Validity, reliability, and feasibility of the Singapore version of Professionalism Mini-Evaluation Exercise (P-MEX) to assess medical professionalism in the SingHealth residency program in the Singapore General Hospital

Introduction: There are limited medical professionalism assessment tools that are adapted for Singapore. We aimed to evaluate the validity, reliability and feasibility of the Singapore version of the Professionalism Mini-Evaluation Exercise (P-MEX) for assessment of professionalism of residents at a teaching hospital in Singapore. Methods: We collected assessment data from residents from July 2019 to January 2020. Content validity was evaluated through cognitive debriefing interviews (CDIs). Construct validity was evaluated using a priori hypothesis with another comparator instrument. Structural validity was assessed through both confirmatory factor analysis (CFA) using the original four-factor model and exploratory factor analysis (EFA). Internal consistency was assessed using Cronbach’s alpha. Results: CDIs conducted with nine faculty supported content validity of the Singapore version of P-MEX. The cross-sectional data demonstrated satisfactory construct validity (83% of hypotheses met) and good internal consistency (Cronbach’s alpha ranged from 0.72 to 0.93). The CFA of the original four-factor model of the P-MEX did not obtain meet all the acceptable fit of indexes. EFA suggested a two-factor model—the first factor had an eigenvalue of 8.52 and explained 73.8% of the variance, while the second factor had an eigenvalue of 1.90 and explained 26.2% of the variance. Conclusion: This study supports the content validity, construct validity, internal consistency of the Singapore version of P-MEX in assessing medical professionalism in the local residency training programme. However, there was no conclusive support for the original four-factor model of the P-MEX. EFA identified 2 main factors, which appeared to encompass “Patient care and inter-professional relationship skills” and “Reflective skills”. Keywords: Professionalism, Singapore, Validation, Assessment