Document Type : Original Article


1 Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Medical Education Development Center, Zanjan University of Medical Sciences, Zanjan

2 Department of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences

3 Department of Medical Education, School of Medicine, Tehran University of Medical Sciences Department of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Health Professions Education Research Center, Tehran University of Medical

4 Digestive Disease Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences

5 Department of Epidemiology, School of Public Health, Tehran University of Medical Sciences

6 Department of Medical Education, School of Medicine, Tehran University of Medical Sciences Education Development Center, Tehran University of Medical Sciences, Tehran, Iran


BACKGROUND: Professional behavior of physicians is under scrutiny by medical associations,
media, and patients; therefore, medical students are expected to be self‑directed learners rather than
the passive ones. One of the useful strategies for professional development and life‑long learning of
students is self-regulated learning. Self‑regulation concept and lifelong learning commitment are in
the heart of medical practice. Therefore, this study aimed to evaluate the validity of Self‑Reflection
and Insight Scale (SRIS) to inspect the medical students’ readiness for self‑regulation.
MATERIALS AND METHODS: SRIS was translated according to the Sousa and Rojjanasrirat
guideline. To examine the reliability and validity evidence of the scale, 136 medical students from
Tehran University of Medical Sciences completed the questionnaire. Internal consistency and
intraclass correlation were used to examine the reliability evidence, as well as qualitative content
validity, and confirmatory factor analysis and exploratory factor analysis (EFA) were used to examine
the construct validity of the scale.
RESULTS: The content validity of the scale was verified. Cronbach’s alpha and the Interclass Correlation
Coefficient value for the four‑factor model was 0.87 and 0.79, respectively. Goodness‑of‑fit indices
displayed acceptable and poor values (P = 0.0001, χ2 = 373.51, df = 167, Root Mean Square Error
Of Approximation = 0.096, standardized root mean square residual = 0.12). EFA was conducted; a
well‑structured model was achieved through the EFA. The new four‑factor model was extracted as
the best model by performing EFA.
CONCLUSION: SRIS Persian version is saturated with four factors and has desirable content validity
and constructs reliability.


1. Cho KK, Marjadi B, Langendyk V, HuW. Medical student changes
in self‑regulated learning during the transition to the clinical
environment. BMC Med Educ 2017;17:59.
2. Stewart K, Wyatt R, MerckGW. Unprofessional behaviour and
patient safety. Int J Clin Leader 2011;17:93‑100.
3. Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld‑JaegerJ,
Bost P. Patient complaints and malpractice risk. JAMA
4. Rawson JV, Thompson N, Sostre G, Deitte L. The cost of disruptive
and unprofessional behaviors in health care. Acad Radiol
5. Weiss KB, Wagner R, Nasca TJ. Development, testing, and
implementation of the ACGME clinical learning environment
review (CLER) program. J Grad Med Educ 2012;4:396‑8.
6. Hansen AM, Hogh A, Persson R, Karlson B, Garde AH,
Ørbaek P. Bullying at work, health outcomes, and physiological
stress response. J Psychosom Res 2006;60:63‑72.
7. Papadakis MA, Hodgson CS, Teherani A, Kohatsu ND.
Unprofessional behavior in medical school is associated with
subsequent disciplinary action by a state medical board. Acad
Med 2004;79:244‑9.
8. Roth A, Ogrin S, Schmitz B. Assessing self‑regulated learning in
higher education: A systematic literature review of self‑report
instruments. J Pers Eval Educ 2016;28:225‑50.
9. van Houten‑Schat MA, Berkhout JJ, van Dijk N, Endedijk MD,
Jaarsma AD, Diemers AD. Self‑regulated learning in the clinical
context: A systematic review. Med Educ 2018;52:1008‑15.
10. Pintrich PR. The role of motivation in promoting and sustaining
self‑regulated learning. Int J Educ Res 1999;31:459‑70.
11. Winne PH. Student’s calibration of knowledge and learning
processes: Implications for designing powerful software learning
environments. Int J Educ Res 2004;41:466‑88.
12. Zimmerman B. Investigating self‑regulation and motivation:
Historical background, methodological developments, and future
prospects. Amer Educ Res J. 2008;45:166‑83.
13. Grant AM. Rethinking psychological mindedness: Metacognition,
self‑reflection, and insight. Behav Change 2001;18:8‑17.
14. Lucy B, Valerie P, William L. Online self‑regulatory learning
behaviors as a mediator in the relationship between online course
perceptions with achievement. Int Rev Res Open Dis 2008;9 (2).
15. Magno C. Developing and assessing self‑regulated learning. The
Assessment Handbook: Continuing Education Program. Vol. 1.
2009. Available at SSRN:
[Last accessed on 2019 Jun 26].
16. Pintrich PR, Smith DA, Garcia T, Mckeachie WJ. Reliability
and predictive validity of the motivated strategies for learning
questionnaire (Mslq). Educ Psychol Meas 1993;53:801‑13.
17. Weinstein CE, Palmer DR, Schulte AC. Learning and Study
Strategies Inventory (LASSI). Clearwater, FL: H and H Publishing
Company; 1987.
18. Xu X. Evaluation of the relationship between one’s differentiation
of cognitive processes and metacognitive self‑ratings. Behav Res
Methods 2009;41:244‑55.
19. HarringtonR, LoffredoDA. Insight, rumination, and self‑reflection
as predictors of well‑being. J Appl Psychol 2010;145:39‑57.
20. SauterFM, HeyneD, Blöte AW, van WidenfeltBM, WestenbergPM.
Assessing therapy‑relevant cognitive capacities in young people:
Development and psychometric evaluation of the self‑reflection
and insight scale for youth. Behav Cogn Psychother 2010;38:303‑17.
21. Harrington R, Loffredo D. Insight, rumination, and self‑reflection
as predictors of well‑being. J Psychol 2010;145:39‑57.
22. DaSilveira A, DeSouza ML, Gomes WB. Self‑consciousness
concept and assessment in self‑report measures. Front Psychol
23. Grant A, Franklin J, Langford P. The self‑reflection and insight
scale: A new measure of private self‑consciousness. Soc Behav
Pers 2002;30 821‑35.
24. Roberts C, Stark P. Readiness for self‑directed change in
professional behaviours: Factorial validation of the self‑reflection
and insight scale. Med Educ 2008;42:1054‑63.
25. Silvia PJ, Duval TS. Objective self‑awareness theory: Recent
progress and enduring problems. Pers Soc Psychol Rev
26. Sandars J. The use of reflection in medical education: AMEE guide
no. 44. Med Teach 2009;31:685‑95.
27. Hays RB, Jolly BC, Caldon LJ, McCrorie P, McAvoy PA,
McManus IC, et al. Is insight important? Measuring capacity to
change performance. Med Educ 2002;36:965‑71.
28. Silveira AC, Castro TG, Gomes VB. Scale of self‑reflection and insight: New measure of self‑consciousness adapted and
revalidated for Brazilian adults. Dialnet Plus 2012;43 (2).
29. Chen SY, Lai CC, Chang HM, Hsu HC, Pai HC. Chinese version
of psychometric evaluation of self‑reflection and insight scale on
Taiwanese nursing students. J Nurs Res 2016;24:337‑46.
30. Aşkun D, Çetin FJ. Turkish version of self‑reflection and insight
scale: A preliminary study for validity and reliability of the
constructs. Psychol Stud 2017;62:21‑34.
31. Cook DA, Beckman TJ. Current concepts in validity and reliability
for psychometric instruments: Theory and application. Am J Med
32. Sousa VD, Rojjanasrirat W. Translation, adaptation and validation
of instruments or scales for use in cross‑cultural health care
research: A clear and user‑friendly guideline. J Eval Clin Pract
33. Severinsson E. Evaluation of the Manchester clinical supervision
scale: Norwegian and Swedish versions. J Nurs Manag
34. Hooper D, Coughlan J, Mullen M. Structural equation modelling:
Guidelines for determining model fit. EJBRM 2008;6:53‑60.
35. KlineRB. Principles and Practice of Structural Equation Modeling.
4th ed. USA: Guilford Press; 2005.
36. Tabachnick BG. Using Multivariate Statistics. 5th ed. Needham
Heights, MA, USA: Allyn and Bacon, Inc.; 2006.
37. Wheaton B, Muthén B, Alwin DF, Summers GF. Assessing
reliability and stability in panel models. Sociol Methodol
38. Andersson BT, Christensson L, Fridlund B, Brostrom A.
Development and psychometric evaluation of the radiographer’s
competence scale. Open J Nurs 2012;2:85‑96.