Effect of the framing of questionnaire items regarding satisfaction with training on residents' responses

Acad Med. 1999 Feb;74(2):192-4. doi: 10.1097/00001888-199902000-00018.


Purpose: To determine whether framing questions positively or negatively influences residents' apparent satisfaction with their training.

Method: In 1993-94, 276 residents at five Canadian internal medicine residency programs responded to 53 Likert-scale items designed to determine sources of the residents' satisfaction and stress. Two versions of the questionnaire were randomly distributed: one in which half the items were stated positively and the other half negatively, the other version in which the items were stated in the opposite way.

Results: The residents scored 43 of the 53 items higher when stated positively and scored ten higher when stated negatively (p < .0001). When analyzed using an analysis-of-variance model, the effect of positive versus negative framing was highly significant (F = 129.81, p < .0001). While the interaction between item and framing was also significant, the effect was much less strong (F = 5.56, p < .0001). On a scale where 1 represented the lowest possible level of satisfaction and 7 the highest, the mean score of the positively stated items was 4.1 and that of the negatively stated items, 3.8, an effect of 0.3.

Conclusions: These results suggest a significant "response acquiescence bias." To minimize this bias, questionnaires assessing attitudes toward educational programs should include a mix of positively and negatively stated items.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Canada
  • Data Collection / methods
  • Female
  • Humans
  • Internal Medicine / education*
  • Internship and Residency*
  • Job Satisfaction*
  • Male
  • Surveys and Questionnaires*