Identifying the attributes of instructional quality in ambulatory teaching sites: a validation study of the MedEd IQ

Instructional quality in ambulatory settings may vary. The MedEd IQ is an instrument that measures unique aspects of the clinical instructional process. This study assesses the construct and factorial validity of the MedEd IQ. First-year students (n = 764) in Introduction to Clinical Medicine courses and third-year students (n = 711) in family medicine clerkships evaluated 249 clinical teaching sites affiliated with two medical schools, using MedEd IQ questionnaires at the conclusion of clinical training (1996-2000). Factor structures were identified and relationally defined through exploratory and confirmatory factor analytic techniques, and a measurement model for assessing instructional quality was refined. Four unique factors were identified that contribute to instructional quality: preceptor activities, learning environment, learner involvement, and learning opportunities. Of 33 items within the instrument, 22 were retained in the final structural model. Two indices of fit, a comparativefit index of .935, and a root mean square error of approximation of .063 indicated close agreement between the defined model and the observed relationships between items. The MedEd IQ measures four factors important to ambulatory medical education and provides a basis for a new measurement approach to assessing instructional quality.