Developing a Japanese communication skills attitude scale through factor analysis and identifying unique learning attitudes

Communication education is internationally recognized as a core element of medical education, and Japan is no exception. In Japan, it has been reported that “student attitude” is a significant barrier to communication education. The Communication Skills Attitude Scale (CSAS) has been translated and widely used in many countries to assess medical students’ attitudes toward learning communication skills (CS). However, a validated Japanese version had not yet been developed. This study aimed to develop and validate a Japanese version of the Communication Skills Attitude Scale (CSAS-J) and to support evidence-based, culturally appropriate CS education in Japan. The CSAS-J was developed through translation and back-translation of the original English version and reviewed by medical education experts. A total of 197 first- and fourth-year medical students participated in the final analysis. Principal factor analysis with Harris-Kaiser rotation was conducted, and internal consistency was assessed using Cronbach’s alpha (α). Factor analysis revealed a four-factor structure consisting of 15 items: “Learning Motivation” (α = 0.812), “Clinical Utility” (α = 0.805), “Skepticism toward Learning” (α = 0.645), and “Undervaluing the Importance of CS” (α = 0.582), with an overall α of 0.860. This study confirmed that the newly developed CSAS-J is a reliable and valid scale for assessing Japanese medical students’ attitudes toward learning CS. Notably, in addition to factors common to other countries, this study identified two negative attitudinal factors that appear to be unique to Japan: “Skepticism toward Learning” and “Undervaluing the Importance of CS.” These findings provide valuable insights for the design of educational interventions. Future studies should verify the CSAS-J’s validity across multiple institutions. It is expected that the CSAS-J will support the development of evidence-based communication education and contribute to safer and more reliable clinical practice.