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

Purpose. To determine whether framing questions positively or negatively in fluences residents' apparent satisfac tion with their training. Method. In 1993 -94, 276 residents at five Canadian internal medicine resid ency programs responded to 53 Likert-scale items designed to determine sour ces of the residents' satisfaction and stress. Two versions of the question naire were randomly distributed: one in which half the items were stated po sitively and the other half negatively, the other version in which the item s were stated in the opposite way. Results. The residents scored 43 of the 53 items higher when stated positiv ely and scored ten higher when stated negatively (p < .0001). When analyzed using an analysis-of-variance model, the effect of positive versus negativ e framing was highly significant: (F = 129.81, p < .0001). While the intera ction between item and framing was also significant, the effect was much le ss 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 pos itively 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 bia s." To minimize this bias, questionnaires assessing attitudes toward educat ional programs should include a mix of positively and negatively stated ite ms.