title: Investigating the use of negatively phrased survey items in medical education settings: common wisdom or common mistake?
abstract: BACKGROUND
  Attitude surveys in medical education often combine negative items with positive items, a "common wisdom" strategy to counteract response sets. A body of research in other fields has demonstrated that negatively phrased items affect reliability and validity by introducing measurement artifact into scores. The authors investigated the effect of negatively phrased items in the Medical School Learning Environment Survey (MSLES) with data from six medical student cohorts at the University of Texas Medical Branch, Galveston, Texas.
  
  
  METHODS
  This study describes the impact of negatively phrased items in the MSLES through analysis of item and scale means and comparisons of coefficient alpha values.
  
  
  RESULTS
  Findings indicate that negatively phrased items performed differently than the positively phrased items. Negatively phrased items were associated with lower scale reliability.
  
  
  CONCLUSIONS
  The authors conclude, as did earlier studies, that negatively phrased items introduce an artifact into attitude measurement. The "common wisdom" practice of routinely including negative items should be employed with care.
authors.affiliation: Division of Geriatrics, University of South Carolina School of Medicine, Columbia 29203, USA. thomas.stewart@palmettohealth.org
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Stewart
authors.forename: Ann W
authors.initials: AW
authors.lastname: Frye
mesh_terms: D001290:Attitude; D004501:Education, Medical; D004644:Emotions; D006801:Humans; D007398:Interpersonal Relations; D007858:Learning; D009042:Motivation; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012931:Social Environment; D013337:Students, Medical / Q000523:psychology*