Cross-cultural adaptation and validation of the Indonesian version of the operating room educational environment measure with Indonesian residents

Assessing residents’ perceptions of the operating room (OR) educational environment is critical for shaping competencies in surgical training and influencing learning outcomes, professional development, and patient safety. Evaluation of these perceptions provides evidence of the effectiveness of teaching, supervision, and teamwork in supporting learning in the OR and helps educators identify areas for improvement in residency programs. The Operating Room Educational Environment Measure (OREEM) is an instrument developed to evaluate learning conditions in the OR. In this study, we aimed to assess the validity, reliability, and cross-cultural applicability of the Indonesian version of the OREEM questionnaire adapted to Indonesian surgical residents. The original 40-item OREEM was translated into Bahasa Indonesia using a standardized forward and backward translation procedure. Eight experts in surgical education assessed content relevance and clarity based on a contemporary conceptual framework comprising 5 themes and 26 subthemes. The content validity ratio (CVR) and item-level content validity index (I-CVI) were calculated using ratings from 26 experts. Construct validity was examined using exploratory factor analysis (EFA) with Varimax rotation based on responses from 244 residents. Internal consistency reliability was analyzed using Cronbach’s alpha and corrected item–total correlations. Thirty-nine items were retained for the final Indonesian version of the OREEM. A total of 21 items exceeded the CVR threshold (≥ 0.37), and 22 achieved acceptable I-CVI values (≥ 0.79). EFA supported a three-factor structure—Teaching and Atmosphere, Learning Opportunities and Workload, and Training, Skills, and Supervision—accounting for 32.34% of the total variance. The overall Cronbach’s alpha was 0.887, with 84.6% of items demonstrating corrected item–total correlations above 0.30. The 39-item Indonesian version of the OREEM demonstrated acceptable validity and high internal consistency, suggesting its potential utility as a valid instrument for assessing residents’ perceptions of the OR learning environment in Indonesia.