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Introduction: The Manchester Clinical Placement Index (MCPI) is an instrument to measure medical undergraduates' real-patient learning in communities of practice both in hospital and in GP placements. Its suitability to evaluate the quality of placement learning environments has been validated in an English-language context; however, there is a lack of evidence for its applicability in other languages. Our aim was to thoroughly explore the factor structure and the key psychometric properties of the Hungarian language version. Methods: MCPI is an 8-item, mixed-method instrument which evaluates the quality of clinical placements as represented by the leadership, reception, supportiveness, facilities and organization of the placement (learning environment) as well as instruction, observation and feedback (training) on 7-point Likert scales with options for free-text comments on the strengths and weaknesses of the given placement on any of the items. We collected data online from medical students in their preclinical (1st, 2nd) as well as clinical years (4th, 5th) in a cross-sectional design in the academic years 2019-2020 and 2021-2022, by the end of their clinical placements. Our sample comprises data from 748 medical students. Exploratory and confirmatory factor analyses were performed, and higher-order factors were tested. Results: Although a bifactor model gave the best model fit (RMSEA = 0.024, CFI = 0.999, and TLI = 0.998), a high explained common variance (ECV = 0.82) and reliability coefficients (ωH = 0.87) for the general factor suggested that the Hungarian version of the MCPI could be considered unidimensional. Individual application of either of the subscales was not supported statistically due to their low reliabilities. Discussion: The Hungarian language version of MCPI proved to be a valid unidimensional instrument to measure the quality of undergraduate medical placements. The previously reported subscales were not robust enough, in the Hungarian context, to distinguish, statistically, the quality of learning environments from the training provided within those environments. This does not, however, preclude formative use of the subscales for quality improvement purposes.
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BACKGROUND: Patients with their given complaints and symptoms expect certain diagnoses to be estimated with the same probability when seen by different family doctors. These estimations showed extreme variation among family doctors in Switzerland. The present study investigated whether there is any difference in the probabilities of the same diagnoses given by Hungarian doctors and, if so, what the responsible factors are. Estimates given by specialists, residents of family medicine, and medical students were also compared. MATERIAL/METHODS: In this cross-sectional study, 484 family physicians, 124 medical residents, and 148 medical students completed a questionnaire that assessed the diagnostic probability of six clinical scenarios. RESULTS: Medians and ranges of probability were almost the same in both countries. Significant negative correlation was observed between age and the estimation of COPD among the family physicians (Spearman's r=-0.231, p<0.001). This correlation was even more expressed in men and was independent of gender, previous specialization in internal medicine or pulmonology, and the location of practice. Family physicians rated the probability of myocardial infarction higher than the residents (p<0.01). They also rated the probability of congestive heart disease higher than the medical students (p<0.001). Women residents and students gave higher estimates in almost all clinical settings than did men. CONCLUSIONS: Diagnostic estimates of the same clinical scenarios vary widely among Hungarian family doctors, residents, and medical students. The independent inverse relationship between the doctor's age and his/her estimate of the probability of COPD underscores the need to intensify education on this disease.