Journal of Taibah University Medical Sciences (2019) 14(2), 123e130

Taibah University

Journal of Taibah University Medical Sciences

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Original Article

Dimensionality and reliability of USM pre-clinical medical students’

guidance and counselling needs questionnaire
Zarawi M.Z.M.N. Nor, PhD a, *, Najib N.M. Yaacob, DrPH b and
Jamilah A.M. Mohammad, MMEd a
a
Department of Medical Education, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian,
Malaysia
b
Unit of Biostatistics and Research Methodology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia,
Kubang Kerian, Malaysia

Received 20 October 2018; revised 27 December 2018; accepted 5 January 2019; Available online 4 February 2019

‫ﺍﻟﻤﻠﺨﺺ‬ Abstract

.‫ ﻻ ﺗﻮﺟﺪ ﺁﻟﻴﺔ ﻧﻤﻮﺫﺟﻴﺔ ﻟﻠﺘﻌﺎﻃﻒ ﻭﺗﻘﺪﻳﻢ ﺍﻟﻤﺸﻮﺭﺓ ﻟﻄﻼﺏ ﺍﻟﻄﺐ‬:‫ﺃﻫﺪﺍﻑ ﺍﻟﺒﺤﺚ‬
‫ﺗﻬﺪﻑ ﻫﺬﻩ ﺍﻟﺪﺭﺍﺳﺔ ﻟﺘﺤﺪﻳﺪ ﺃﺑﻌﺎﺩ ﻭﻣﻮﺛﻮﻗﻴﺔ ﺍﺳﺘﺒﺎﻧﺔ ﺍﻟﺘﻮﺟﻴﻪ ﻭﺍﻟﻤﺸﻮﺭﺓ ﻟﻄﻼﺏ ﺍﻟﻄﺐ‬
.‫ﻗﺒﻞ ﺍﻟﺴﻨﻮﺍﺕ ﺍﻟﺴﺮﻳﺮﻳﺔ ﻓﻲ ﺟﺎﻣﻌﺔ ﺳﻴﻨﺰ ﺑﻤﺎﻟﻴﺰﻳﺎ‬
‫ ﺃﺟﺮﻳﺖ ﺩﺭﺍﺳﺔ ﻣﻘﻄﻌﻴﺔ ﻣﺴﺘﻌﺮﺿﺔ ﺑﻴﻦ ﻃﻼﺏ ﺍﻟﻄﺐ ﺍﻟﺠﺎﻣﻌﻴﻴﻦ ﻓﻲ‬:‫ﻃﺮﻕ ﺍﻟﺒﺤﺚ‬
‫ ﺍﺳﺘﺒﺎﻧﺔ ﺍﺣﺘﻴﺎﺟﺎﺕ ﻃﻼﺏ ﺍﻟﻄﺐ‬.‫ﻣﺪﺭﺳﺔ ﺍﻟﻌﻠﻮﻡ ﺍﻟﻄﺒﻴﺔ ﻓﻲ ﺟﺎﻣﻌﺔ ﺳﻴﻨﺰ ﺑﻤﺎﻟﻴﺰﻳﺎ‬
٦٨ ‫ ﺫﺍﺗﻴﺎ ﺗﺤﺘﻮﻱ ﻋﻠﻰ‬-‫ﻟﻠﺘﻮﺟﻴﻪ ﻭﺗﻘﺪﻳﻢ ﺍﻟﻤﺸﻮﺭﺓ ﺑﺠﺎﻣﻌﺔ ﺳﻴﻨﺰ ﺑﻤﺎﻟﻴﺰﻳﺎ ﻫﻲ ﺃﺩﺍﺓ ﺗﺪﺍﺭ‬
‫ ﻭﺍﻟﻤﺴﺘﺸﺎﺭ ﻭﺍﻟﻤﺤﺎﺿﺮﻳﻦ ﻓﻲ‬،‫ﻋﻨﺼﺮﺍ ﺃﻭﻟﻴﺎ ﺗﻢ ﺗﻄﻮﻳﺮﻫﺎ ﺑﻌﺪ ﺗﻮﺻﻴﺔ ﻃﻼﺏ ﺍﻟﻄﺐ‬
‫ ﻭﺃﺟﺮﻱ‬،‫ ﻟﺘﺤﺪﻳﺪ ﺃﺑﻌﺎﺩ )ﺑﻨﺎﺀ ﺍﻟﺼﻼﺣﻴﺔ( ﻭﻣﻮﺛﻮﻗﻴﺔ ﺍﻻﺳﺘﺒﺎﻧﺔ‬.‫ﻗﺴﻢ ﺍﻟﺘﻌﻠﻴﻢ ﺍﻟﻄﺒﻲ‬
.‫ﺗﺤﻠﻴﻞ ﺍﻟﻌﺎﻣﻞ ﺍﻻﺳﺘﻜﺸﺎﻓﻲ ﻭﺗﺤﻠﻴﻞ ﻣﻮﺛﻮﻗﻴﺔ ﺍﻟﺘﻨﺎﺳﻖ ﺍﻟﺪﺍﺧﻠﻲ ﺃﻟﻔﺎ ﻛﺮﻭﻧﺒﺎﺥ‬
‫ ﻭﺃﻇﻬﺮ ﺗﺤﻠﻴﻞ ﺍﻟﻌﺎﻣﻞ‬.‫ ﻃﺎﻟﺒﺎ ﻓﻲ ﻫﺬﻩ ﺍﻟﺪﺭﺍﺳﺔ‬٢٠٨ ‫ ﺗﻢ ﻣﺸﺎﺭﻛﺔ ﻣﺎ ﻣﺠﻤﻮﻋﻪ‬:‫ﺍﻟﻨﺘﺎﺋﺞ‬
‫ﺃﻥ ﺍﻟﻌﻨﺎﺻﺮ ﻛﺎﻧﺖ ﺃﺣﺎﺩﻳﺔ ﺍﻷﺑﻌﺎﺩ ﻣﻊ ﺃﺭﺑﻌﺔ ُﺑﻨﻰ ﻣﺤﺘﻤﻠﺔ ﺳﻴﺘﻢ ﺍﺳﺘﺨﺮﺍﺟﻬﺎ ﻣﻦ‬
‫ ﻭﻣﻬﺎﺭﺍﺕ ﺍﻟﺘﻮﺍﺻﻞ‬،(‫ ﻋﻨﺎﺻﺮ‬٧) ‫ﺍﻟﺬﺍﺗﻴﺔ‬e ‫ ﻫﺬﻩ ﺍﻟُﺒﻨﻰ ﻛﺎﻧﺖ ﻣﻬﺎﺭﺍﺕ ﺍﻟﻘﻴﺎﺩﺓ‬.‫ﺍﻻﺳﺘﺒﺎﻧﺔ‬
‫ ﻋﻨﺎﺻﺮ( ﻣﻊ‬٣) ‫ ﻋﻨﺎﺻﺮ( ﻭﻣﻬﺎﺭﺍﺕ ﺍﻟﺘﻜﻴﻒ ﺍﻟﻨﻔﺴﻲ‬٥) ‫ ﻭﻣﻬﺎﺭﺍﺕ ﺍﻟﺘﻌﻠﻢ‬،(‫ ﻋﻨﺎﺻﺮ‬٥)
-٧٩.٠‫ ﻭ‬٠.٨٤-٠.٦٥‫ﻭ‬،٠.٨٨– ٠.٥٦‫ ﻭ‬،٠.٨٢-٠.٥٦ ‫ﻋﺎﻣﻞ ﺍﻟﺘﺤﻤﻴﻞ ﻳﺘﺮﺍﻭﺡ ﻣﻦ‬
‫ ﻭﻛﺎﻧﺖ ﻣﻮﺛﻮﻗﻴﺔ ﺍﻟﺘﻨﺎﺳﻖ ﺍﻟﺪﺍﺧﻠﻲ )ﺃﻟﻔﺎ ﻛﺮﻭﻧﺒﺎﺥ( ﻟﻜﻞ ﻣﺠﺎﻝ‬.‫ ﻋﻠﻰ ﺍﻟﺘﻮﺍﻟﻲ‬٠.٨٠
.٠.٩٣ ‫ﻋﻠﻰ ﺍﻟﺘﻮﺍﻟﻲ ﻣﻊ ﺃﻟﻔﺎ ﺍﻟﺸﺎﻣﻠﺔ‬٠.٨٧‫ ﻭ‬٠.٨٧‫ ﻭ‬،٠.٩٠‫ ﻭ‬،٠.٨٩
‫ ﺑﻨﺪﺍ ﻣﻦ ﺍﺳﺘﺒﺎﻧﺔ‬٢٠ ‫ ﺍﺳﺘﻨﺘﺠﺖ ﻫﺬﻩ ﺍﻟﺪﺭﺍﺳﺔ ﺃﻥ ﺃﺭﺑﻌﺔ ﻋﻮﺍﻣﻞ ﻣﻊ‬:‫ﺍﻻﺳﺘﻨﺘﺎﺟﺎﺕ‬
‫ﺍﺣﺘﻴﺎﺟﺎﺕ ﻃﻼﺏ ﺍﻟﻄﺐ ﻟﻠﺘﻮﺟﻴﻪ ﻭﺗﻘﺪﻳﻢ ﺍﻟﻤﺸﻮﺭﺓ ﺑﺠﺎﻣﻌﺔ ﺳﻴﻨﺰ ﺑﻤﺎﻟﻴﺰﻳﺎ ﺗﺤﻤﻞ‬
.‫ﺻﻼﺣﻴﺔ ﺟﻴﺪﺓ ﻭﻗﻴﻤﺔ ﻣﻮﺛﻮﻗﻴﺔ ﻋﻨﺪ ﺗﻘﺪﻳﻤﻬﺎ ﻟﻄﻼﺏ ﺍﻟﻄﺐ ﻗﺒﻞ ﺍﻟﺴﻨﻮﺍﺕ ﺍﻟﺴﺮﻳﺮﻳﺔ‬
‫ ﻃﻼﺏ ﺍﻟﺴﻨﺔ ﺍﻟﺘﺤﻀﻴﺮﻳﺔ ﺍﻟﻄﺒﻴﺔ؛ ﺧﺪﻣﺔ ﺍﻟﻤﺸﻮﺭﺓ؛ ﺗﺤﻠﻴﻞ‬:‫ﺍﻟﻜﻠﻤﺎﺕ ﺍﻟﻤﻔﺘﺎﺣﻴﺔ‬
‫ﺍﻟﻌﺎﻣﻞ ﺍﻻﺳﺘﻜﺸﺎﻓﻲ؛ ﺻﻼﺣﻴﺔ؛ ﺍﻟﻤﻮﺛﻮﻗﻴﺔ‬
* Corresponding address: Department of Medical Education,
School of Medical Sciences, Health Campus, Universiti Sains
Malaysia, Kubang Kerian, Kelantan, Malaysia.
E-mail: zarawi@usm.my (Z.M.Z.M.N. Nor)
Peer review under responsibility of Taibah University.
Production and hosting by Elsevier
Objective: There is no standard mechanism for empathy
guidance and counselling for medical students. This study
aimed to determine the dimensionality and reliability of a
questionnaire developed for establishing guidance and
counselling for pre-clinical medical students at Universiti
Sains Malaysia (USM).
Methods: A cross-sectional study was conducted among
undergraduate medical students of the School of Medical
Sciences of USM. The proposed USM Medical Students’
Guidance and Counselling Needs (USM-MSGCN)
questionnaire is a self-administered instrument that con-
sists of 68 initial items developed from the recommen-
dation of medical students, counsellors, and lecturers in
the medical education department. To determine the
dimensionality (construct validity) and reliability of the
questionnaire, exploratory factor analysis and Cron-
bach’s alpha internal consistency reliability analysis were
conducted.
Results: A total of 208 students participated in the
study. Factor analysis revealed that the items were not
unidimensional; four potential constructs could be
extracted from the questionnaire, namely, self-leadership
(7 items), communication (5 items), learning (5 items),
and psychological coping skills (3 items), with factor
loading ranges of 0.56e0.82, 0.56e0.88, 0.65e0.84, and
0.79e0.80, respectively. These domains had the
following internal consistency reliability (Cronbach’s
alpha): 0.89, 0.90, 0.87, and 0.87, respectively; the overall
alpha value was 0.93.

1658-3612 Ó 2019 The Authors.

Production and hosting by Elsevier Ltd on behalf of Taibah University. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/). https://doi.org/10.1016/j.jtumed.2019.01.002
124 Z.M.Z.M.N. Nor et al.
Conclusion: Four factors, with 20 items in the USM-
MSGCN questionnaire had good validity and reliability
values when administered among the pre-clinical medical
students.
Keywords: Counselling service; Exploratory factor analysis;
Pre-medical students; Reliability; Validity
Ó 2019 The Authors.
Production and hosting by Elsevier Ltd on behalf of Taibah
University. This is an open access article under the CC BY-
NC-ND license (http://creativecommons.org/licenses/by-nc-
nd/4.0/).
Introduction
Counselling, in its broadest sense, refers to a person
helping another to clarify issues in his or her life and adopt
further lines of action.1 Counselling service has become
significant when people suffer from alarming levels of
psychological problems, such as stress, depression, and
anxiety.2e7 Such psychological problems occur owing to
the rapid development that impacts on the physical and
mental well-being of people,8 including medical students.9
In the context of higher education, a counselling services
centre offers consultation services to tackle not only
students’ psychological well-being but also their educa-
tional, career, and social development issues.10,11 The United
Nations Educational, Scientific and Cultural Organization
(UNESC0) has specified three main roles of the student’s
affair section in higher education institutions: promoting
personal, career, and education development.10e12 To
promote these roles, counselling centre services are
provided by professional counsellors who are responsible
for developing a comprehensive counselling blueprint.8,13
The positive impacts of counselling service have been
recognised by students14e16 because they are consistent
with their needs17 both nationally and internationally.18e20
The high rates of stress, depression, and anxiety among
medical students21e25 confirm the importance of counselling
services26,27 for them to succeed in medical training.
Therefore, it is important that clients are provided with
counselling care of good quality. To design counselling
care intervention strategies tailored to clients’ need, it is
crucial to identify clients using an accurate and validated
assessment instrument. Despite the importance of
counselling service, the credibility of its few assessment
tools are not well studied.28 Therefore, the present study
aimed to assess the dimensionality of the developed tool,
the USM Pre-Clinical Medical Students’ Guidance and
Counselling Needs questionnaire (USM-MSGCN), and then
report on its validation. Consistent with the study aim, a null
hypothesis was developed. The suggested items of the USM-
MSGCN were unidimensional; the research hypothesis was
that these items would be multi-dimensional.
Studies on counselling needs beliefs in the context of ed-
ucation research have explored counselling needs through
implementing the Mooney checklist29e31 and Depression,
Anxiety and Stress Scales (DASS-21) instrument.31,32 The
Mooney checklist was developed by Gordon and Mooney
(1950), whereas DASS-21 was developed by researchers at
the University of New South Wales, Australia (1995).33
These instruments remain the most popular and widely
used in counselling service. Despite their popularity, these
instruments have limitations: they only focus on
psychological components and exclude academic domains.
Moreover, the targeted user is generalised; there is no
instrument that gives specific focus on medical students.
In the context of medical training, the scope of counselling
and guidance needs is broad, including (i) mental health
assessment,19,24,34e36 (ii) career development,37,38 and (iii)
personal and professional development.9,20,39e43 Evidence
from literature review confirms that these domains represent
the prominent problems of medical students.3e5,7,35,44
Furthermore, studies have shown that these problems can be
reduced through appropriate counselling intervention. For
instance, studies on the effect of counselling intervention for
physicians have showed that appropriate interventions can
reduce job stress and burnout.35,45
In other studies, career counselling and advising services
are reported as important to medical students, including
providing information on career options, elective guidance,
residency applications, and social accountability.46,47 For
example, Canadian Medical school has enforced four areas
covered by counselling: (i) career planning in medicine, (ii)
providing a support system to enhance access to career
information, (iii) collaborating with third parties to
support medical students in career decision making, and (v)
integrating career development theory and experiential
learning practices in career consultation.37,47e49
Meanwhile, medical students also need to be nurtured with
respect to their ethical responsibility to self and others,
reliability and dependability, service orientation, social
skills, capacity for improvement, resilience and
adaptability, cultural competence, oral communication,
and teamwork.9,50e52
Indeed, medical training has many issues that need urgent
attention by the relevant parties. Despite the importance of
counselling service to medical training, there is no specific
instrument that assesses the counselling and guidance needs
of those undertaking training. This situation has led to poor
services in provided counselling. A credible instrument of the
counselling and guidance needed for the targeted group,
namely, medical students, is important. Thus, the present
study aimed to assess the dimensionality of a developed
relevant questionnaire and then validate the same.
Materials and Methods
Development of USM-MSGCN questionnaire
Development of the USM-MSGCN questionnaire began
by collecting relevant information about counselling and
guidance services offered to medical students in higher
institution through literature reviews and focus group dis-
cussions with pre-clinical medical students and students’
counsellors in the student affair department. Next, we cat-
egorised the data gathered based on similarities and differ-
ences to come up with a profile of counselling and guidance
services. The last stage was to promote items related to the
counselling and guidance issues.
 Guidance and counselling need questionnaire 125

In seeking the content and face validity of the USM-

Table 1: Profile of study participants (n [ 208).
MSGCN questionnaire, five medical instructors and 20
medical students were recruited. Subsequently, necessary Variables Frequency (%)
adjustments were made based on the comments given. Sex (n ¼ 208)
The questionnaire used a five-point rating scale to mea- Male 63 (30.3)
sure students’ responses on counselling and guidance service Female 145 (69.7)
needs: 1 ¼ extremely not needed, 2 ¼ not needed, 3 ¼ less Ethnicity (n ¼ 204)
needed, 4 ¼ needed, and 5 ¼ extremely needed. Malay 150 (2.1)
Chinese 24 (2.5)
Indian 26 (1.5)
Assessment of dimensionality and reliability
Others 4 (.9)
Year of study (n ¼ 208)
A cross-sectional study was conducted in June 2017 Year 1 123 (9.1)
among undergraduate students of the School of Medical Year 2 85 (0.9)
Sciences, Universiti Sains Malaysia, to assess the dimen- Qualification (n ¼ 206)
sionality and reliability of the USM-MSGCN questionnaire. High School Certificate 5 (.4)
The inclusion criterion was enrolment as a medical under- Matriculation 98 (7.1)
graduate student in the pre-clinical year. Science Foundation Programme 68 (2.7)
Other 35 (6.8)
The sample size estimation was based on the sample-to-
Origin (n ¼ 208)
variable (N:p) ratio of 3:1.53 As there were 68 items in the Urban 158 (6.0)
initial questionnaire, the sample size required was 204. Rural 20 (4.0)
After accounting for 10% non-response rate, the required Status of accommodation (n ¼ 208)
sample size was 227. Years one and two students were Hostel 206 (9.0)
recruited as respondents via convenient sampling method. Non-hostel 2 (.0)
Prior to answering the questionnaire, the respondents were Scholarship (n ¼ 208)
briefed on the background of the study and time given. Yes 90 (3.3)
Informed consent was requested from the potential re- No 118 (6.7)
spondents. Data were gathered by the guided self-
administered questionnaire. Ethical approval for this study
was obtained from the School of Medical Sciences and Hu- the university hostel, and about half (56.7%) did not hold
man Ethical Committee of USM. any scholarship.
Item level descriptive statistics (Table 2) showed that the
Statistical analysis mean score for all 68 items ranged from 2.60 to 4.60. Based
on the EFA, the initial solution showed a KMO value of
The item-level characteristics of each item were assessed 0.926 and Bartlett’s Test of Sphericity was significant [c2
by descriptive statistics to examine floor and ceiling effects. (2278) ¼ 12188, P < 0.001]. Eigenvalues and scree plot
To determine the dimensionality of all items, exploratory showed that the initial 68 items consisted of more than one
factor analysis (EFA) was conducted. Keiser-Meyer-Olkin factor. Thus, the null hypothesis was rejected, and we
(KMO) and Bartlett’s Test of Sphericity were calculated concluded that the items were not unidimensional.
to test the partial correlation among items as suggestive of Varimax schedule rotated component matrix showed that
sample adequacy. The dimensionality of the USM-MSGCN the items formed four dimensions, which predicted 62.5%
questionnaire was evaluated by assessing the number of of the variants of dependent variables (44.3%, 7.1%, 7.0%,
domains by Eigenvalues and scree plot. Based on the and 4.1% for factors 1, 2, 3, and 4, respectively). Sixteen
number of domains, item selection for each domain was items were removed sequentially for having a factor
made based on communalities, correlation, and factor loading of <0.5; thus, 52 items remained, with factor
loading values. Items with factor loading of <0.5 and loading ranges from 0.52 to 0.84.
communalities of <0.3 were removed. Cronbach’s alpha Considering the literature review and previous study of
internal consistency reliability analysis was used to deter- the topic, 17 items were grouped under the construct of Self-
mine the reliability of each domain of the USM-MSGCN leadership Skills, seven items for Communication Skills, 12
questionnaire. Items within each domain were inspected; items for Learning Skills, and 16 items for Psychological
redundant items were removed made based on discussion Coping Skills. The factor loading for each domain ranged
among experts. All data entry and statistical analysis were from 0.52 to 0.82 for Self-leadership Skills, 0.53 to 0.8 for
conducted using IBM SPSS version 24.0. Communication Skills, 0.55 to 0.84 for Learning Skills, and
0.72 to 0.83 for Psychological Coping Skills.
Results The Cronbach’s alpha internal consistency reliability of
the questionnaire after the initial removal of items based on
A total of 208 undergraduate medical students partici- factor loading and communalities was 0.95 for Self-
pated in the study (Table 1). Majority of the respondents leadership Skills, 0.93 for both Communication and
were female (69.7%), Malays (72.1%), in year one (59.1%), Learning Skills, and 0.98 for Psychological Coping Skills. As
and from the matriculation stream (47.1%). Moreover, the Cronbach’s alpha value for all domains exceeded 0.90,
76% came from urban areas. Almost all (99%) stayed at the items in each domain were inspected for redundancy.
126 Z.M.Z.M.N. Nor et al.

Table 2: Item-level descriptive analysis for the USM Pre-Clinical Medical Students’ Guidance and Counselling Needs questionnaire
(n [ 208).
Items n (%) Mean SD
Extremely not needed Not needed Less needed Needed Extremely needed
A1 5 (.4) 20 (.6) 35 (6.8) 71 (4.1) 77 (7) 3.94 1.07
A2 21 (0.1) 52 (5) 69 (3.2) 44 (1.2) 22 (0.6) 2.97 1.14
A3 29 (3.9) 38 (8.3) 57 (7.4) 52 (5) 32 (5.4) 3.10 1.27
A4 31 (4.9) 49 (3.6) 51 (4.5) 40 (9.2) 37 (7.8) 3.01 1.32
A5 27 (3) 47 (2.6) 54 (6) 54 (6) 26 (2.5) 3.02 1.23
B6 14 (.7) 23 (1.1) 52 (5) 71 (4.1) 48 (3.1) 3.56 1.16
B7 14 (.7) 29 (3.9) 41 (9.7) 75 (6.1) 49 (3.6) 3.56 1.19
B8 11 (.3) 17 (.2) 49 (3.6) 66 (1.7) 65 (1.3) 3.75 1.14
B9 19 (.1) 38 (8.3) 58 (7.9) 56 (6.9) 37 (7.8) 3.26 1.21
B10 32 (5.4) 46 (2.1) 56 (6.9) 36 (7.3) 38 (8.3) 3.01 1.32
B11 19 (.1) 36 (7.3) 59 (8.4) 54 (6) 40 (9.2) 3.29 1.22
B12 26 (2.5) 37 (7.8) 54 (6) 55 (6.4) 36 (7.3) 3.18 1.27
C13 12 (.8) 18 (.7) 49 (3.6) 64 (0.8) 65 (1.3) 3.73 1.16
C14 12 (.8) 15 (.2) 57 (7.4) 72 (4.6) 52 (5) 3.66 1.11
C15 11 (.3) 17 (.2) 62 (9.8) 67 (2.2) 51 (4.5) 3.63 1.10
D16 35 (6.8) 45 (1.6) 69 (3.2) 37 (7.8) 22 (0.6) 2.84 1.21
D17 45 (1.6) 56 (6.9) 63 (0.3) 26 (2.5) 18 (.7) 2.60 1.20
D18 37 (7.8) 40 (9.2) 66 (1.7) 41 (9.7) 24 (1.5) 2.88 1.25
D19 18 (.7) 25 (2) 44 (1.2) 52 (5) 69 (3.2) 3.62 1.29
D20 28 (3.5) 44 (1.2) 65 (1.3) 49 (3.6) 22 (0.6) 2.97 1.19
D21 35 (6.8) 50 (4) 64 (0.8) 42 (0.2) 17 (.2) 2.79 1.19
D22 32 (5.4) 41 (9.7) 63 (0.3) 50 (4) 22 (0.6) 2.95 1.22
D23 20 (.6) 25 (2) 51 (4.5) 53 (5.5) 59 (8.4) 3.51 1.28
E24 16 (.7) 22 (0.6) 61 (9.3) 76 (6.5) 33 (5.9) 3.42 1.11
E25 14 (.7) 24 (1.5) 53 (5.5) 86 (1.3) 31 (4.9) 3.46 1.09
E26 19 (.1) 32 (5.4) 55 (6.4) 66 (1.7) 36 (7.3) 3.33 1.20
E27 25 (2) 39 (8.8) 62 (9.8) 50 (4) 32 (5.4) 3.12 1.23
E28 19 (.1) 30 (4.4) 54 (6) 73 (5.1) 32 (5.4) 3.33 1.17
E29 19 (.1) 24 (1.5) 49 (3.6) 61 (9.3) 55 (6.4) 3.52 1.25
E30 19 (.1) 31 (4.9) 57 (7.4) 65 (1.3) 36 (7.3) 3.33 1.19
E31 25 (2) 30 (4.4) 74 (5.6) 56 (6.9) 23 (1.1) 3.11 1.15
E32 23 (1.1) 29 (3.9) 56 (6.9) 65 (1.3) 35 (6.8) 3.29 1.22
E33 15 (.2) 30 (4.4) 49 (3.6) 58 (7.9) 56 (6.9) 3.53 1.23
E34 16 (.7) 31 (4.9) 47 (2.6) 56 (6.9) 58 (7.9) 3.52 1.25
E35 13 (.3) 29 (3.9) 29 (3.9) 60 (8.8) 77 (7) 3.76 1.26
E36 9 (.3) 16 (.7) 31 (4.9) 46 (2.1) 106 (1) 4.08 1.16
E37 4 (.9) 19 (.1) 32 (5.4) 48 (3.1) 105 (0.5) 4.11 1.09
E38 8 (.8) 12 (.8) 36 (7.3) 57 (7.4) 95 (5.7) 4.05 1.10
E39 2 () 5 (.4) 25 (2) 44 (1.2) 132 (3.5) 4.44 0.87
E40 6 (.9) 9 (.3) 20 (.6) 61 (9.3) 111 (3.4) 4.27 1.00
E41 6 (.9) 7 (.4) 20 (.6) 48 (3.1) 127 (1.1) 4.36 0.99
E42 3 (.4) 4 (.9) 11 (.3) 56 (6.9) 134 (4.4) 4.51 0.80
E43 0 (.0) 5 (.4) 12 (.8) 49 (3.6) 142 (8.3) 4.58 0.71
E44 0 (.0) 4 (.9) 10 (.8) 51 (4.5) 143 (8.8) 4.60 0.67
E45 14 (.7) 16 (.7) 63 (0.3) 74 (5.6) 41 (9.7) 3.54 1.10
E46 15 (.2) 22 (0.6) 64 (0.8) 73 (5.1) 34 (6.3) 3.43 1.11
E47 22 (0.6) 30 (4.4) 58 (7.9) 62 (9.8) 36 (7.3) 3.29 1.22
E48 20 (.6) 24 (1.5) 61 (9.3) 54 (6) 49 (3.6) 3.42 1.24
E49 17 (.2) 21 (0.1) 53 (5.5) 67 (2.2) 50 (4) 3.54 1.20
F50 13 (.3) 21 (0.1) 56 (6.9) 62 (9.8) 56 (6.9) 3.61 1.17
F51 21 (0.1) 32 (5.4) 58 (7.9) 55 (6.4) 42 (0.2) 3.31 1.24
F52 14 (.7) 30 (4.4) 48 (3.1) 62 (9.8) 54 (6) 3.54 1.21
F53 14 (.7) 29 (3.9) 51 (4.5) 64 (0.8) 50 (4) 3.51 1.19
F54 15 (.2) 28 (3.5) 53 (5.5) 53 (5.5) 59 (8.4) 3.54 1.23
F55 15 (.2) 31 (4.9) 57 (7.4) 56 (6.9) 49 (3.6) 3.45 1.21
G56 15 (.2) 26 (2.5) 63 (0.3) 60 (8.8) 44 (1.2) 3.44 1.17
G57 14 (.7) 25 (2) 68 (2.7) 52 (5) 49 (3.6) 3.47 1.17
G58 13 (.3) 30 (4.4) 63 (0.3) 53 (5.5) 49 (3.6) 3.46 1.18
G59 15 (.2) 28 (3.5) 62 (9.8) 59 (8.4) 44 (1.2) 3.43 1.17
G60 15 (.2) 26 (2.5) 57 (7.4) 63 (0.3) 47 (2.6) 3.49 1.18
G61 15 (.2) 26 (2.5) 59 (8.4) 61 (9.3) 47 (2.6) 3.48 1.18
 Guidance and counselling need questionnaire 127

Table 2 (continued )
Items n (%) Mean SD
Extremely not needed Not needed Less needed Needed Extremely needed
H62 15 (.2) 29 (3.9) 54 (6) 62 (9.8) 48 (3.1) 3.48 1.20
H63 17 (.2) 34 (6.3) 60 (8.8) 49 (3.6) 47 (2.6) 3.36 1.23
H64 18 (.7) 37 (7.8) 52 (5) 51 (4.5) 50 (4) 3.38 1.26
H65 17 (.2) 36 (7.3) 56 (6.9) 58 (7.9) 41 (9.7) 3.34 1.21
H66 15 (.2) 39 (8.8) 54 (6) 50 (4) 50 (4) 3.39 1.24
H67 20 (.6) 22 (0.6) 44 (1.2) 46 (2.1) 76 (6.5) 3.65 1.32
H68 22 (0.6) 23 (1.1) 42 (0.2) 50 (4) 71 (4.1) 3.60 1.34

In the Self-leadership Skills domain, five items addressed
the issue of time management (A1eA5), eight items
addressed group leadership skills (B6eB8, C13eC15, E30,
and E32), and four items addressed skills of being a group
member (B9eB12). All items pertaining to skills for time
management were retained as each item tested different
questions (A1, time for academic matters; A2, time for co-
curriculum; A3, time for self-care; A4, time for family; and
A5, time for social life). Regarding the eight items on group/
organisation leadership skills, only item B7 (‘I need the skills
for being a group leader’) was retained as this item alone
could sufficiently reflect the need for skills in group/organi-
sation management. Items B9eB12 addressed the issue of
skills for being a group member. Of these four items, item B9
(‘I need the skills for being a group follower’) was retained as
it echoed the other three items (B10, skills for respecting
other group members; B11, skills for accepting other group
members; and B12, skills for cooperating with group mem-
bers). The final version of the Self-leadership Skills domain
consisted of seven items with factor loading ranges from 0.56
to 0.82 and Cronbach’s alpha internal consistency reliability
of 0.89.
In the Communication Skills domain, three items were
related to verbal communication skills (D16eD18) and four
items to non-verbal communication skills (D20eD23). Items
assessing skills related to top management language were
removed (item D18, verbal communication skills; D22, non-
verbal communication skills), as these items tested the same
question as item D16 (verbal communication skills) and D20
(non-verbal communication skills) in a different guise. The
final version of the Communication Skills domain consisted
of five items with factor loading ranges from 0.56 to 0.88 and
Cronbach’s alpha internal consistency reliability of 0.90.
In the Learning Skills domain, one item assessed time
management skills for examinations (E37), one item assessed
the need for guidance for being in an academic peer support
group (E44), five items assessed skills related to lectures
(E33eE36 and E38), and five items assessed skills for
answering examination questions (E39eE43). Item E44 (‘I
need a guide for being in an academic peer support group’)
was removed as the content did not fit the domain of learning
skills. From the five items assessing skills related to lectures,
items E36 (‘I need guidance for understanding and remem-
bering lecture notes’) and E38 (‘I need skills to understand the

Table 3: Construct validity and internal consistency reliability for the final version of the USM Pre-Clinical Medical Students’
Guidance and Counselling Needs questionnaire (n [ 208).
Dimension Item Question Factor Cronbach’s Overall
Loading Alpha Cronbach’s
alpha
1: Self-leadership A1 I need skills in managing my time for academic matters. 0.61 0.89 0.93
Skills A2 I need skills in managing my time for coecurricular activities. 0.71
A3 I need skills in managing my time for self-care. 0.82
A4 I need skills in managing my time for family. 0.81
A5 I need skills in managing my time for social life. 0.79
B7 I need skills in leading group work. 0.57
B9 I need skills in being a good group follower. 0.56
2: Communication D16 Verbal: I need guidance in understanding my lecturers’ language. 0.83 0.90
Skills D17 Verbal: I need guidance in understanding my colleagues’ language. 0.83
D20 Non-verbal: I need guidance in understanding my lecturers’ language. 0.88
D21 Non-verbal: I need guidance in understanding my colleagues’ language. 0.85
D23 Non-verbal: I need guidance in understanding my patients’ language. 0.56
3: Learning Skills E36 I need guidance in understanding and remembering lecture notes. 0.65 0.87
E37 I need the following skill: Time management in examinations. 0.79
E38 I need the following skill: Understanding the topic’s learning outcomes. 0.84
E39 I need the following skill: Tackling questions. 0.84
E40 I need the following skill: Technique for scoring good marks. 0.72
4: Psychological F52 I need the following skill: Coping mechanism for stress. 0.79 0.87
Coping Skills G59 I need the following skill: Coping mechanism for anxiety. 0.80
H65 I need the following skill: Coping mechanism for depression. 0.79
128 Z.M.Z.M.N. Nor et al.
topic’s learning outcome’) were retained, as these two items
were able to represent the other three items concerning lec-
tures (E33, guide for taking lecture notes; E34, guide for
drawing mind maps; and E35, guide for summarising lecture
notes). Two out of the five items related to skills for answering
examinations were retained (E39, skills for tackling exami-
nation questions; and E40, skills for scoring good marks). The
other three items were removed (E41, skills to answer
scenario-based questions; E42, skills to answer multiple truee
false/single best answer questions; and E43, skills to answer
short essay questions), as these were closely related to item
E39. The final version of the Learning Skills domain consisted
of five items with factor loading ranges from 0.65 to 0.84 and
Cronbach’s alpha internal consistency reliability of 0.87.
In the Psychological Coping Skills domain, five items
assessed psychological skills to cope with stress (F51eF55),
six items assessed skills to cope with anxiety (G56eG61), and
five items assessed skills to cope with depression (H62eH66).
We retained one item each that best represented psychologi-
cal coping skills for stress, anxiety, and depression (F52, skills
for coping with stress; G59, skills for coping with anxiety; and
H65, skills for coping with depression). The final version of
the Psychological Coping Skills domain consisted of three
items with factor loading ranges from 0.79 to 0.80 and
Cronbach’s alpha internal consistency reliability of 0.87.
The overall Cronbach’s alpha for the final version of the
20-item USM-MSGCN questionnaire was 0.93. Table 3
shows the construct validity and reliability of the final
questionnaire version.
Discussion
This study explored the dimensionality and reliability of
the developed USM-MSGCN questionnaire. The back-
ground of the study respondents was aligned with the re-
ality of the population of medical students in Malaysia,
comprised of individuals of varied ethnicities, residential
origin, entry qualifications, and sex. Thus, these features
were considered as representative of Malaysian medical
students’ characteristics.
Dimensionality relates to the homogeneity of items. It can
be defined as the number of common factors needed to ac-
count for the correlation among items. The dimensionality of
a measure can be assessed with exploratory or confirmatory
factor analysis, or both. During the initial stage of scale
development, EFA is commonly conducted, as the idea
regarding a new measure’s dimensionality tends to be
limited.54 In the present study, EFA was used to determine
the questionnaire’s dimensionality. EFA was used instead
of principal component analysis (PCA) because 1) PCA is
often used for scale reduction instead of factor exploration,
and 2) PCA has been shown to overestimate factor loading
and possibly result in negatively biased component
correlations.55
EFA revealed that after the elimination of items based on
factor loading and communalities, the preliminary final
version of the questionnaire, which consisted of 52 items, had
high coefficient alpha values for all the domains (ranges from
0.93 to 0.98). One of the possible reasons for this outcome is
that the alpha was affected by the length of the test.56
Although coefficient alpha values from 0.70 to 0.95 are
reported to be acceptable,57 a maximum value for
coefficient alpha of 0.90 is recommended.58 An alpha that
is too high may also suggest that some items within the
domains are redundant and that further evaluations are
required.56,58 Thus, we removed the possible redundant
items, and the total number of items was substantially
reduced from 52 to 20.
The resulting 20-item questionnaire showed a good fit and
relevance to medical students’ needs for counselling and
guidance service in the Malaysian context. The items were well
loaded on four domains, namely, Communication, Self-
leadership, Psychological, and Learning Skills, with all items
having a factor loading exceeding 0.5. As such, all the con-
structs developed were independent of one another and
aligned with the conceptualised students’ issues in higher ed-
ucation. The results also revealed that these items could
measure what should be measured; in this context, the pre-
medical students’ need for guidance and counselling needs.
The domains created are aligned with those in previous studies
on the areas of counselling service for medical students.
Therefore, the developed questionnaire is a valid tool that can
be applied to assess the counselling and guidance services
needs among Malaysian medical students specifically.
The results of the reliability analyses showed that the
model items of the USM-MSGCN questionnaire had high
internal consistency, with an overall Cronbach’s alpha of
0.93, which is considered as a good reliability value.59
Indeed, the developed USM-MSGCN questionnaire prom-
ises to be a reliable instrument in surveying medical students’
needs for counselling and guidance service. The four vali-
dated dimensions in the USM-MSGCN questionnaire are
extra domains for the Mooney checklist and DASS in-
struments. The inclusion of communication, self-leadership,
and learning skills domains is important to tackle the is-
sues faced by pre-medical students, helping them progress in
their study smoothly. The results of the present study are
consistent with evidence from previous studies on the
importance of counselling and guidance service and better
instruments to measure counselling and guidance needs.14e16
Although the factor and reliability analyses provided
strong evidence of the validity and reliability of the USM-
MSGCN questionnaire in assessing counselling and guid-
ance service needs of pre-clinical medical students, a limita-
tion of the present study is that it only involved one medical
school in Malaysia. Moreover, the USM-MSGCN ques-
tionnaire is limited to undergraduate medical students.
Similar studies applicable to other undergraduate medical
students are needed so that the result can be compared,
particularly the similarities and differences. The invitation of
medical students as study population is also recommended to
highlight their counselling and guidance needs. Through
these efforts, the survey on the counselling and guidance
service needs of medical students will be more comprehen-
sive, valid, and credible.
Conclusion
We found that the developed USM-MSGCN ques-
tionnaire is a multidimensional instrument that consists of
four related domains (self-leadership, communication,
learning, and psychological coping skills). In addition, the
 Guidance and counselling need questionnaire
instrument promised a good index of validation. Thus, it
is a valid and reliable instrument for assessing the needs
for counselling service among pre-clinical medical stu-
dents. We expect that this instrument will benefit not only
the students but also counsellors and students affair
officials.
Source of funding
The authors received no specific funding or any kind of
financial support for this work.
Conflict of interest
The authors have no conflict of interest to declare.
Ethical approval
The present study was conducted after approval by the
USM ethics committee.
Authors’ contributions
ZMMN significantly contributed to the research design,
data collection, statistical analysis, interpretation of results,
and manuscript writing. NMY significantly contributed to
the research design, statistical analysis, interpretation of
results, and manuscript writing. JAMM significantly
contributed to the research design, data collection, inter-
pretation, and manuscript writing. All authors have critically
reviewed and approved the final draft and are responsible for
the content and similarity index of the manuscript.
Acknowledgment
The authors would like to thank the Head of Department,
Department of Medical Education, School of Medical Sci-
ence, Universiti Sains Malaysia for his continuous support
and contributions in completing this study.
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How to cite this article: Nor ZMZMN, Yaacob NNM,
Mohammad JAM. Dimensionality and reliability of USM
pre-clinical medical students’ guidance and counselling
needs questionnaire. J Taibah Univ Med Sc
2019;14(2):123e130.