East Meets West: A Multisite Validity Study of the China Medical Professionalism Inventory.

Introduction: The characteristics of medical professionalism (MP) vary across cultural contexts. Professionalism constructs and MP tools currently rely on Western cultural perspectives. Chinese leaders are calling for MP tools that connect to historical traditions, current culture, and modern conceptualizations of MP inside and outside China. Methods: The authors developed the China Medical Professionalism Inventory using standard processes in two steps. Phase I, "development of item pool," involved reviewing the literature to generate an item pool and conducting a first survey of Chinese clinical experts to develop content evidence. Phase II, "delineation of validity evidence," included three psychometric studies of practicing physicians and a second expert survey to create the final version of the tool; these processes aimed to determine validity evidence for content, internal structure, and relationships to other variables. Results: Systematic review of the English- and Chinese-language literature identified 1537 professionalism-specific items from 63 sources to form the item pool. The authors conducted two rounds of expert review, including surveying nationally prominent Chinese clinician-leaders (n = 34, response rate 85%, and n = 76, response rate 63%). The authors conducted three psychometric studies of practicing Chinese physicians (n = 360, response rate 92%; n = 3653, response rate 90%; and n = 955, response rate 95%). The results generated the 20-item CMPI, with four factors: "Respect, Compassion, and Communication; Integrity; Excellence; and Responsibility." Discussion: The CMPI presented validity evidence for content, internal structure, and relationship to other variables. This study may extend the conceptualization and reach of MP measurement.