjustment Scale (WSAS). The 3 assessment measures were translated into BSL and piloted with the Deaf signing population in the United Kingdom (n = 113). Participants completed the PHQ-9, GAD-7, WSAS, and Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) online. The reliability and validity of the BSL versions of PHQ-9, GAD-7, and WSAS have been examined and were found to be good. The construct validity for the PHQ-9 BSL version did not find the single-factor solution as found in the hearing population. The BSL versions of PHQ-9, GAD-7, and WSAS have been produced in BSL and can be used with the signing Deaf population in the United Kingdom. This means that now there are accessible mental health assessments available for Deaf people who are BSL users, which could assist in the early identification of mental health difficulties.

Background: There is a need for assessments of psychological difference and disorder in people who have more severe intellectual disability (ID). Hyperactivity and impulsivity are two behavioural domains of importance as they are correlated with self-injury and aggression and this alludes to a shared cognitive correlate of compromised behavioural inhibition. Additionally, compromised behavioural inhibition is demonstrably related to repetitive behaviour and the latter might be expected to be associated with impulsivity and hyperactivity. Methods: The Activity Questionnaire (TAQ) was developed for this study. Three sub-scales with high levels of face validity were supported by factor analysis of the scoring of 755 intellectually disabled participants on the TAQ items. These sub-scales mapped onto the constructs of Overactivity, Impulsivity and Impulsive Speech. Test-retest, inter-rater reliability and internal consistency were robust. TAQ scores and scores on the Repetitive Behaviour Questionnaire (RBQ) were collected for a sample of 136 participants with varying degrees of ID. Results: Scores on the TAQ at sub-scale and full-scale level were not related to level of adaptive functioning. There were significant positive associations between overactivity (TAQ) and stereotyped behaviour (RBQ), impulsivity (TAQ) and restricted preferences (RBQ), and impulsive speech (TAQ) and repetitive speech (RBQ). Conclusions: The TAQ is a reliable assessment of hyperactivity and impulsivity for people with ID with robust factor structure. Validity requires evaluation. The relationship between impulsivity and restricted preferences may result from a common cognitive impairment in inhibition, which may underpin these two classes of behaviour. (Contains 6 tables and 3 footnotes.)

Purpose: The purpose of this paper is to present a case study of City & Guilds' development of simulation-based assessments for its ICT user qualification. These simulations are authentic scenario-based replicas of word processing and spreadsheet software, which present a series of tasks that the test-taker completes as if they were using actual software, thus demonstrating their ICT competence. Design/methodology/approach: The methodology for the pilot study involved running a series of small trials at five customer sites, with test-takers completing a detailed questionnaire. It is from this questionnaire that most of the conclusions about the simulations are drawn. Findings: The case study explains the reasons why City& Guilds wanted to pursue this development work and presents the findings of a pilot exercise in which the simulations were trailed by a group of learners and tutors. The strengths and weaknesses of the simulations are evaluated, particularly in terms of assessment validity, and opportunities for further development work are discussed. Research limitations/implications: The main limitation of this paper is that the sample used for trialling was small; this was a necessity imposed by tight budgets and deadlines. Furthermore, the authors were required to use the existing City & Guilds test delivery platform, which had implications for the type of simulation that could be developed. Originality/value: In terms of originality, it is the authors' opinion that the paper has value because it offers a unique insight into the challenges faced by a vocational awarding organisation in its efforts to develop new assessments. Although the technology involved is not completely new, it is believed that the candid evaluation of the simulations will be of interest to anyone working with e-assessments, regardless of their level of familiarity with the UK education system. (Contains 3 figures and 3 notes.)

Providing fair assessment with timely feedback for students is a difficult task with science laboratory classes containing large numbers of students. Throughout our Faculty, such classes are assessed by short-answer questions (SAQs) centred on principles encountered in the laboratory. We have shown recently that computer-assisted assessment (CAA) has several advantages and is well received by students. However, student evaluation has shown that this system does not provide suitable feedback. We thus introduced peer assessment (PA) as a complementary procedure. In October 2006, 457 students registered for a first-year practical unit in the Faculty of Life Sciences, University of Manchester. This unit consists of ten compulsory biology practical classes. The first four practicals were assessed using PA; the remaining six practicals were assessed by CAA and marked by staff or postgraduate student demonstrators. The reliability and validity of PA were determined by comparing duplicate scripts and by staff moderation of selected scripts. Student opinions were sought via questionnaires. We show that both assessments are valid, reliable, easy to administer and are accepted by students. PA increases direct feedback to students, although the initial concerns of student groups such as mature and EU/International students need to be addressed using pre-PA training. (Contains 2 tables and 9 figures.)

Children with developmental disorders may present with listening and/or speech discrimination difficulties. This study explores whether teachers can identify these difficulties, using a questionnaire that rates children's listening, speech discrimination and comprehension abilities. The questionnaire was given to class-teachers of 52 pupils, aged four to five years, who had failed at least one of two formal assessments of comprehension and speech discrimination. Results showed significant correlation between teacher ratings of verbal comprehension and attentive listening and test scores for verbal comprehension. There was no significant correlation between ratings and test scores for speech discrimination skills. The questionnaire's internal consistency was found to be reliable overall, but validity in measuring speech discrimination was poor. (Contains 6 tables, 1 figure, and 2 appendices.)

From June to November 2003 an exploratory survey was made of the assessment of written English in a small sample of English language degrees in Europe. All programmes had similar components, the study of English language and literature, cultural or area studies, and English language development. Some involved the study of another language. Theoretical perspectives on test validity informed the construction of a questionnaire to collect quantitative and qualitative data from the programmes in the sample in order to investigate expectations about attainment of proficiency in written English. Responses were obtained from 32 English language degree programmes in 14 European countries: Austria, Belgium, Denmark, France, Germany, Italy, Latvia, the Netherlands, Poland, Portugal, Romania, Spain, Switzerland, and the United Kingdom. The sample was not large enough to be representative of such degrees throughout Europe, but this exploratory study revealed a wide variation between countries, within the same country and, in some cases, within the same department with regard to what was measured, the contexts sampled, and the assessment instrument adopted and measures taken to ensure the reliability of the assessment. The study revealed variable evidence to support the outcomes of the assessment across the sample, leading to the conclusion that there was wide variation in what is attained in proficiency in written English on these English language degree programmes, which is indicative of similar degrees across Europe. The framework used for data collection yielded themes, practices, and concerns that would inform the development of common guidelines for assessment. (Contains 10 footnotes, 6 tables, and 3 figures.)

This paper presents a summary of outcomes from the first stage of a 3-year project funded through the Australian Research Council Strategic Partnership Industry Research Training (ARC-SPIRT) scheme and the Catholic Education Office in Victoria. This longitudinal study, in Catholic primary and secondary schools, will investigate the effectiveness and sustainability of a whole-school approach to improving inclusive practice, strengthening transition networks outside the school and improving learning for students with disabilities. The first stage of the project evaluates the recently developed "Index for Inclusion" (2000). The Index clearly provides a valuable starting point, but as it was developed in the UK, there is a need to establish its validity for use in the Australian context. There is a need, therefore, to ensure its content fits with local "cultures" including Commonwealth legislation and State and school-level policy legislation. The paper reports on a six-phase process of validation and modification including both quantitative and qualitative analyses and the resulting trial versions of four questionnaires. (Contains 1 table and 4 notes.)

Describes development of a new rating scale for use by teachers. The Prosocial Behaviour Questionnaire is designed for use in the investigation of elementary school children's behavior. A copy of the rating scale is included. (Author/DB)

Background: Childhood asthma is an important unmet need. To date, patient-reported outcome measures (PROMs) for children with asthma have used a combination of caregiver or proxy-reported and self-reported measures. No comprehensive measure is available to assess the severity and impact of daytime and nighttime asthma symptoms and rescue medication use for self-completion by children aged 6–11 years. This study aimed to develop a novel, interactive, electronic Pediatric Asthma Symptom Diary (ePASD) measuring self-reported key symptom severity and proximal impacts of asthma in young children with varying reading ability and disease severity, consistent with US Food and Drug Administration (FDA) PRO guidance and the International Society for Health Economics and Outcomes Research (ISPOR) good research practices. Methods: A targeted literature review and clinician interviews were undertaken to characterize symptoms and impacts experienced by children with mild-to-severe asthma. Concept elicitation interviews (CEIs) were conducted with 44 children and their caregivers (30 US; 14 UK). Following item and digital application development, the ePASD was assessed for relevance, understanding, and interpretability through cognitive debriefing interviews (CDIs) with 21 US children. Face validity/translatability assessments were also performed. Results: Key measurement concepts included cough, wheeze, difficulty breathing, chest tightness/discomfort, nighttime awakening, and daytime activity limitations. Concept saturation was reached during CEIs for primary asthma-related daytime and nighttime symptoms and core impacts. Most CDI participants found the ePASD items clear, understandable, and comprehensive. Standardized training is anticipated to facilitate reliable child self-report. Conclusion: The ePASD, a novel PROM for children aged 6–11 years with asthma, uses an innovative multimedia approach and has been developed in accordance with FDA PRO guidance and ISPOR good research practices, directly capturing the child's self-reported asthma symptoms, impacts on daily activities and nighttime awakening, and rescue medication use. [ABSTRACT FROM AUTHOR]

Aim: To design an individualised questionnaire to measure the impact of cancer and its treatments on quality of life (QoL). Materials & Methods: Design of the Cancer‐Dependent Quality of Life (CancerDQoL) questionnaire was based on the Audit of Diabetes Dependent QoL (ADDQoL) questionnaire and related –DQoLs for other conditions. Item selection, face validity and content validity were established through clinician and patient ratings of the importance and relevance of 60 domains from the –DQoL Item Library, and semi‐structured interviews with 25 English‐speaking participants with a range of cancers attending a cancer centre in Zimbabwe (age range: 25‐78 years; 16 women, 9 men). Ten interviews were subsequently conducted with UK English‐speaking participants with a range of cancers attending Maggie's Centres in London and Dundee (age range: 40‐76; 5 women, 5 men) to adapt the CancerDQoL for UK use. Results: The first draft of the CancerDQoL contained 25 domain‐specific items from the ‐DQoL Item Library plus four overview items. Zimbabwean participants indicated that cancer negatively impacted on all life domains included, except 'having children'. Weighted impact (impact ratings multiplied by importance) was most negative for 'sex life', 'depend on others' and 'physical capability'. The least negative weighted impact was found for 'having children', 'spiritual/religious life' and 'past medical/self‐care'. UK interviews confirmed no new items were required. Conclusions: Face and content validity of the CancerDQoL is established for an adult sample of English‐speaking cancer patients in Zimbabwe and confirmed in an adaptation following UK interviews. Key points: Generic and cancer‐specific health status and function tools are often misrepresented in the literature as if they are measures of (health‐related) quality of life (QoL)The Cancer Dependent Quality of Life (CancerDQoL) questionnaire was designed based on the Audit of Diabetes Dependent Quality of Life (ADDQoL) questionnaire and related ‐DQoLs for other conditions, to provide an individualised measure of the impact of cancer on QoLFace and content validity of the CancerDQoL is established through semi‐structured interviews with 25 English‐speaking cancer patients in Zimbabwe and confirmed in an adaptation following 10 UK interviews with English‐speaking cancer patientsBy accurately measuring the impact of cancer and its treatment on QoL using a genuine, individualised measure of QoL, rather than a health status tool, clinicians will be able to derive a more holistic view of the impact of cancer and its treatment on an individual's QoLA substantial dataset has now been collected to evaluate the psychometric properties of the CancerDQoL [ABSTRACT FROM AUTHOR]

Aims: To identify the incidence and type of sharps injuries within a UK nursing student population. Background: Evidence suggests that nursing students sustain sharps injuries across the world, but there is a lack of data from the UK. Design: Questionnaire survey. Methods: A survey was administered to a volunteer sample of nursing students (n=1015) in a university, following which the survey was distributed to nursing students nationwide using snowball sampling via social media. Datasets from 1015 nursing students were available for analysis. Results: Sharps injuries were most likely to occur with glass ampoules, when preparing injections and to occur in the second year of the programme. Contributing factors to sharps injury were identified, with inexperience being the primary cause. Some nursing students reported psychological impacts after sustaining the sharps injury. Conclusion: Sharps injuries are common among nursing students, and can have many psychological consequences for an individual. [ABSTRACT FROM AUTHOR]

Purpose: Previous research suggests that service user and carer involvement (SUCI) in clinical psychology training may have an impact. The purpose of this study was to develop a validated questionnaire to enable trainee clinical psychologists to rate this. Design/methodology/approach: A collaborative project was carried out with service users and carers and trainee clinical psychologists. The principles of questionnaire design were followed. The authors developed and validated a trainee self-report questionnaire, based on focus groups and relevant literature indicating potential impacts of involvement on practice. A draft 60-item version was piloted with 15 trainee clinical psychologists. Then, 133 trainees from 22 UK clinical psychology courses completed it (estimated response rate of 13.2%). The sample was representative of UK trainees in gender and ethnicity, but slightly older. Findings: The principal component analysis produced a 36-item questionnaire with four factors: human communication, carer perspectives, empathy and challenging/changing. The questionnaire showed good internal consistency and test-retest reliability. Stakeholder consultation suggested face and content validity and there was some indication of construct validity. Originality/value: The project has resulted in a usable co-produced questionnaire, which is now available to clinical psychology courses to assess the self-reported impact of SUCI in training, and which may also be used in future research. [ABSTRACT FROM AUTHOR]

Objectives: To assess and compare the face (FV) and content validity (CV) of three ex vivo animal models for simulation training in pediatric laryngotracheal reconstruction (LTR). Methods: Feasibility of performing LTR was assessed on the head and neck of three different animals (lamb/suckling-pig/rabbit) and laryngeal dimensions and qualitative observations were recorded. A 19-item five-point Likert scale questionnaire was completed for each model to assess FV and CV. Data was prospectively collected and analyzed using descriptive and nonparametric statistics. Results: All three models were suitable for LTR simulation with laryngeal dimensions corresponding to 0-2 years (rabbit), 5-10 (pig) and >10 years (lamb model). Five trainees and five expert pediatric otolaryngologists performed LTR on each model. The overall median FV score was 5 for the lamb model (IQR 4-5), 3 for the rabbit (IQR 2-3), and 4 for the pig (IQR 4-4). The overall median CV score was 5 for the lamb (IQR 5-5), 2 for the rabbit (IQR 2-3), and 4 for the pig model (IQR 4-4). Comparison of the models demonstrated the lamb to be favored as the most realistic and practical model for simulation training in pediatric LTR, with both the lamb and the porcine model attaining validation thresholds. Conclusion: Our study is the first comparative validation assessment of animal models for use in pediatric LTR simulation and it supports the use of ex vivo lamb and porcine models for use in LTR surgical skills training. The lamb model was the favored simulation model while the rabbit was considered inferior for simulation training in pediatric LTR. Level of Evidence: 3b [ABSTRACT FROM AUTHOR]

Objective: To evaluate the psychometric properties of the HIV Disability Questionnaire (HDQ) among people living with HIV (PLHIV) in London, United Kingdom (UK). Methods: This is a cross-sectional measurement study. We recruited and administered the self-reported HDQ, seven criterion measures, and a demographic questionnaire with adults living with HIV accessing HIV care. We determined median and interquartile ranges (IQR) for disability presence, severity and episodic scores (range 0–100). We calculated Cronbach’s alpha (α) Kuder-Richardson-20 (KR-20) statistics for disability and episodic scores respectively (internal consistency reliability), smallest detectable change (SDC) for each HDQ severity item and domain (precision), and tested 36 a priori hypotheses assessing correlations between HDQ and criterion scores (construct validity). Results: Of N = 243 participants, all were male, median age 40 years, 94% currently taking antiretroviral therapy, and 22% living with ≥2 concurrent health conditions. Median HDQ domain scores ranged from 0 (IQR: 0,7) (difficulties with day-to-day activities domain) to 27 (IQR: 14, 41) (uncertainty domain). Cronbach’s alpha for the HDQ severity scale ranged from 0.85 (95% Confidence Interval (CI): 0.80–0.90) in the cognitive domain to 0.93 (95%CI: 0.91–0.94) in the mental-emotional domain. The KR-20 statistic for the HDQ episodic scale ranged from 0.74 (95%CI: 0.66–0.83) in the cognitive domain to 0.91 (95%CI: 0.89–0.94) in the uncertainty domain. SDC ranged from 7.3–15.0 points on the HDQ severity scale for difficulties with day-to-day activities and cognitive symptoms domains, respectively. The majority of the construct validity hypotheses (n = 30/36, 83%) were confirmed. Conclusions: The HDQ possesses internal consistency reliability and construct validity with varied precision when administered to males living with HIV in London, UK. Clinicians and researchers may use the HDQ to measure the nature and extent of disability experienced by PLHIV in the UK, and to inform HIV service provision to address the health-related challenges among PLHIV. [ABSTRACT FROM AUTHOR]

Purpose: To explore exercise beliefs and behaviours of individuals with Joint Hypermobility syndrome/Ehlers-Danlos syndrome - hypermobility type and to explore patient experiences of physiotherapy. Methods: A cross sectional questionnaire survey design was used to collect quantitative and qualitative data from adult members of the Hypermobility Syndromes Association and Ehlers-Danlos Syndrome Support UK. Descriptive and inferential statistics were used to analyse the data. Qualitative data was analysed thematically. Results: 946 questionnaires were returned and analysed. Participants who received exercise advice from a physiotherapist were 1.75 more likely to report high volumes of weekly exercise (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.30-2.36, p < 0.001) than those with no advice. Participants who believed that exercise is important for long-term management were 2.76 times more likely to report a high volume of weekly exercise compared to the participants who did not hold this belief (OR = 2.76, 95% CI = 1.38-5.50, p = 0.004). Three themes emerged regarding experience of physiotherapy; physiotherapist as a partner, communication - knowledge, experience and safety. Conclusion: Pain, fatigue and fear are common barriers to exercise. Advice from a physiotherapist and beliefs about the benefits of exercise influenced the reported exercise behaviours of individuals with Ehlers-Danlos syndrome - hypermobility type in this survey. Implications for rehabilitation: Exercise is a cornerstone of treatment for Ehlers-Danlos syndrome/Ehlers-Danlos syndrome - hypermobility type. Pain, fatigue and fear of injury are frequently reported barriers to exercise. Advice from physiotherapists may significantly influence exercise behaviour. Physiotherapists with condition specific knowledge and good verbal and non-verbal communication facilitate a positive therapeutic experience. [ABSTRACT FROM AUTHOR]

There is limited consensus about what constitutes humanly sensitive care, or how it can be sustained in care settings. A new humanised care assessment tool may point to caring practices that are up to the task of meeting persons as humans within busy healthcare environments. This paper describes qualitative development of a tool that is conceptually sensitive to human dimensions of care informed by a life‐world philosophical orientation. Items were generated to reflect eight theoretical dimensions that constitute what makes care feel humanly focused. An action research group process in 2014–2015 with researchers, service users, healthcare professionals in two diverse clinical settings (stroke rehabilitation and dermatology) was used. Feedback on conceptual content, transparency of meaning and readability was then gained from a panel in Sweden and third‐year student nurses in the UK. The tool can be applied to attune staff to human dimensions of care, offering items which point to concrete examples of humanising and dehumanising features of practice in ways that have not yet been fully captured in the caring literature. Based on theoretically led experiential items, with dedicated focus on what makes people feel more, or less than human, it may offer improvement on available assessments of care. [ABSTRACT FROM AUTHOR]

The 2011 Census in England broke new ground, as a question about language had never previously been asked. After stakeholder consultations and a series of trials, the census authority decided on two questions based on earlier censuses in the USA: one about the respondent’s ‘main language’ and another about proficiency in English. This paper provides a critique of the census questions, showing how the pressure to produce questions which were straightforward to answer and consistent with the predominant monolingual ideology led to the choice of two questions which were problematic in different ways. This raises doubts about the validity of the questions themselves and the usefulness of the data collected. [ABSTRACT FROM AUTHOR]

Objective. Timely access to holistic multidisciplinary care is the core principle underpinning management of juvenile idiopathic arthritis (JIA). Data collected in national clinical audit programmes fundamentally aim to improve health outcomes of disease, ensuring clinical care is equitable, safe and patient-centred. The aim of this study was to develop a tool for national audit of JIA in the UK. Methods. A staged and consultative methodology was used across a broad group of relevant stakeholders to develop a national audit tool, with reference to pre-existing standards of care for JIA. The tool comprises key service delivery quality measures assessed against two aspects of impact, namely disease-related outcome measures and patient/carer reported outcome and experience measures. Results. Eleven service-related quality measures were identified, including those that map to current standards for commissioning of JIA clinical services in the UK. The three-variable Juvenile Arthritis Disease Activity Score and presence/absence of sacro-iliitis in patients with enthesitis-related arthritis were identified as the primary disease-related outcome measures, with presence/absence of uveitis a secondary outcome. Novel patient/carer reported outcomes and patient/carer reported experience measures were developed and face validity confirmed by relevant patient/carer groups. Conclusion. A tool for national audit of JIA has been developed with the aim of benchmarking current clinical practice and setting future standards and targets for improvement. Staged implementation of this national audit tool should facilitate investigation of variability in levels of care and drive quality improvement. This will require engagement from patients and carers, clinical teams and commissioners of JIA services. [ABSTRACT FROM AUTHOR]

Aims and objectives To update and re-validate the Valuing Patients as Individuals Scale for use as a patient appraisal of received healthcare. Background Healthcare in the United Kingdom and beyond is required to deliver high quality, person-centred care that is clinically effective and safe. However, patient experience is not uniform, and complaints often focus on the way patients have been treated. Legislation in United Kingdom requires health services to gather and use patients' evaluations of care to improve services. Design This study uses scoping literature reviews, cognitive testing of questionnaire items with patient and healthcare staff focus groups, and exploratory factor analysis. Methods/Setting/Participants Data were collected from 790 participants across 34 wards in two acute hospitals in one National Health Service Health Board in Scotland from September 2011-February 2012. Ethics and Research and Development approval were obtained. Results Fifty six unique items identified through literature review were added to 72 original Valuing Patients as Individuals Scale items. Face validity interviews removed ambiguous or low relevance items leaving 88 items for administration to patients. Two hundred and ninety questionnaires were returned, representing 37% response rate, 71 were incomplete. Thus 219 complete data were used for Exploratory Factor Analysis with varimax orthogonal rotation. This revealed a 31 item, three factor solution, Care and Respect; Understanding and Engagement; Patient Concerns, with good reliability, concurrent and discriminant validity in terms of gender. A shortened 10 item measure based on the top 3 or 4 loading items on each scale was comparable. Conclusions The Updated Valuing Patients as Individuals Scale is sufficiently developed to capture patient appraisals of received care. Relevance to clinical practice The short scale version is now being routinized in real-time evaluation of patient experience contributing to this United Kingdom, National Health Service setting meeting its policy and legislative requirements. [ABSTRACT FROM AUTHOR]

The Mental Well-being Adjusted Life Year (MWALY) is an alternative outcome measure to the quality-adjusted life year (QALY) in economic evaluations of interventions aimed at improving mental well-being. However, there is a lack of preference-based mental well-being instruments for capturing population mental well-being preferences. To derive a UK preference-based value set for the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS). 225 participants that were interviewed between December 2020 and August 2021 completed 10 composite time trade-off (C-TTO) and 10 discrete choice experiment (DCE) interviewer-administered exercises. Heteroskedastic Tobit and conditional logit models were used to model C-TTO and DCE responses respectively. The DCE utility values were rescaled to a C-TTO comparable scale through anchoring and mapping. An inverse variance weighting hybrid model (IVWHM) was used to derive weighted-average coefficients from the modelled C-TTO and DCE coefficients. Model performance was assessed using statistical diagnostics. The valuation responses confirmed the feasibility and face validity of the C-TTO and DCE techniques. Apart from the main effects models, statistically significant associations were estimated between the predicted C-TTO value and participants' SWEMWBS scores, gender, ethnicities, education levels, and the interaction terms between age and useful feeling. The IVWHM was the most optimal model with the fewest logically inconsistent coefficients and the lowest pooled standard errors. The utility values generated by the rescaled DCE models and the IVWHM were generally higher than those of the C-TTO model. The predictive ability of the two DCE rescaling methods was similar according to the mean absolute deviation and root mean square deviation statistics. This study has produced the first preference-based value set for a measure of mental well-being. The IVWHM provided a desirable blend of both C-TTO and DCE models. The value set derived by this hybrid approach can be used for cost-utility analyses of mental well-being interventions. • This is the first attempt to derive a preference-based value set for a generic mental well-being instrument. • The valuation responses supported the face validity and feasibility for the valuation of the SWEMWBS. • The Inverse Variance Weighting hybrid model is firstly applied in preference elicitation research. • Units of QALY gain and MWALY gain have different implications for economic evaluations of mental well-being interventions. • This study tests the use of remote-control function in videoconferencing during the interview. [ABSTRACT FROM AUTHOR]

Background: There are many professional associations representing chiropractors and chiropractic in the United Kingdom (UK). Each has its unique selling points (USPs) and chiropractors can choose to join as many as they like; however, cost of membership has to be weighed against perceived benefits. The predictors of UK chiropractic association membership and motivational factors to join these associations, have not formally been identified. This research study aimed to identify some of the factors and motivations in Welsh Institute of Chiropractic (WIOC) Alumni regarding their decision to join (or not) a UK chiropractic professional association. Methods: An online survey instrument, comprising 23 questions, was administered from November-December 2015 via a link announced on 'The WIOC Alumni' Facebook group (N = 655), the active platform for the WIOC Alumni Organisation. Results: One hundred forty-eight respondents (approximately 22.6 % of 'The WIOC Alumni' Facebook group membership) completed the survey. Ten factors were reported to be important in decision making: 'promoting public awareness of chiropractic' (91.2 %), 'access to professional indemnity insurance' (89.2 %), 'overall professionalism of the association' (87.2 %), 'the identity of the association' (77.7 %), 'positive attitude to research' (77.0 %), 'workplace support and advice' (68.9 %), 'access to events \ courses \ seminars' (64.2 %), 'Continuing Professional Development (CPD) activities' (62.2 %), 'cost of membership' (59.5 %) and 'addresses my area of interest' (56.1 %). 'Many of my friends have joined' (71.6 %) was considered unimportant, whereas 'Lobbying: Influencing policy' and 'career development' were considered important by almost twice as many as those that consider them unimportant (45.3 %: 25.7 % and 43.9 %: 27.0 % respectively), 'requirement of employment' and 'associations newsletter' were seen as unimportant by roughly twice as many as those considering them important (44.6 %: 28.4 % and 35.8 %: 28.4 % respectively). Should it become an option, almost 71 % of respondents would support the unification of the four main UK chiropractic associations, (the British, McTimoney, Scottish and United, Chiropractic Associations: BCA MCA, SCA and UCA, respectively). Conclusions: Several factors have an important effect on motivations to join UK chiropractic professional associations. Further research is required to determine if this is WIOC specific or can be extrapolated more generally. [ABSTRACT FROM AUTHOR]

Background Content analysis of replies to closed questions in questionnaires can be undertaken to understand remarks that may explain the responses, provide illustrative examples of issues raised in the questionnaire, define new issues or issues of importance that were not covered in the questionnaire and inform the design of new questions in future surveys. Aim To discuss the usefulness of summative content analysis to free text in postal questionnaires. Discussion Content analysis provides useful comparative insights between two respondent groups in the case example provided. Five themes emerged: poor understanding of the concept of 'patient lateral transfer work technique' and the direct instrument nursing observation (DINO) instrument's key directions; outcomes of patient transfer; positive responses; manual handling risk; and poor translation into English of DINO. Conclusion Respondents need an opportunity to clarify their responses to questionnaires using free text, to provide insight into their understanding of the question being asked, understanding of the concept or construct being discussed, and data triangulation through the confirmation of item responses and free-text comments. Implications for practice Responses to questions in a postal questionnaire and the opportunity for free-text commentary by respondents enable the identification of hidden meanings behind tickbox responses to questions. [ABSTRACT FROM AUTHOR]

Background: The EQ-5D is frequently used to derive utilities for patients with type 2 diabetes (T2D). Despite widely available quantitative psychometric data on the EQ-5D, little is known about content validity in this population. Thus, the purpose of this qualitative study was to examine content validity of the EQ-5D in patients with T2D.Methods: Patients with T2D in the UK completed concept elicitation interviews, followed by administration of the EQ-5D-5L and cognitive interviewing focused on the instrument's relevance, clarity, and comprehensiveness.Results: A total of 25 participants completed interviews (52.0 % male; mean age = 53.5 years). Approximately half (52 %) reported that the EQ-5D-5L was relevant to their experience with T2D. When asked if each individual item was relevant to their experience with T2D, responses varied widely (24.0 % said the self-care item was relevant; 68.0 % said the anxiety/depression item was relevant). Participants frequently said items were not relevant to themselves, but could be relevant to patients with more severe diabetes. Most participants (92.0 %) reported that T2D and/or its treatment/monitoring requirements had an impact on their quality of life that was not captured by the EQ-5D-5L. Common missing concepts included food awareness/restriction (n = 13, 52.0 %); activities (n = 11, 44.0 %); emotional functioning other than depression/anxiety (n = 8, 32.0 %); and social/relationship functioning (n = 8, 32.0 %).Conclusions: The results highlight strengths and potential limitations of the EQ-5D-5L, including missing content that could be important for some patients with T2D. Suggestions for addressing limitations are provided. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine nurses' knowledge and attitudes towards pain assessment for people with dementia in a nursing home setting. Background: Pain is highly prevalent among older people, yet is often under -recognised and undertreated in people with dementia. People with dementia can lose the ability to report pain and it is the role of the nurse to identify and appropriately assess pain, to provide effective treatment. This requires nurses to have sufficient knowledge and training in the assessment and management of pain in residents with dementia; however, research suggests deficits in this area. Methods: A cross-sectional survey design was used to determine nurses' knowledge and attitudes to pain assessment in dementia. A questionnaire comprising three sections was distributed to 96 registered nurses across 17 nursing homes in a health-care trust in a UK region. Results: A total of 32 responses were obtained (response rate 33%). The majority of nurses had a good knowledge in relation to the assessment and management of pain in residents with dementia. There was, however, some uncertainty among nurses over analgesic choice, the safety of opioid use in dementia, and the use of dementia-specific pain assessment tools for residents with no cognitive impairment. The main barriers to effective pain assessment for older people with dementia were workload pressures, poor staffing and lack of medical support. Conclusion: This study highlights the need to develop pain education programmes and clear guidance specifically designed for nurses caring for older people with dementia. It also emphasises the need for better communication and co-ordination of pain treatment for nursing home residents with dementia. [ABSTRACT FROM AUTHOR]

Background. Therapists frequently advise the use of activity pacing as a coping strategy to manage long-term conditions (eg, chronic low back pain, chronic widespread pain, chronic fatigue syndrome/myalgic encephalomyelitis). However, activity pacing has not been clearly operationalized, and there is a paucity of empirical evidence regarding pacing. This paucity of evidence may be partly due to the absence of a widely used pacing scale. To address the limitations of existing pacing scales, the 38-item Activity Pacing Questionnaire (APQ-38) was previously developed using the Delphi technique. Objective. The aims of this study were: (1) to explore the psychometric properties of the APQ-38, (2) to identify underlying pacing themes, and (3) to assess the reliability and validity of the scale. Design. This was a cross-sectional questionnaire study. Methods. Three hundred eleven adult patients with chronic pain or fatigue participated, of whom 69 completed the test-retest analysis. Data obtained for the APQ-38 were analyzed using exploratory factor analysis, internal and test-retest reliability, and validity against 2 existing pacing subscales and validated measures of pain, fatigue, anxiety, depression, avoidance, and mental and physical function. Results. Following factor analysis, 12 items were removed from the APQ-38, and 5 themes of pacing were identified in the resulting 26-item Activity Pacing Questionnaire (APQ-26): activity adjustment, activity consistency, activity progression, activity planning, and activity acceptance. These themes demonstrated satisfactory internal consistency (Cronbach a=.72-.92), test-retest reliability (intraclass correlation coefficient=.50-.78, P≤.001), and construct validity. Activity adjustment, activity progression, and activity acceptance correlated with worsened symptoms; activity consistency correlated with improved symptoms; and activity planning correlated with both improved and worsened symptoms. Limitations. Data were collected from self-report questionnaires only. Conclusions. Developed to be widely used across a heterogeneous group of patients with chronic pain or fatigue, the APQ-26 is multifaceted and demonstrates reliability and validity. Further study will explore the effects of pacing on patients' symptoms to guide therapists toward advising pacing themes with empirical benefits. [ABSTRACT FROM AUTHOR]

Background: There has been much debate by both academics and clinical agencies about the motivations and abilities of nurse graduates to work in mental health nursing. The aim of this study was to recruit student nurses from a dedicated mental health nursing program in the United Kingdom (UK) and a comprehensive nursing program in Australia and illuminate their motivations towards considering mental health nursing as a career choice. Methods: This study comprised of two UK and four Australian Schools of Nursing within Universities. A 12 item survey was developed for the purpose of this study and was checked for face validity by experienced mental health nurses. Convenience sampling was used and 395 responses were received. Results: The comprehensive program represented by the Australian sample, revealed a third of respondents indicated that mental health nursing was definitely not a career option, while only 8 % of the UK specialised program reported mental health nursing was not seven for them. In both groups a higher level of motivation to work in mental health emanated from personal experience and/or work experience/exposure to mental health care. Conclusions: A greater focus on clinical exposure in comprehensive programs could enhance professional experience needed to increase student motivations for mental health nursing. [ABSTRACT FROM AUTHOR]

ObjectiveTo develop new methods of evaluating face validity in the context of a revised final professional examination for medical undergraduates, organized on three sites, over 2 days. MethodsThe opinion of the students and examiners was surveyed by Likert-style questionnaires, with additional open comments. Expert opinion was gathered from external examiner reports and a recent Quality Assurance Agency (QAA) Subject Review Report. ResultsThe questionnaires had an overall response rate of 84%. Internal reliability, assessed by comparing responses to appropriate questions, was good with an equivalence of 45% (weighted kappa 0·54) for the students and 33% (weighted kappa 0·41) for the assessors. There was little evidence of inconsistency between days or sites. The majority of the opinions from the students, examiners and external experts were positive. Negative comments related to time pressure and case mix. ConclusionThe measurement of face validity proved feasible and valuable and will assist in the further development of the course and the examination. [ABSTRACT FROM AUTHOR]