Original Research

Developing conceptually sound items for a clinical courage questionnaire


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Robert Brooks
1 PhD, Associate Professor Rural Medicine ORCID logo

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Isabella A White
2 Academic GP Trainee

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Lucie Walters
3 FACRRM, Director * ORCID logo

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Susan Williams
4 PhD, Researcher

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Ian Couper
5 MFamMed, FCFP(SA), Director ORCID logo

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Jill Konkin
6 FRRMS, Interim Coordinator Rural Integrated Community Clerkship ORCID logo

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David G Campbell
7 MBBS, FACRRM, Censor-in-Chief ORCID logo


1 Department of Rural Health, Broken Hill University, Broken Hill, NSW 2880, Australia

2 Adelaide Rural Clinical School, The University of Adelaide, Nairne, SA 5252, Australia

3 Adelaide Rural Clinical School, Faculty of Health and Medical Sciences, The University of Adelaide, Mount Gambier, SA 5290, Australia

4 Department of Rural Health, University of Sydney, Broken Hill, NSW 2880, Australia

5 Ukwanda Centre for Rural Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa

6 Office of Rural & Regional Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB T6G 1C9, Canada

7 Australian College of Rural and Remote Medicine, Cunninghame Arm Medical Centre, Lakes Entrance, Vic. 3909, Australia

ACCEPTED: 12 January 2023

early abstract:

Introduction: Clinical courage can be described as a rural doctor’s adaptability and willingness to undertake clinical work at the limits of their training and experience to meet the needs of their patients. This paper describes the in-house development of survey items to include in a quantitative measure of clinical courage.
Methods: The questionnaire development involved two key concepts: a second order latent factor model structure and a nominal group technique used to develop consensus amongst the research team members.
Results: The steps taken to develop a sound clinical courage questionnaire are described in detail. The resulting initial questionnaire is presented, ready for testing with rural clinicians and refinement.
Conclusions: This paper outlines the psychometric process of questionnaire design and presents the resultant clinical courage questionnaire.