Best practice versus actual practice: an audit of survey pretesting practices reported in a sample of medical education journals

Background: Despite recommendations from survey scientists, surveys appear to be utilized in medical education without the critical step of pretesting prior to survey launch. Pretesting helps ensure respondents understand questions as survey developers intended and that items and response options are relevant to respondents and adequately address constructs, topics, issues or problems. While psychometric testing is important in assessing aspects of question quality and item performance, it cannot discern how respondents, based upon their lived experiences, interpret the questions we pose. Aim: This audit study explored whether authors of medical education journal articles within audited journals reported pretesting survey instruments during survey development, as recommended by survey scientists and established guidelines/standards for survey instrument development. Methods: Five national and international medical education journals publishing survey articles from Jan. 2014 – Dec. 2015 were audited to determine whether authors reported pretesting during survey development. All abstracts within all issues of these journals were initially reviewed. Two hundred fifty-one articles met inclusion criteria using a protocol piloted and revised prior to use. Results: The number of survey articles published per journal ranged from 11 to 106. Of 251 audited articles, 181 (72.11%) described using a new instrument without pretesting, while 17 (6.77%) described using a new instrument where items were pretested. Fifty-three (21.12%) articles described using pre-existing instruments; of these, no articles (0%) reported pretesting existing survey instruments prior to use. Conclusions: Findings from this audit study indicate that reported survey pretesting appears to be lower than that reported in healthcare journals. This is concerning, as results of survey studies and evaluation projects are used to inform educational practices, guide future research, and influence policy and program development. Findings apply to both survey developers and faculty across a range of fields, including evaluation and medical education research.