Design and validation of a questionnaire for perception of academic bullying in the clinical medical education environment

Academic bullying (AB) in clinical medical education settings often involves excessive workloads, threats to professional standing, and verbal or sexual harassment. These behaviors can severely impact trainees’ psychological well-being and career development. Although general tools exist for assessing workplace bullying, no validated instrument is currently designed specifically to capture the unique dynamics of bullying within clinical medical education. This study aimed to develop and validate a comprehensive questionnaire tailored to this context. This mixed-method study was conducted across several teaching hospitals affiliated with Tehran University of Medical Sciences. Questionnaire items were initially developed through literature review and focus group discussions. Content and face validity were established via expert panel evaluations and cognitive interviews. Construct validity was assessed using exploratory and confirmatory factor analyses. Internal consistency was evaluated using Cronbach’s alpha and composite reliability. Convergent and divergent validity were assessed via average variance extracted (AVE), composite reliability (CR), and the Fornell-Larcker criterion. The final version of the questionnaire was administered to 403 participants, including clinical medical students, residents, and fellows. The finalized questionnaire included 41 items grouped into eight distinct factors, capturing a wide range of bullying behaviors such as professional sabotage, verbal and sexual harassment, gender and racist discrimination, educational deprivation, and abuse of authority. Exploratory and confirmatory factor analyses supported the factor structure, with satisfactory model fit indices. The questionnaire demonstrated strong internal consistency across all subcategories (Cronbach’s alpha > 0.7) and acceptable composite reliability (CR > 0.76). Convergent and discriminant validity were supported overall. This study developed and validated a reliable questionnaire to measure academic bullying in clinical medical education. The tool captures a wide range of bullying behaviors and can help guide future research, support institutional evaluations, and inform efforts to create safer and more respectful learning environments.