The original Japanese scale contains 18 items and four domains. It had previously been validated among healthcare professionals, but its measurement properties had not been verified among undergraduate medical students. The investigators therefore tested whether the established four-factor structure applied to this population.

An initial confirmatory factor analysis did not support that structure. Items 13 and 16 were removed because they showed extreme floor effects and severe non-normality, and the researchers also considered them conceptually unsuitable for students without substantial clinical experience. After removing the two items, researchers evaluated a modified 16-item model.

Its fit to the data was acceptable, with a root mean square error of approximation of 0.067, a comparative fit index of 0.93, a Tucker–Lewis index of 0.92, and a standardized root mean square residual of 0.054. The study also assessed known-groups validity by comparing scores according to sexual and gender minority status, gender, and students’ awareness of sexual and gender minority people in their personal networks. Sexual and gender minority students scored significantly higher than cisgender heterosexual participants on all domains except Clinical Training.

This pattern is an association within the surveyed sample, not evidence that identity itself produces greater clinical skill or that one group uniformly performs better in practice. Among cisgender heterosexual students, women recorded higher total, Attitudinal Awareness, and Basic Knowledge scores than men. Students who reported greater awareness of sexual and gender minority individuals within their personal networks also tended to have higher overall scores.

These findings show that the modified scale discriminated among groups defined by reported characteristics and experiences. Because the design was observational and cross-sectional, it cannot determine whether personal familiarity, gender, or minority status caused the score differences. Internal consistency was evaluated with Cronbach’s alpha and ordinal McDonald’s omega.

The researchers reported acceptable to excellent consistency for the total scale and its subscales. In combination with the factor-analysis results and known-groups comparisons, these findings support the modified 16-item instrument as a standardized tool for medical students to self-assess their clinical skills and attitudes related to sexual and gender minority healthcare. The authors concluded that the modified scale could support the development of curricula targeting the healthcare needs of sexual and gender minority communities.

Its demonstrated purpose is student self-assessment and curriculum development, rather than proof that graduates will provide better care or that a particular educational program will improve patient outcomes. The instrument is based on students’ own reports, so its results should not be interpreted as direct measurements of clinical performance. The evidence is limited to the online, cross-sectional survey of students at three Japanese medical universities.

Whether the modified scale performs similarly in practicing clinicians, students at other institutions, or populations in other countries remains unestablished by this study. The results also apply to the particular sample and validation process, in which two problematic items were removed before the 16-item model was assessed. Within these boundaries, the research identifies a shorter self-report instrument with acceptable structural fit, group discrimination, and internal consistency for use in Japanese medical education.

Subject of Research: Psychometric validation of a modified Japanese clinical-skills scale for sexual and gender minority healthcare among medical students

Article Title: Validation of the LGBT-DOCSS-JP among medical students: psychometric properties of a modified 16-item version

Article References: Kanakubo, Y., Okazaki, F., Kim, H., Aoki, T., Sugiyama, Y., Mutai, R., Yoshida, E., & Matsushima, M. (2026). Validation of the LGBT-DOCSS-JP among medical students: psychometric properties of a modified 16-item version. BMC Medical Education. https://doi.org/10.1186/s12909-026-10346-z

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10346-z

Keywords: medical education, psychometric validation, sexual and gender minority health, clinical skills, Japanese medical students, self-assessment, confirmatory factor analysis, scale validation, health disparities, LGBT-DOCSS-JP, Validation, medical