Document Type : Original Article


1 Associate Professor, Department of Emergency Medicine, Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Science, Qazvin, Iran

2 Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Qazvin, Iran

3 Ph.D. in Health Education and Promotion, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran


BACKGROUND: COVID‑19 pandemic poses unique physical and emotional challenges in providing
clinical education. Failure to identify the challenges and problems that students face in the clinical
learning environment hinders their effective learning and growth. Consequently, the progress of
their skills is affected. The aim of this study was to develop a challenge in the clinical education
environment of medical students during the outbreak of COVID‑19 questionnaire and to test its
psychometric properties.
MATERIALS AND METHODS: This study is part of a larger study that was conducted using a
combined consecutive method in Qazvin. In the first stage, a phenomenological study was performed
with van Manen’s method by interviewing 12 students at Qazvin University. To extract the items of
the tool in the second stage, the concept was defined. Ultimately, the psychometric properties of
the questionnaire were evaluated with face validity, content validity (quantitative and qualitative),
construct validity (exploratory factor analysis), internal consistency (Cronbach’s alpha), and test–retest
reliability (intraclass correlation coefficient).
RESULTS: The initial tool had 70 questions. After validation, 53 items remained in the final
questionnaire. Four extracted dimensions were as follows: “Inadequate professional competency,”
“Inefficient clinical planning” and “outcomes of learning‑teaching activities,” and “the challenges
related to the stigma of medical staff.” Cronbach’s alpha for the whole questionnaire was
0.98 (range: 0.87–0.98). The test–retest (intraclass correlation coefficient) reliability was
0.98 (P < 0.001).
CONCLUSIONS: According to the obtained results, if the items of “Inadequate professional
competency,” “Inefficient clinical planning” and “outcomes of learning‑teaching activities,” and “the
challenges related to the stigma of medical staff,” the challenges of students’ clinical education can
be reduced during the COVID‑19 outbreak.


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