Development and Validation of the Perceived Power Distance Scale in US Undergraduate Medical Education

Power dynamics and hierarchy are influential facets of the medical learning environment that are often experienced but seldom studied. One reason for this gap is the lack of sound instruments to measure perceived power distance in medicine. Accordingly, we developed and evaluated the Perceived Power Distance Scale (PPDS). Initial item development involved a literature search that identified a power distance orientation instrument (beliefs about power distance), which we adapted to measure perceived power distance (perceptions of power distance). We gathered item content validity evidence from a panel of seven international scholars of power and hierarchy, resulting in minor item revision. Next, a convenience sample of 312 US medical students completed a survey comprising PPDS (to establish internal validity through confirmatory factor analysis and reliability estimation); a locally adapted power distance measure (to establish convergent validity); and a psychological safety measure (to establish discriminant validity). The best-fitting model was a higher order 1 + 5 factor model for PPDS, and PPDS overall scale reliability was adequate at 0.81. The correlation between the PPDS and an independent measure of power distance was 0.60 (convergent validity) and the correlation of the PPDS with psychological safety was -0.54 (discriminant validity). The PPDS demonstrated adequate evidence of content, internal, convergent, and discriminant validity, along with appropriate reliability evidence to measure perceived power distance in US medical schools. The PPDS can be used as a tracking metric to improve learning environments within medical education in coordination with organizational development efforts.