Perceptions of Justice in Clinical Learning Environments: Development and Validation of an Organizational Justice Measure for Medical Trainees

Michael J Cullen; Jessica Hane; You Zhou; Ben Seltzer; Paul R Sackett; Susan M Culican; Krima Thakker; John Q Young; Taj Mustapha; Organizational Justice Study Group

doi:10.1097/ACM.0000000000005669

Perceptions of Justice in Clinical Learning Environments: Development and Validation of an Organizational Justice Measure for Medical Trainees

Acad Med. 2024 Feb 27. doi: 10.1097/ACM.0000000000005669. Online ahead of print.

Authors

Michael J Cullen¹, Jessica Hane, You Zhou², Ben Seltzer³, Paul R Sackett⁴, Susan M Culican⁵, Krima Thakker⁶, John Q Young⁷, Taj Mustapha⁷; Organizational Justice Study Group

Affiliations

¹ M.J. Cullen is senior director of assessment, evaluation, and research for graduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-4755-4276.
² J. Hane is assistant professor, Departments of Internal Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-1957-6128.
³ Y. Zhou is a graduate student, Industrial/Organizational Psychology Program, University of Minnesota-Twin Cities, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0003-1142-5445.
⁴ B. Seltzer is a research and data analyst, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0009-0007-1441-7762.
⁵ P.R. Sackett is professor of psychology, Industrial/Organizational Psychology Program, University of Minnesota-Twin Cities, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0001-7633-4160.
⁶ S.M. Culican is professor, Department of Ophthalmology and Visual Neurosciences, and associate dean for graduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota; ORCID: https://orcid.org/0000-0002-4310.
⁷ K. Thakker is research coordinator, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York; ORCID: https://orcid.org/0000-0002-1737-2113.

PMID: 38412473
DOI: 10.1097/ACM.0000000000005669

Abstract

Purpose: This study aimed to develop an instrument to measure medical trainees' perceptions of justice in clinical learning environments.

Method: Between 2019 and 2023, the authors conducted a multiyear, multi-institutional, multiphase study to develop a 16-item justice measure with 4 dimensions: interpersonal, informational, procedural, and distributive. The authors gathered validity evidence based on test content, internal structure, and relationships with other variables across 3 phases. Phase 1 involved drafting items and gathering evidence that items measured intended dimensions. Phase 2 involved analyzing relevance of items for target groups, examining interitem correlations and factor loadings in a preliminary analysis, and obtaining reliability estimates. Phase 3 involved a confirmatory factor analysis and collecting convergent and discriminant validity evidence.

Results: In phase 1, 63 of 91 draft items were retained following a content validation exercise gauging how well items measured targeted dimensions (mean [SD] item ratings within dimensions, 4.16 [0.36] to 4.39 [0.34]) on a 5-point Likert scale (with 1 indicating not at all well and 5 indicating extremely well). In phase 2, 30 items were removed due to low factor loadings (i.e., < 0.40), and 4 items per dimension were selected (factor loadings, 0.42-0.89). In phase 3, a confirmatory factor analysis supported the 4-dimension model (χ2 = 610.14, P < .001; comparative fit index = 0.90, Tucker-Lewis Index = 0.87, root mean squared error of approximation = 0.11, standardized root mean squared residual = 0.06), with convergent and discriminant validity evidence showing hypothesized positive correlations with a justice measure (r = 0.93, P < .001), trait positive affect (r = 0.46, P < .001), and emotional stability (r = 0.33, P < .001) and negative correlations with trait negative affect (r = -0.39, P < .001).

Conclusions: Results indicate the measure's potential utility in understanding justice perceptions and designing targeted interventions.