Skip to main content

Development and validation of the Perceived Benefits of Team-Interaction Training Questionnaire (PBTITQ) among undergraduates



The effectiveness of team-interaction training has been proven. However, there is a lack of objective and accurate evaluation tools for the impact and benefits of team-interaction training on participants. This study aims to develop and validate a tool for exploring undergraduates’ perception of benefits in team-interaction. It can further insight into the perceived benefits of team-interaction training for undergraduates and evaluates the effectiveness of the course, and provides a reference point for the development of university team-interaction training courses.


This study was conducted in three stages. Phase 1 consisted of item generation: A theoretical framework was crafted based on social cognitive theory, self-efficacy theory, and sports performance models. Fifty-two items were generated based on the theoretical framework, participant interviews, and literature review. After Delphi consultation and pilot tests, 39 items moved on to Phase 2. Phase 2 consisted of forming a preliminary questionnaire: the contents to be included were selected through item analysis and exploratory factor analysis (EFA). A total of 40 classes were selected for EFA. After EFA, a three-factor structure with 25 items was formed. The third stage tested psychometric properties through confirmatory factor analysis (CFA), test-retest reliability, criterion-related validity, and internal consistency.


The final PBTITQ consisted of 23 items, each rated from “1” (fully disagree) to “5” (fully agree). EFA and CFA supported the three-factor structure of PBTITQ, which included Cohesion, Communication, and Efficiency. The Cronbach’s alpha of the PBTITQ was 0.90, the test-retest reliability was 0.88, and the split-half reliability was 0.81. PBTITQ significantly correlated with the GEQ (r = 0.808, p < 0.05) and the TDM (r = 0.796, p < 0.05).


The PBTITQ is an effective tool for assessing the perceived benefits of team-interaction training among undergraduates.

Peer Review reports


Team-interaction is a dynamic and changing sequence of social actions between individuals, including monitoring, coordinating, and communicating, which are regarded together as the dominant methods of teamwork [1]. Previous studies have shown that team-based cooperation at work significantly improves productivity, increases team performance, and reduces the occurrence of work errors [2,3,4,5,6].

Currently, in a significant number of recruitments, companies often list team-interaction skills as an important requirement [7]. Team-interaction seems to be becoming an essential competency that is crucial for undergraduates. However, traditional academic culture does not take into account the importance of team-interaction [8]. Traditional curricula do not seem to address the skill needs of the workplace. As a result, some universities have begun to incorporate team-interaction into their syllabi [9]. Research has shown that team-interaction training for undergraduates facilitates the exchange of knowledge and ideas as well as practical skills [10]. This not only facilitates their rapid integration into the job market, but also improves their academic performance and supports their development throughout their academic and professional careers. Based on the emergence of such training, there is a need for a suitable evaluation tool to assess the effectiveness of team-interaction training.

Questionnaires are tools for the quantitative evaluation of the effectiveness of training. A number of questionnaires have been developed in the past to assess the effectiveness of team-interaction training. For example, the Group Environment Questionnaire (GEQ) is designed to measure the perceived benefit of student cohesion [11]. The TeamSTEPPS Team Perception Questionnaire is intended to assess individuals’ perception of team-interaction skills and behaviours [12]. The Team Development Measure (TDM) is designed to evaluate the efficacy of the team and the team-based problems that prohibit this development [13]. Although researchers have tried to develop some assessment tools on team interaction training from different perspectives, there is still a lack of suitable questionnaires to quantitatively measure undergraduate perception of benefits of team interaction.

Some scholars have indicated that the choice to engage in social behaviour, such as participating in team interaction, should be analysed in terms of benefits, as they are subjectively perceived by the participants [14]. Findings from university cooperative learning showed that perceived benefit mediates the effects of external conditions on learning and provides valuable insights [2]. Therefore, perceived benefits play an imperative role as the key link in evaluating team-interaction training.

The purpose of this study was to develop and validate an instrument to assess the perceived benefits of team-interaction training for undergraduate. It can further insight into the perceived benefits of team-interaction training for undergraduates and evaluates the effectiveness of the course, and provides a reference point for the development of university team-interaction training courses.


This study was conducted in three phases (Fig. 1). Phase 1 consisted of item generation: Items to generate the PBTITQ based on a theoretical framework of this study, participant interviews, a literature review, Delphi consultation, and pilot tests. Phase 2 consisted of forming a preliminary questionnaire: The preliminary questionnaire was formed through item analysis and exploratory factor analysis (EFA). Phase 3 consisted of testing psychometric properties: Psychometric characteristics of questionnaires were assessed using confirmatory factor analysis (CFA), internal consistency, test-retest reliability, and criterion-related validity.

Fig. 1
figure 1

Questionnaire development and validation process


From October 25 to December 31, 2021, team-interaction training was conducted among 1,698 first-year undergraduates in 80 classes at China Medical University. These participants were asked to complete the PBTITQ after five 90-minute sessions of team-interaction training. The basic demographic information of the participants is shown in Table 1. The training course schedule is shown in Table 2. This course was coordinated and arranged by three Physical Education teachers who had received training in psychological counselling. A teacher was responsible for explaining the rules before each practical activity and summarising the content of the course at the end to clarify any confusion of the participants. The other two teachers were responsible for cooperating in organizing the course activities. During the study, undergraduates provided informed consent, participated voluntarily and could withdraw at any time.

Table 1 General demographic information of the participants
Table 2 The team-interaction training lesson series

Three phases of questionnaire development

Phase 1- item generation

Building a theoretical framework

The theoretical framework of this study was based on social cognitive theory, self-efficacy theory, and sports performance models [15,16,17]. Social cognitive theory emphasizes that human cognition, environment and behaviour are not independent of each other but in a dynamic reciprocal relationship in which they constantly interact and influence each other [15]. Therefore, in this study, we defined perceived benefits of team interaction as an organically combined cyclical process rather than as a step-by-step process with independent components. Self-efficacy theory argues that successful experiences with activities help individuals achieve higher perseverance, better behavioural choices, and more positive emotional states [16]. From this perspective, we determined that team activities affect participant performance and perceived benefits. Sports performance models suggested that coordination, communication, and psychological characteristics all affect performance in sports [17]. Therefore, we considered these factors as influencing postcooperative performance. As a result of the above understanding, we constructed the theoretical framework of this study (Fig. 2).

Fig. 2
figure 2

The theoretical framework for developing the Perceived Benefits of Team-Interaction Training Questionnaire

Participant interviews and literature review

After the course, a class (N = 24) was randomly selected by lottery from 80 classes. Students were asked about their perceived benefits from team-interaction training. Additionally, we reviewed the literature on the perceived benefits of team-interaction training to construct questionnaire items more comprehensively.

A systematic search of several databases (e.g., Google Scholar, PubMed, ProQuest and Japan Medical Abstracts) was conducted, focusing on content about undergraduate students’ perceived benefits of team interaction as of October 1, 2022, searched through the following keywords: “team”, “interaction”, “teamwork”, “collaboration”, “questionnaire”, “training”, “physical”, “survey”, “undergraduate”, “benefits”, “Perception”, “Tools” and “Education”.

Finally, 52 items were developed and identified for this study based on the theoretical framework, literature review, and perceived-benefit interviews with participants.

Delphi consultation to study consensus on the items

We conducted a Delphi consultation to test the content of the initial questionnaire. A total of 12 experts were invited to participate. Their research areas included sports, pedagogy, psychology, and exercise psychology. The median and quartile of expert working years were 17.50 (14.25, 30.00). All experts had senior titles, including five professors and seven associate professors. Among them, eight had a master’s degree or above, and four had a bachelor’s degree. The importance of the items was assessed from 1 (very unimportant) to 5 (very important) using a Likert scale. Experts provided feedback and advice for item improvement.

We calculated the expert authority coefficient using the following formula: Cr = (Ca + Cs)/2 (Ca refers to the expert’s judgement criteria, and Cs refers to the level of familiarity with the items). To calculate the item-level content validity indices (CVI), we divided the number of experts who selected levels 4 (important) and 5 (extremely important) on a particular item by the total number of experts. Items with CVI < 0.80 were considered for modification or deletion [18]. In the second Delphi consultation, the same group of experts answered the questions and agreed on the evaluation of the questionnaire.

Pilot test

One class (N = 26) was randomly selected from 80 classes using a lottery. They served as participants in the pilot test using a Delphi postconsultation questionnaire. They were asked to assess the comprehensibility, readability, and completion time of the questionnaires. Based on these recommendations, the researchers made changes to the items’ wording. For reliability and validity, these data were excluded from the analysis.

Phase 2- forming a preliminary questionnaire

Item analysis

Items with the following situations were considered for deletion: critical ratio < 3, item-total correlation coefficient < 0.40, or factor loading < 0.45 [19].

Exploratory factor analysis

Exploring the latent factor structure of the questionnaire was done using EFA. The class that participated in the pilot test was not included in the candidates for EFA. Using class-based cluster sampling, 40 classes (N = 852) were randomly selected from the remaining 79 classes for EFA. The data of 59 participants were removed due to improper completion of the questionnaire. Finally, 793 effective response samples were collected, and the effective response rate was 93.08%.

Before factor analysis, we performed Bartlett’s test of sphericity and the Kaiser-Meyer-Olkin measure of factor validity to verify suitability for factor analysis. Maximum likelihood and promax rotation were used for EFA. Three criteria were used in the selection of the number of factors: (1) a scree-Test: the gravel plot showed a clear change between the steep slope of the large factor and the gradual tailing of its residual factor; (2) a Cronbach’s alpha of 0.70 or higher, and (3) the likelihood of factor interpretation [20]. At this point, the preliminary questionnaire was completed.

Phase 3- testing psychometric properties

Confirmatory factor analysis

In the CFA phase, we included the remaining 39 classes to test the effectiveness of the EFA-based measurement model. The data of 42 participants were removed due to irregular completion of the questionnaire. Finally, 778 effective response samples were collected, with an effective response rate of 94.88%. The preliminary questionnaire was used for CFA. The root mean square error of approximation, goodness-of-fit index, adjusted goodness-of-fit index, comparative fit index, and Tucker-Lewis index were used to assess the CFA goodness of fit [21].

Reliability: internal consistency and test-retest reliability analysis

The internal consistency of the questionnaire was tested using Cronbach’s alpha coefficient, and a value greater than 0.70 was considered acceptable. Test-retest reliability was used to consider stability. Two weeks after the questionnaire was completed, 25 classes (N = 601) were randomly selected in a lottery, and they were asked to complete the same questionnaire again for test-retest reliability analysis. In this instance, each student had a dedicated number to ensure that the same person did not complete the questionnaire twice and to easily match the retest questionnaire. This number was strictly confidential and not revealed to others.

Criterion-related validity

The Group Environment Questionnaire (GEQ) and Team Development Measure (TDM) were used to measure criterion-related validity. The GEQ was compiled by Carron et al. [11]. This study adopted the Chinese version of the GEQ revised by Ma in 2004 [22]. This questionnaire has been widely used to assess the team cohesion of undergraduate athletes, with Cronbach’s alpha coefficients exceeding 0.7 for all four subscales, indicating high reliability and validity [23]. It was scored on a 9-point scale, with a scale of 1, representing “strongly disagree”, to 9 representing “strongly agree”. It included four factors: Attraction to Individuals by Group Task, Attraction of Individuals by Group Interaction, Group Task Consistency, and Group Interaction Consistency. The GEQ contained 15 items, including two negative items. The negative items were reverse encoded. The Cronbach’s alpha for the GEQ in this study was 0.91.

TDM was compiled by Stock et al. [13]. The Chinese version of TDM used in this study was localized by Yan et al. in 2017 [24]. It has a Cronbach’s alpha of 0.68, which achieves reasonable reliability and good reliability in assessing teamwork [25]. It included four factors: Communication, Roles and Goals, Cohesion, and Team Primacy. TDM was scored using a 4-point Likert scale, with 1 to 4 representing “strongly disagree” to “strongly agree”. The TDM contained 28 items, including three negative items. The negative items were reverse encoded. The Cronbach’s alpha for TDM in this study was 0.93.

Data collection

General demographic information and the PBTITQ were added to all questionnaires in this study. (1) General demographic information included age, gender, past experiences in team-interaction training and cooperation, and a dedicated number. (2) The PBTITQ was scored on a 5-point Likert scale, with 1 to 5 representing strongly disagree, disagree, generally agree, relatively agree, and strongly agree. In the CFA phase, we added the GEQ and TDM. All items of this questionnaire were in Mandarin. After team-interaction training, participants were given the questionnaires through the Questionnaire Star Platform, which is a professional software platform for online questionnaire design. Participants were asked to complete the questionnaire anonymously within 30 min and could only submit the questionnaire once without leaving blank items.

Data analysis

Data were analysed using IBM SPSS 21.0 (IBM, Armonk, NY, USA) and AMOS 20.0 (IBM, Chicago, IL, USA). Descriptive analysis was performed on the characteristics of the participants. The negative items were reverse encoded. The Shapiro-Wilk test for normality and a Q-Q plot were used to perform tests for normality. If normality was not respected for at least one of these two tests, normality was rejected. The criterion-related validity of the PBTITQ was examined with Pearson correlation analysis. A two-sided p < 0.05 was used as the criterion for a statistically significant difference.


Content validity

The values of Cr, Cs and Ca were 0.86, 0.79 and 0.92, respectively. In the first round of the Delphi consultation, the average CVI for the entire questionnaire was 0.87. We reviewed the 22 items to be revised one by one, deleted 11 items with a CVI lower than 0.8 and merged two items with similar meanings. In addition, three entries were removed because experts believed that they only applied to a small group of participants (e.g., As a leader, I have an obligation to lead teammates to victory). The remaining items were revised and entered into the second round of the Delphi consultation. Based on the first round of Delphi expert suggestions, we added two new items on cultural differences and listening to others. In the second round, the CVI for the items was between 0.89 and 1.00, and the average CVI was 0.94. The questionnaire reached consensus in the second round of the Delphi consultation, and a total of 39 items were formed.

Item analysis

In the item analysis, it was found that critical ratio was < 3 for Items 3 and 17, the item-total correlation coefficient was < 0.40 for Items 10 and 30, and factor loadings were < 0.45 for Items 24, 26, and 38. By removing the above items, a questionnaire with 32 items was formed. The questionnaire was then used for EFA.

Construct validity

The Kaiser-Meyer-Olkin coefficient was 0.876, and Bartlett’s test of sphericity yielded a significant value of < 0.01.

We examined the underlying construct of the 32 items by conducting EFA. Finally, three potential factors were determined, and the cumulative variance contribution rate was 82.60%. Items 9, 11, 16, 23, 25, 29, and 32 were excluded due to factor loadings < 0.50. Therefore, a total of 25 items in three factors entered CFA (Table 3).

In conjunction with the theoretical framework of this study, each factor was explained based on the three factors generated by EFA. Factor 1 is composed of ten items, called Cohesion. Factor 2 is composed of seven items and is named Communication. Factor 3 is composed of eight items and is named Efficiency. Overall correlation coefficients for the items range from 0.522 to 0.821, with all p < 0.05.

Table 3 Exploratory factor analysis of the Perceived Benefits of Team-Interaction Training Questionnaire

Construct validity

CFA tested the validity of the three-factor measurement model based on EFA. Items 28 and 33 were excluded due to low factor loading. A questionnaire with 23 items was formed at this stage (see Online Resource 1 for English version). The results showed that the model fit was good (χ2/df = 2.353, root mean square error of approximation = 0.068, goodness-of-fit index = 0.903, adjusted goodness-of-fit index = 0.922, comparative fit index = 0.925, Tucker-Lewis index = 0.918). Therefore, it was suggested that the questionnaire has reasonable construct validity (Fig. 3).

Fig. 3
figure 3

Confirmatory factor analysis of the Perceived Benefits of Team-Interaction Training Questionnaire


Cronbach’s alpha for the PBTITQ was 0.90. For factor reliability, the Cohesion coefficient was 0.89, the Communication coefficient was 0.92, and the Efficiency coefficient was 0.80. The test-retest reliability for the questionnaire was 0.88, and the test-retest reliability of the three factors were 0.78, 0.81, and 0.73. The split-half of the questionnaire was 0.81, and the split-half of the three factors were 0.70, 0.80, and 0.79.

Criterion-related validity

The PBTITQ significantly correlated with GEQ (r = 0.808, p < 0.05) and TDM (r = 0.796, p < 0.05). The results showed that the PBTITQ had good criterion-related validity with both questionnaires (Table 4).

Table 4 The correlation coefficient between PBTITQ, GEQ, and TDM


This study developed and validated the PBTITQ among undergraduates based on a theoretical framework, participant interviews, and a literature review. The results showed that the PBTITQ has favourable psychometric properties, including reliability, validity, and good internal consistency among subscales. These results indicated that the PBTITQ was a valid and reliable tool for measuring undergraduates’ perceived benefits following team interaction.

The final PBTITQ consisted of 23 items with 5-point ratings. However, all five negative items (Items 8, 10, 17, 28, and 33) were excluded from the questionnaire. While it is recommended that negative items be included in questionnaires to reduce default bias, some experts advise against their use because they lead to inconsistent responses and are difficult to specify in the measurement model [26]. After excluding these and other inappropriate items, the measurement characteristics of the PBTITQ version were favorably improved.

The final version of the questionnaire included three factors, namely, Cohesion, Communication, and Efficiency. Based on the high correlation coefficients among the three factors, the overlap of differences between the factors suggests the existence of a common source of constructs [27], namely, perceived benefits of team-interaction.

The study also implied that the definitions of these three factors can be subsumed under the larger structure of perceived benefits from team interactions. This study provided sufficient evidence to demonstrate the validity of the PBTITQ with a three-factor construct. In a specific situation or game, the common goal of the group greatly increases the cohesion of the participants, who continually communicate and exchange opinions and finally improve their efficiency. Additionally, whether experiencing successes or failures, participants continue to accumulate experience, learn from, and better communicate with groups, ultimately improving team cooperation efficiency and achieving more success [28].

Cohesion, the first factor of the questionnaire, has been defined as a nonstatic process mainly driven by the tendency of a group to stick together and remain united in pursuit of instrumental goals and/or to satisfy participant affective desires [29]. A previous study pointed out that team cohesion, as an emerging emotional state, has an influential impact on both teams and individuals [30]. Cohesion was associated with positive mental health, reduced team conflict, and improved performance [31,32,33]. For example, Item 14, “I’ve learned to respect others’ values after participating in team interaction training,” reflects the benefit participants perceive from respecting teammates’ values. In teams, value differences are inevitable. Only by integrating values into the team, recognizing real differences in values, and balancing the relationship between various values, can the competitiveness of the team be enhanced, and team conflicts be reduced.

The Cohesion factor of our questionnaire mainly focuses on the participants’ perceived benefits after training from the aspects of trust, respect for teammates, cooperation and mutual assistance. Through this factor, the cohesion level of students can be accurately identified to help educators conduct targeted teaching and ultimately improve cohesion. High cohesion helps to build team structures, allowing participants to communicate openly and learn from each other to experience higher levels of performance [34].

Communication is one of the essential elements of progress in human social practice and work achievement, requiring speakers to align with their listeners [35]. We can maximize the goal of effective communication through talking, listening, and nonverbal communication [36]. Based on action theory, actions or activities greatly improve participants’ abilities and result in an overall improvement [37]. However, without appropriate communication skills to solve the problems that arise among the participants in the team-interaction process, the participants will feel more pressure and the efficiency of the team will be reduced [38]. Therefore, improving communication skills is an effective way to promote team interaction.

With the emphasis on communication skills in various industries, universities have paid increasing attention to the training of undergraduate communication ability [39]. Previous self-assessment teamwork tools for medical students also included communication as an imperative aspect [40]. In the Communication factor, our questionnaire mainly examines the participants’ perceived benefits of training on the aspects of expression, listening, and interactive feedback. For instance, Item 1, “I’ve learned how to listen to the opinions and ideas of others after participating in team interaction training,” and Item 5, “I will express my opinion frankly if there is a problem,” indicate the students’ perception of the benefits of listening and speaking to others after training. Team-interaction training effectively helps participants provide feedback and improve team cooperation by recalling effective means of communication used during their training.

Efficiency is the third factor of the PBTITQ, which affects participants’ fit with the team and affects the overall performance and subsequent behaviour of the team [41]. That is, the more efficient the team is, the easier it is to perform well, and the easier it is to maintain a positive mentality among the participants. A study on team questionnaire development also identified efficiency as an imperative factor to measure the effectiveness of teamwork [42]. Therefore, in this factor, content that can improve team efficiency or team success is included.

Within the factor of Efficiency, a few items, such as Item 37, “I think we are more likely to win if I have confidence in the team,” and Item 20, “I can regulate my negative emotions when unexpected situations arise in team-interaction,” revealed the participants’ perceived benefits of team confidence and self-regulation to overall team performance. By reviewing this content, participants can modify their behaviours to achieve high team performance or acquire a high level of awareness of team conditions through spontaneous adaptation to dynamic changes in the competitive environment [43]. This pattern of constantly making behavioural adjustments is not only the result of perceived benefits but also the way that this study proposes that individuals can improve team effectiveness.

Strengths and limitation include implications for practice

The main advantage of this study is the innovative nature of the questionnaire. An extensive review of the literature was carried out prior to the preparation of the questionnaire. As of yet, there is no suitable questionnaire on the perceived benefits of team-interaction training for undergraduates. We emphasize the importance of teaching team-interaction in universities. Moreover, the items of the questionnaire were decided based on qualitative data collected from undergraduates involved in team interactions with a deep understanding of benefit perception. This allowed the properties of benefit perception to be accurately captured in team-interaction situations.

Despite these strengths, this study is subject to several limitations. This experiment was open only to first-year undergraduates, and the general applicability of the PBTITQ needs to be further validated when applied to other professional classifications or students in other years. In addition, this questionnaire was conducted in a medical university, and women accounted for the majority of the sample population. If the male-to-female ratio is changed, the findings may require further exploration. Finally, due to the limitations of the school curriculum, only one relatively common form of team interaction training was set up in this study, and other forms of training were not implemented in the process of questionnaire development. Therefore, the evaluation efficacy of the PBTITQ for other forms of team-interaction training needs to be further explored. It is suggested that training with a more representative population and team-interaction projects with different forms of content can be carried out in the future. This will further test the validity of the questionnaire.

University faculty can incorporate these skills into their course design or conduct extracurricular activities such as the experiential education used in this study [44, 45]. Such courses are designed to allow participants to actively learn and experience team-interaction in a realistic and concrete setting. Teaching such team-interaction at universities is critical, especially for medical students. In the healthcare field, a variety of problems arise between team members as a result of poor teamwork, which greatly increases the chances of harming patients [46]. A team-interaction course can significantly improve the individual and team skills of healthcare professionals entering the clinic, allowing them to rationalize the distribution of work and improve work efficiency [44, 47]. At the same time, it can also improve the quality of work and patient satisfaction. It prepares healthcare to enter into multidisciplinary collaboration and create a team-oriented professional healthcare environment.


The PBTITQ reflected the three-factor structure formed by benefit perception in the context of team interaction: Cohesion, Communication, and Efficiency. It was developed with a sufficient degree of reliability and validity. Currently, the topic is not widely covered. We developed the first instrument that can measure the perceived benefits of team-interaction training for undergraduates, strengthening the evidence with the discussability of the topic. This study may serve as a basis for future research to help curriculum developers incorporate such training into university curricula and improve medical students’ team-interaction skills once they enter the clinic. Additional future research should continue to explore the perceived benefits of team-interaction and assess the perceived benefits from the perspectives of different schools, specialties, and training modalities, and increase the number of items assessed in the questionnaire. This will improve undergraduate students’ team-interaction skills and provide an adequate foundation for entering the workplace.

Availability of data and materials

The data that support the findings of this study are available from the corresponding author, Shuang Zang, upon reasonable request.



Perceived Benefits of Team-Interaction Training Questionnaire


exploratory factor analysis


confirmatory factor analysis


Group Environment Questionnaire


Team Development Measure


content validity indices


  1. Schöbel M, Kleindienst C. The psychology of team interaction. Psychol Team Interact. 2001;78:33–8.

    Google Scholar 

  2. Buchs C, Gilles I, Antonietti J-P, Butera F. Why students need to be prepared to cooperate: a cooperative nudge in statistics learning at university. Educational Psychol. 2015;36(5):956–74.

    Article  Google Scholar 

  3. Murphy M, McCloughen A, Curtis K. The impact of simulated multidisciplinary Trauma Team Training on team performance: a qualitative study. Australas Emerg Care. 2019;22(1):1–7.

    Article  Google Scholar 

  4. Schmutz JB, Meier LL, Manser T. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open. 2019;9(9): e028280.

    Article  Google Scholar 

  5. Schwartz ME, Welsh DE, Paull DE, Knowles RS, DeLeeuw LD, Hemphill RR, Essen KE, Sculli GL. The effects of crew resource management on teamwork and safety climate at Veterans Health Administration facilities. J Healthc Risk Manag. 2018;38(1):17–37.

    Article  Google Scholar 

  6. Welp A, Meier LL, Manser T. The interplay between teamwork, clinicians’ emotional exhaustion, and clinician-rated patient safety: a longitudinal study. Crit Care. 2016;20(1):110.

    Article  Google Scholar 

  7. Hirsch BJ. Wanted. Phi Delta Kappan. 2017;98(5):12–7.

    Article  Google Scholar 

  8. Yan L, Yinghong Y, Lui SM, Whiteside M, Tsey K. Teaching soft skills to university students in China: the feasibility of an Australian approach. Educational Stud. 2018;45(2):242–58.

    Article  Google Scholar 

  9. Kelly S, Duffy MB, Ruiz P. Experiential learning for undergraduate nursing students: Engagement with a University Health Center. J Nurs Educ. 2021;60(5):289–92.

    Article  Google Scholar 

  10. De Prada E, Mareque M, Pino-Juste M. Teamwork skills in higher education: is university training contributing to their mastery? Psicologia reflexão e crítica. 2022;35(1):5.

    Article  Google Scholar 

  11. Carron AV, Widmeyer WN, Brawley LR. The measurement of cohesion in sports teams: the Group Environment Questionnaire. Can J Sport Sci. 1989;14(1):55–9.

    Google Scholar 

  12. Kakemam E, Rouzbahani M, Rajabi MR, Roh YS. Psychometric testing of the Iranian version of the TeamSTEPPS teamwork perception questionnaire: a cross-cultural validation study. BMC Health Serv Res. 2021;21(1):705.

  13. Stock R, Mahoney E, Carney PA. Measuring team development in clinical care settings. Fam Med. 2013;45(10):691–700.

    Google Scholar 

  14. Spiegel T, Pollak Y. Attention Deficit/Hyperactivity disorder and increased Engagement in sexual risk-taking behavior: the role of Benefit Perception. Front Psychol. 2019;10: 1043.

    Article  Google Scholar 

  15. Bandura A. Human agency in social cognitive theory. Am Psychol. 1989;44(9):1175–84.

    Article  Google Scholar 

  16. Bandura A. Self-efficacy mechanism in human agency. Am Psychol. 1982;37(2):122–47.

    Article  Google Scholar 

  17. Wiemeyer J, Kickmeier-Rust M, Steiner CM. Performance Assessment in Serious Games. In: Serious Games edn. Edited by Dörner R, Göbel S, Effelsberg W, J. W. Cham: Springer International Publishing; 2016: 273–302.

  18. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459–67.

    Article  Google Scholar 

  19. Wu ML. Statistical analysis practices in Questionnaire Development. Chongqing, China: Chongqing University Press; 2010.

    Google Scholar 

  20. Sakaluk JK, Short SD. A Methodological Review of Exploratory Factor Analysis in Sexuality Research: used practices, best practices, and Data Analysis resources. J Sex Res. 2017;54(1):1–9.

    Article  Google Scholar 

  21. Marsh HW, Guo J, Dicke T, Parker PD, Craven RG. Confirmatory Factor Analysis (CFA), exploratory structural equation modeling (ESEM), and Set-ESEM: optimal balance between goodness of fit and parsimony. Multivar Behav Res. 2020;55(1):102–19.

    Article  Google Scholar 

  22. Ma HY. Revision of group environment questionnaire. J Beijing Sport Univ. 2008;31(3):339–42.

    Google Scholar 

  23. Cao LZ, Chi LZ. The effect of group cohesion on internet addiction in athletes: the mediating role of social support. Chin J Clin Psychol. 2016;24(2):302–6.

    Google Scholar 

  24. Yan XF, Zhou Y, Jia EG. Localization and evaluation of team development scale. Chin J Mod Nurs. 2017;23(21):2697–703.

    Google Scholar 

  25. Wang J. Establishment and management evaluation of immediate bedside ultrasound nursing team in ICU. Health Manage. 2021;7:180–1.

    Google Scholar 

  26. Swain SD, Weathers D, Niedrich RW. Assessing three sources of Misresponse to reversed likert items. J Mark Res. 2008;45(1):116–31.

    Article  Google Scholar 

  27. Cattell RB. The Scree Test for the number of factors. Multivar Behav Res. 1966;1(2):245–76.

    Article  Google Scholar 

  28. Lázaro SM, Benito L, Felipecastaño E, Isabel P, García VP. Assessment of Social Skills of Students of Social Education. Revista De Psicodidáctica. 2016;21:139–56.

    Article  Google Scholar 

  29. Carron AV, Brawley LR. Cohesion: conceptual and measurement issues. Small Group Research. 2000;31(1):89–106.

    Article  Google Scholar 

  30. Thompson BM, Haidet P, Borges NJ, Carchedi LR, Roman BJ, Townsend MH, Butler AP, Swanson DB, Anderson MP, Levine RE. Team cohesiveness, team size and team performance in team-based learning teams. Med Educ. 2015;49(4):379–85.

    Article  Google Scholar 

  31. Easterlin MC, Chung PJ, Leng M, Dudovitz R. Association of Team Sports Participation with Long-Term Mental Health outcomes among individuals exposed to adverse childhood experiences. JAMA Pediatr. 2019;173(7):681–8.

    Article  Google Scholar 

  32. Schermuly CC, Meyer B. Good relationships at work: the effects of leader–Member Exchange and Team–Member Exchange on psychological empowerment, emotional exhaustion, and depression. J Organizational Behav. 2016;37(5):673–91.

    Article  Google Scholar 

  33. Keith MJ, Dean DL, Gaskin J, Anderson G. Team Building through Team Video games: Randomized Controlled Trial. JMIR Serious Games. 2021;9(4): e28896.

    Article  Google Scholar 

  34. Mathieu JE, Kukenberger MR, D’Innocenzo L, Reilly G. Modeling reciprocal team cohesion-performance relationships, as impacted by shared leadership and members’ competence. J Appl Psychol. 2015;100(3):713–34.

    Article  Google Scholar 

  35. Baugh AD, Vanderbilt AA, Baugh RF. Communication training is inadequate: the role of deception, non-verbal communication, and cultural proficiency. Med Educ Online. 2020;25(1): 1820228.

    Article  Google Scholar 

  36. Vogel D, Meyer M, Harendza S. Verbal and non-verbal communication skills including empathy during history taking of undergraduate medical students. BMC Med Educ. 2018;18(1):157.

    Article  Google Scholar 

  37. Planas LG, Er NL. A systems approach to scaffold communication skills development. Am J Pharm Educ. 2008;72(2): 35.

    Article  Google Scholar 

  38. Ekstrand J, Lundqvist D, Davison M, D’Hooghe M, Pensgaard AM. Communication quality between the medical team and the head coach/manager is associated with injury burden and player availability in elite football clubs. Br J Sports Med. 2019;53(5):304–8.

    Article  Google Scholar 

  39. Tervajärvi L, Hutri-Kähönen N, Rautiola AM. Student-LED interprofessional sequential simulation improves communication and teamwork. Nurse Educ Pract. 2021;51: 102983.

    Article  Google Scholar 

  40. Gordon CJ, Jorm C, Shulruf B, Weller J, Currie J, Lim R, Osomanski A. Development of a self-assessment teamwork tool for use by medical and nursing students. BMC Med Educ. 2016;16(1):218.

    Article  Google Scholar 

  41. Mukherjee S, Huang Y, Neidhardt J, Uzzi B, Contractor N. Prior shared success predicts victory in team competitions. Nat Hum Behav. 2019;3(1):74–81.

    Article  Google Scholar 

  42. Song H, Chien AT, Fisher J, Martin J, Peters AS, Hacker K, Rosenthal MB, Singer SJ. Development and validation of the primary care team dynamics survey. Health Serv Res. 2015;50(3):897–921.

    Article  Google Scholar 

  43. Liu HY, Chen NH, Wang IT, Wu SM, Han CY, Hsu DY, Han HM, Huang DH. Predictors of individually perceived levels of team creativity for teams of nursing students in Taiwan: a cross-sectional study. J Prof Nurs. 2021;37(2):272–80.

    Article  Google Scholar 

  44. Brusa JL. An experiential-learning lesson to encourage Teamwork and Healthy practices. J Microbiol Biol Educ. 2019;20(2):20.2.30.

    Article  Google Scholar 

  45. de Prada Creo E, Mareque M, Portela-Pino I. The acquisition of teamwork skills in university students through extra-curricular activities. Education + Training. 2020;63(2):165–81.

    Article  Google Scholar 

  46. Rosengarten L. Teamwork in nursing: essential elements for practice. Nurs Manag (Harrow). 2019;26(4):36–43.

    Google Scholar 

  47. Barton G, Bruce A, Schreiber R. Teaching nurses teamwork: integrative review of competency-based team training in nursing education. Nurse Educ Pract. 2018;32:129–37.

    Article  Google Scholar 

Download references


Not applicable.


This work was supported by the Research project of undergraduate teaching reform in China Medical University in 2023 [grant number: YDJG20230145], the Education Science Research Project of the Education Department of Liaoning Province [grant number: LJKZ0779], the Medical Education Research Subject of China Medical University for the 14th Five-Year Plan [grant number: YDJK2021048], and The work was supported by the Higher Education Undergraduate Teaching Reform Project of Liaoning Province [grant number: 0480]. The funders had no role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations



Ming Chen: Investigation, Data curation, Conceptualization, Writing–review & editing, Preparation, Supervision. Hefang Chen: Investigation, Formal analysis, Conceptualization, Methodology, Writing–original draft, Preparation. Yifan Wu: Conceptualization, Methodology, Writing–review & editing. Ruijun Yang: Formal analysis, Writing–review & editing. Chaowei Guo: Writing–review & editing. Meizhen Zhao: Writing - review & editing. Chaoli Xin: Writing–review & editing. Shuang Zang: Conceptualization, Methodology, Writing–review & editing, Formal analysis, Project administration, Supervision.

Corresponding author

Correspondence to Shuang Zang.

Ethics declarations

Ethics approval and consent to participate

The Ethics Committee of China Medical University reviewed and approved this study, and the ethics number is [2020] 089. All participants received verbal and online explanations of the questionnaire and were told that their informed consent was confirmed if they completed and submitted the questionnaire. In addition, all steps of the study and methods were carried out in accordance with the principles of Helsinki Declaration.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, M., Chen, H., Wu, Y. et al. Development and validation of the Perceived Benefits of Team-Interaction Training Questionnaire (PBTITQ) among undergraduates. BMC Med Educ 23, 840 (2023).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: