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The Career Preference Factors Scale (CPFS): Development and Psychometric

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 International Medical Journal Vol. 20, No. 1, pp. 72 - '76, February 2013

The Career Preference Factors Scale (CPFS): Development

and Psychometric Properties

Md. Anayet Ullah, Arunodaya Barman, Rogayah Ja'afar,

Muhamad Saiful Bahri Yusoff

ABSTRACT

Background: A reliable and valid multi item scale is desirable in medical education to measure students perceived factors
that influence their career choice. This pilot study outlines the developments of a new scale to explore these factors.
Methods: Based on literature reviews, medical student and expert comments and factor analysis, 19 items Career Preference
Factors Scale (CPFS) was developed. One hundred eighty six third year medical students were participated in this study. Factor
analysis using a principal component analysis (PCA) with varimax rotation was conducted to determine the factors underpin-
ning the scale. The reliability of the scale as well as its domains were determined by computing cronbach's alpha and Equal-
Length Spearman Brown coefficients. Point biserial correlations were calculated between career choice (general practice vs spe-
cialty practice) and the factors.
Results: Principal component analysis (PCA) with varimax rotation resulted in a 5 factor scale. The factors were labeled as
medical life style, social orientation, economy and prestige, hospital orientation and ease to build up. The 5 factors demonstrat-
ed acceptable internal consistency and stability, and correlated in the expected direction with the choice of general practice.
Conclusions: The development of the new valid and reliable scale to measure the influencing factors of medical student's
career choice will enable researchers to explore the role of the factors in selecting their future career at the different stages of
undergraduate medical course.

KEY WORDS
career preference, perceived influencing factors, undergraduate medical students, general practice

INTRODUCTION tice) of the newly admitted medical students' in different universities

The relationship between specialty distribution and the perfor-
mance of a health care system is now largely accepted'). There is a
negative impact of geographic and professional specialty maldistribu-
tion on healthcare quality and equity"r.
During the undergraduate course from first year to fifth year,
medical students construct their future career identity through a
process of medical socialization5r. Students develop definite and
influential perceptions about the content and characteristics of each
speciaity during this time6). Both personal and academic (preclinicai
& clinical) experiences are important in shaping students'perceptions
of specialty and their personal choice. The choice of the tuture career
is a complex personal decision based on their perception resulted as
the multi-factorial interaction during preclinical and clinical phases'r.
Medical educators need to explore the influencing factors of stu-
dent career preferences so that they can consider these factors during
student selection to get desired number of different categories of doc-
tors. Over the last few decades. a number of literatures8 "r from
around the world addressed the student perceived influencing factors
of their future career choice. But to the best of our knowledge, all the
authors used a single item to measure a factor (students'perception)
that affects their choice except Wright et aP).Wright et al') in2004,
measured 5 perceived influencing factors (medical life style, societal
orientation, prestige, hospital orientation and varied scope of prac-
Received on February 22,201.2 and accepted on May 16,2012
Department of Medical Education, School of medical sciences, Universiti Sains Malaysia
16150 Kubang Kerian, Kelantan, Malaysia
Correspondence to: Md. Anayet Ullah
(c-mail: md.anayet_u@yahoo.com)
in Canada by a multi-items valid and reliable questionnaire. But the
questionnaire was not designed to measure one of the important fac-
iors, ease to build up career, focusing on struggles for post gradua-
tion, competition in luture practice. ease to get promotion in job etc.
Additionally Wright er a/ used only two items to measure the factor.
varied scope of praotice. The desirable factor structure needs at lea::
3 items in every factor because a factor with fewer than 3 items i:
generally weak and unstable'']'.
Academics advise to use multi-item measures instead of a single
item for measuring psychological attributes. Individual items hair
considerable random measurement error, i.e. are unreliable. Second.
an individual item can only categorize people into a relatively smal.
number of groups. An individual item can not discriminate amon.
fine degrees of an attribute. Third, individual items lack scope. It i,
very unlikely that a single item can fully represent a complex theorer-
ical concept or any specific attribute for that matterrrrs). This papc:
presents the findings of a pilot study, which aimed to develop a vali:
and reliable multi-items tool to measure students' perception regarc-
ing the all possible important factors that influencing their caree
choice including ease to build up career. It is a part of iarger studl :
look at the career preferences of the undergraduate medical studen.>
in Universiti Sains Malaysia, Malaysia.
However to explore the students'perceived factors associare:
with their career choice mainly family medicine and specialty mec.-
cine, it is necessary to design a valid and reliable measuremenf sc; :'

@ zot: Japan International Cultural Exchange Foundation

& Japan Health Sciences Universrtl
 llllah M. A. et al 73

Table 1. Distribution of the factor scores of the students in Table 2. Total variance explained by the factors with
Career Preference Factors Scale eigenvalues greater than I
Factor Mean Median Skewness Kurtosis Kolmogorov Component Initial Eigenvalues
(SD) (Interquartile (Std.error) (Std.error) Smirnov* Total 70 of Variance Cumulative 7o

range) 2i.6t5 23.615

4.959
Medical 16.81 17.0 -.464 .0r8 .084
3.231 15.387 39.003
life style (4.42) (6.0) (. l 84) (.365 )
2.297 10.940 49.943
Social 14.64 15.0 -.598 .400 .l 16
1.562 7.439 57.382
orientation (3.36) (4.0) (.1 84) (.365)
1.213 5.77 5 63.r57
Economic 12.10 12.0 -.232 -.5t2 098
1.019 4.850 68.007
and (3.64) (6.0) (.1 84) (.365)
prestige

Hospital 10.21 10.0 -.593 .109 I )a

orientation (2.89) (3.0) 84)

(. l (.36s)
Reliobilily ond Volidity tesling
Ease to 8.08 9.9 .194 -.626 .150
build up (3.36) (5.0) (.184) (.36s)
Participants
*p < 0.05, Lilliefors Significance Correction
Of the 210 3'o year medical students of Universiti Sains Malaysia,
197(93.8Va) participated in this study. Their ages ranged from 21-23
years (mean 21.6 years and Standard deviation = 0.59 years).
Majority of them were female (n = 117, 62.97o), Malay (n = 114,
6l.3Vo) and came from urban area (n = 96, 51.67o).

Procedures

After receiving approval from the Medical school ethics

Committee at the Universiti Sains Malaysia, the questionnaires were
distributed to the third year students at the end of a lecture class and
were collected back with the responses. Written informed consent
forms were signed by the students before responding to the question-
naires.

Instruments

Self administered questionnaires were used for data collection.

Comporcnt Nunber
The questionnaire was divided into three parts. The first part was
designed to record a student's career preference. The second part was
Figure 1. Scree plot with eigenvalues for each of the 26 compo- the CPFS. The third part was on demographic characteristics includ-
nents ing age, gender, ethnicity and place of family residence.

Data analysis

in a systematic ways with a wider population of medical students.
This paper presents the development of the Career Preference Factors
Scale (CPFS) and to examine its psychometric properties.
MATERIATS AND METHODS
Developmenl of lhe scole
Research team (authors) generated the initial item pool based on
an extensive review of the literatures those explored medical stu-
dents' perceptions regarding the factors influencing their career
choice. Specifically, items were extracted from the studies of Wright
et aP)(2004), Scott e/ al'o(2007) and Ahmad and Jaafar, (1999;'or. 4
pool of 35 items under 5 domains (medical lifestyle, societal orienta-
tion, economy and prestige, hospital orientation and easy to build up
career) were reviewed and modified by the researchers. Face and
content validation process include comprehensive screening of the
questionnaire by medical students and expert faculties. At this stage,
21 items were finally listed. These 21 preliminary items were used in
this survey to develop a final version of the scale. Of the 21 items,7,
4, 4,3,3 items comprised medical lifestyle, societal orientation,
economy and prestige, hospital orientation and ease to build up
career factors respectively. The items were rated with a 5-point
Likert scale ranging from 1 (no influence) to 5 (major influence). The
summation of the item scores of each factor represented the individ-
ual factor score.
Data were analyzed using the Statistical Package for the Social
Sciences (SPSS version i8.0). Exploratory data analysis was con-
ducted to establish the distribution of all the factor (domain) scores.
Kolmogorov-smirnov test was applied to test the normality of these
distributions. Factor analysis using a principal component analysis
(PCA) with varimax rotation was conducted on the collected data of
the 2l items to determine the factors underpinning the scale. The cor-
relation matrix for the principal components analysis revealed that
the items of the individual factor were uncorrelated with the items of
all other factors (r <.3) that warranted a varimax rotation. Initially six
factors were extracted (eigenvalues > 1) from the analysis. But four,
five and six factor solutions with varimax rotation were performed to
select the suitable solution which generated the most pomprehensible
factor structure. The items that loaded more than 0.5 on any one of
the factors and at least 0.20 lower on the other factors were included
in the scale. Internal consistency of the items of the scale (CPFS) as
well as its domains (factors) were determined by computing cron-
bach's alpha coefficients and Equal-Length Spearman Brown coeffi-
cients in splirhalf method. As an alternative to a test-retest approach,
split-half method was applied to calculate the correlations between
two halves of the scale (CPFS) as well as its domains (factors).
Corrected item total correlation of the items of the each factor
(domain) of the CPFS were also computed. Point biserial coffelations
were calculated between career choice (general practice vs specialty
practice) and the factors.
l4 The Career Preference Factors Scale

Table 3. Rotted component matrix with loading for each item of the four factors
Item Item Factor Factor Factor Factor Factor
no- I 234s
I don't like dealing with unccrtainty in my clinical work and this career choice will reduce my 000 .540 211 219 .0l s
discomtbrt with uncertainty

My chosen carecr will provide me flexibility regarding place of work, verities of patients, duration of .066 .719 .034 lzt .079
time and schedule

My chosen career will have an acceptable on-call schedule 155 .781 .202 .096 -.009

My chosen career will have acceptable hours of practice 170 .774 .307 .154 .032

I want to bc able to spend sufficient time with my family 201

My chosen career will allow me to focus on patients at primary health care level .085 -.020 .677 225 119

As well as the treatment developing long-term relationship with the patient is important to me. My .004 .077 .785 .003 .065
chosen career will allow mc to develop this relationship
My social commitment to society has lead me to my chosen career -.098 r65 693 080 .083

I have an interest in promoting health and my chosen career will al]ow me to do this -.069 091 .835 .014 -.041

10 My chosen career will have a high income potcntial and this is important to me irrespective of my .816 .ol2 153

liability
u My chosen career will provide adequate income to meet up my liability .417 .031 .01 3 r87
t2 My chosen career will provide me with high status among my luture colleagues 108 011 1'72 123

t3 My chosen career will have a more stable/secure future than other career choices .691 .165 t13 062 .785
t4 My chosen career will allow me to lbcus on in-hospital care .087 .073 006 .036 .899

t5 My chosen carecr will allow me lo focus on urgent care 21',7 025 108 . 155 .820

t6 I prefer to see the immediatc results of my treatment and my chosen career will allow me to 1r/ -.069 161 139 1ra
experience this

17 An expccted ease promotion in future job led me to my current career choice 069 25t tt2 .920 .041

t8 I prefer to avoid the struggles for post graduation that led me to my current career choice 241 234 .710 ,. I 83

tq An expected less competition in futurc practicc led me to my current career choice 061

Extraction method: Principal component analysis

Rotation method: Varimax with Kaiser Normalization

Table zl. The Cronbachrs alpha, the Equal-Length Spearman Brown coefficients and correlation coefficients
between two halves in split half method of the Career Preference Factors Scale (CPFS) and its' factors

Factors Number of Cronbach's alpha Equal Length Spearman Correlation coellicient

items coefficients Brown coefficients between two halves in
Splir Half method
Total l9 .827 .662 622

Medical lite style .7ft5 824 701

Social orientation .766 .686 615

Economic and prestige 844 820 695

Hospital orientation 819 .166 621

Ease to build up 888 912 891

Table 5. Corrected item-total correlation of the items with the total the scores of the individual factor
Medical life style Social orientation Economic and prestige Hospital orientation Ease to build up

Items r Item r ltem r Item r

.35I I .485 .653 l .685

2 .592 765 719 591

3 .655 3 .533 678 621 891

709 661 628

57t)

Item's ability ofdiscrimination: poor ilr = 0.0 0.19 ; good ifr = 0.2-0.39; very good ifr = > 0.4
 Ullah M. A. et al.
RESULTS
\ormality of the factor scores
Distribution of the factor scores of the students in Career
Preference Factors Scale are shown in Table 1. The values ol the
:kewness and kurtosis with their standard error suggest a pattern of
non-normality distributions of the factor scores of the students. The
results of Kolmogorov-Smirnov Lilliefors tests of the factors scores
confirmed that the factor scores distribution dilfered from normal.
Kaiser-Meyer-olkin and Bartlett's test
KMO measure of sampling adequacy is calculated for individual
and multiple variables and represents the ratio of the squared correla-
tion between variables to the squared partial correlation between
variables (Field, 2000)r'). Hutcheson and Sofionniou (19991,'r suggest
that its values between 0.5 and 0.7 are normal, values between-0.7
and 0.8 are good, values between 0.8 and 0.9 are great and values
above 0.9 are excellent. The initial solution of this factor analysis
revealed a KMO value was good (0.755). Bartlet's test of Sphericity
to support the factorability of the correlation matrix obtained from
the items revealed an approximate chi-square value of 1999.305 with
a significance value of < 0.001, which meant that the factorabilitv of
this correlation matrix obtained from the items was appropriate.
Foclor slructure
Six factors possessed eigenvalues greater than 1, accounting tbr
68.00170 of the variance in the data (Table 2). But 5 factor solution
generated the most comprehensible factor structure that matched with
the conceptualized factors of the scale. However, in 5 factor solution
with varimax rotation, 2 items did not satisfied item inclusion criteria
of the scale. Of the 21 items, 19 items finally constituted the scale
with 5 factors (Table 3). Finally, 5 factor solution with varimax rota-
tion of 19 items of the scale explained 67.984qa of the total variance.
Factor I comprised four irems (10, 1 1, 12 and 13) related to the
students' perception regarding the imporlance of economy and status
for selecting their future oareer. This factor was labelled as economy
and prestige.
Factor 2 had five items (1,2,3, l and 5) related to the sru-
dents'perception regarding the importance of life style for selecting
their future career.
Factor 3 consisted of four items (6, 7, 8 and 9) related to the stu-
dents'perception regarding the importance of social responsibility for
selecting their future career. This factor was labelled as social orien-
tati on.
Factor 4 comprised 3 items (i7, 18 and 19) related to the stu-
dents' perception regarding the importance of effort needed to build
up career fbr selecting their future career. This t'actor was labeled as
ease to build up.
Factor 5 included 3 items (14, l5 and l6) reflecting rhe students,
perception regarding the importance of hospital directed activities for
selecting their future career.
Reliobility
Cronbach's alpha and Equal-length Spearman Brown coeflicients
of the whole scale as well as its' five factors wcre ranged fi-om .766
to .844. and .662 to .942 respectively. The correlation coefficients
between two halves of the scale as well as its'five factors in split half
method were ranged from.621 to.891(Table 4). In terms of internal
reliability analysis, corrected total item correlation is accepted as a
primary criterion that must be equal to or greater than 0.2,,,. All the
items of the individual factor had corrected total item correlation >
.02 (Table 5).
Correlolion onolysis
Correlation between general practice as a first career choice and
the 5 factors were r = .241 for medical life style, r = .147 for social
orientation, r = -.157 for economic and prestige, r = -.336 for hospital
orientation and r = .306 for ease to built up.
75
DISCUSSION
The higher the variability explained by the factor analysis. the
stronger the factor structure of the scale is. However, values ranging
from 40Vo to 60Vo are considered acceptablelr). Thus the varianci
explained in the current study is considered appropriate.
The results of the factor analysis suggested that the CpFS is mul-
tidimensional, it represents students' perception about the influence
of 5 factors on their career choice. It is consistent with the hypothesis
of the study. The sub-domains of the scale represents the individual
factors consisted of several items. Wrigjht et. al.e) also clustered the
variables into -5 groups those they measured for investigating the
medical students sell'perceived influencing factors of their career
choice. They marked these groups as medical lifestyle, societal orien-
tation, prestige, hospital orientarion and varied scope of practice.
These were very close to CPFS.
The reliability is considered to be high when the coefficient value
is close to 1.0. Although there is no standard value of this coefficient
for confirming the reliability, the range from 0.6 to 0.8 seems to be
confirmatory of the reliability,u,,,. Considering these reports on relia-
biiity studies, the CPFS had satisfactory internal consistency.
Corrected total item correlation ofthe items ofeach factors in the scale
indicate that the items had good ability to discriminate their respective
factor scores. The correlaiion coefficients between two halves of the
scale (CPFS) as well as its factors reflect the good stability of it.
The correlations between the 5 factors and general practice as
first career choice suggested that medical life style, societal orienta-
tion and ease to build up were positively correiated with the general
practice as first career choice. And the rest of the factors economic
and prestige, and hospital orientation were negatively correlates with
this choice. It is in the same direction of the research hypothesis and
provides evidence for construct validity of the scale.
The results o1 the study suggested that CPFS is a reliablc instru-
ment with satisfactory internal consistency, scale integrity and stabil-
ity. Content validity both in ternis of face and construct validity is
satisfactory- Horvever. the limitations of the study and scale need to
be highlighted. Methodologically, reliance on split-half merhods ro
determine the stability ol the instrument has been criticized due to the
multiple ways thr: two halves can be fbrmed based on the set of
items. Reliability estimates are likely to vary. Therefbre, the tindings
associated with split-half methods reliability must be treated with
caulion. A future test-retest examination is therefbre desirable. The
factor scores of the scales are non-normally distributed, those need to
perform nonparametric statistical tests and data transformation for
making it close to normality. The point biserial correlations between
the 5 factors and general practice as first career choice indicate that
the discriminating ability of the societal orientation factor between
general practice and specialty practice as first career choice was poor.
It is needed to improve in future by adding new items to the factor or
modillcation of the existing items of the factor.
CONCLUSION
Despite some limitations, this new scale does appear to be a con-
sistent and stable measure of medical students' perception about the
factors influenced them to choose their future career. Further research
is necessary in different population to evaluate its validity, reliability
and generalizability. By using this measurement we could indentify
the predictors of career choices at the different stages of undergradu-
ate medical course and observe the trends of the influencing factors
through out the course which n'ray be helpful for developing any
intervention to get desired medical work force, like admission poli-
cies of medical schools, job tacilities etc. We are currently using this
scale to find out the influencing factors of the undergraduate medical
student career pref'erence in Universiti Sains Malaysia. These find-
ings will help to establish the construct validity of this scale.
ACKNOWLEDGEMENTS
We would l'ike to express our gratitude to Universiti Sains
Malaysia for this short term grant to carry out the study.
76 The Career Preference Factors Scale
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