Development and validation of an instrument to assess the self- confidence of students enrolled in the advanced pharmacy practice experience

American Journal of Pharmaceutical Education, Spring 2002 by Wongwiwatthananukit, Supakit, Newton, Gail D, Popovich, Nicholas G

Development and Validation of an Instrument to Assess the SelfConfidence of Students Enrolled in the Advanced Pharmacy Practice Experience1,2

The purpose of this study was to develop a reliable and valid instrument to measure pharmacy students' self-confidence and to determine the effect of selected student demographic variables as independent predictors of the students' level of self-confidence. The instrument was developed with an underpinning in the self-efficacy theory. Generated instrument items were based on literature review and informal interviews with preceptors/faculty members. Following content validation by internal and national content review panels, the instrument was pilot tested with a sample of 260 students from six colleges of pharmacy and revised based on the results of exploratory factor analysis. Subsequently, a revised instrument was administered to 837 students from 13 colleges of pharmacy and revised based on confirmatory factor analysis and replication of item analysis. The results indicated that the instrument had content validity, high internal consistency reliability, and convergent and discriminant validity. A three-factor structure was identified and interpreted as representing three subscales: knowledge base and pharmaceutical care, professionalism, and communication skills. Several demographic variables (e.g., age, GPA, community service/volunteerism along with level of involvement) were found to be significant predictors of students' level of self-confidence (P

INTRODUCTION

To function in clinical situations in any health care profession requires critical thinking and application of knowledge, a capability to reason, and an ability to contextualize a given situation(l). To be an effective practitioner, however, also requires a confidence in one's ability to use these cognitive skills when performing tasks. Confidence in the ability to perform tasks is an important quality for a pharmacy student to be successful while enrolled in Advanced Pharmacy Practice Experiences (APPE) (i.e., clerkships/rotations) and to ultimately function as a practitioner(2-6).

Bandura has proposed the self-efficacy theory as a model to examine the role of an individual's belief in his competence and whether he would be capable of successfully performing a particular task(7). He defined perceived self-efficacy as peoples' judgments of their capabilities to organize and execute courses of action required to attain designated types of performances. Historically, self-efficacy has been used interchangeably with self-confidence(7-8). Confidence in one's ability to perform a certain task parallels perceptions of self-efficacy in performing the task. Self-efficacy is not concerned with the skills a person possesses, but a person's judgment of what he can do with those skills. This implies that learning involves more than learning to obtain skills in the environment(7). One also learns about oneself and one's ability to perform certain actions in certain situations. In the pharmacy curriculum, the interaction between actual ability/skill and perceived ability/skill has important implications for a student as a learner during the APPE as well as a future competent practitioner. Bandura noted that effective, competent functioning requires knowledge/skills and self-efficacy beliefs to use them well(78). If an individual has the necessary skills and knowledge and positive outcome expectations, and personally values the outcome, the self-efficacy expectations ultimately determine an individual's decision to engage in a behavior, task choices, and quantity and quality of effort to be expended. It also determines an individual's willingness to persevere when confronting obstacles, and possess the resilience needed to face adverse situations(7-8).

From this perspective, many self-efficacy/confidence instruments have been developed and used in the study of health-related behaviors, in education, and in health professions (e.g., especially medicine and nursing) for their specific purposes, populations, and hypotheses testing. Research studies have demonstrated that measurements of self-confidence have had a positive influence on and have been a strong predictor of health behavior change, academic performance, selfregulation, and clinical competence(6,9-15). These have also supported the role of educational/teaching methods [e.g., personal performance accomplishments, mentoring, direct patient-care experience, objective structured clinical examinations (OSCEs)] and their impact on the development of a student's self-confidence. Measurement of student self-confidence may be a more efficient estimate of long-range outcomes than actually collecting longitudinal data of the outcomes. This is because one would know the level of student confidence in performing targeted tasks so that effective instructional strategies/methods can be established and implemented earlier to balance students' self-confidence with their abilities during the curriculum or prior to entering practice.