title: Measuring Moral Courage for Interns and Residents: Scale Development and Initial Psychometrics.
abstract: OBJECTIVE
  To develop a practical and psychometrically sound set of survey items that measures moral courage for physicians in the context of patient care.
  
  
  METHODS
  In 2013, the 731 internal medicine and surgical interns and residents from two northeastern U.S. academic medical centers were invited to anonymously complete a survey about moral courage, empathy, and speaking up about patient safety breaches.
  
  
  RESULTS
  Of the eligible participants, 352 (48%) responded. Principal components analysis of the moral courage items demonstrated a single, meaningful, nine-item factor labeled the Moral Courage Scale for Physicians (MCSP). All item-total score correlations were significant (P < .001) and ranged from 0.57 to 0.76. The Cronbach alpha for the MCSP was 0.90. Consistent with expectations based on theory, MCSP scores were negatively associated with being an intern versus resident (B = -4.17, P < .001), suggesting discriminant validity. MCSP scores were positively associated with respondents' Jefferson Scale of Physician Empathy perspective-taking score (B = 0.53, P < .001), a construct conceptually relevant to moral courage, suggesting convergent validity. Finally, MCSP scores were positively correlated with self-reported speaking up about patient safety breaches (r = 0.19, P = .008), an action that involves moral courage, suggesting concurrent validity.
  
  
  CONCLUSIONS
  The authors provided initial evidence for the reliability and validity of a measure of moral courage for physicians. The MCSP may help researchers and educators to tangibly measure physician moral courage as a concept, and track progress on a set of desired behaviors in response to curricular interventions.
authors.affiliation: W. Martinez is assistant professor of medicine, Division of General Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee.S.K. Bell is associate professor of medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.J.M. Etchegaray is senior behavioral and social scientist, RAND Corporation, Santa Monica, California.L.S. Lehmann is executive director, National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, associate professor of health policy and management, Harvard T.H. Chan School of Public Health, and associate professor of global health and social medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: William
authors.initials: W
authors.lastname: Martinez
authors.forename: Sigall K
authors.initials: SK
authors.lastname: Bell
authors.forename: Jason M
authors.initials: JM
authors.lastname: Etchegaray
authors.forename: Lisa Soleymani
authors.initials: LS
authors.lastname: Lehmann