Introduction: International medical students (IMSs) experience various problems preventing them from making career decisions. Assessing the difficulties involved in the career decision-making process is instrumental for identifying the sources of their career indecision, which may assist them in making more informed career decisions. This study aims to develop and validate an instrument to measure career decision-making challenges of IMSs in China, who are mainly from low- and middle-income countries.

Methods: A new scale, INternational meDical studEnt Carrer decISION-making Scale (INDECISION Scale) was developed utilising data from IMSs in China. Initial item generation stemmed from a literature review and qualitative interviews (n = 20), with items adapted or formulated referencing phrasing used in prior instruments. Subsequent expert validation and cognitive interviews (n = 6) informed adjustments, followed by a pilot study (n = 52) and focus group discussions (n = 6). Exploratory factor analysis (EFA) was performed on data from four Chinese universities (n = 334), followed by confirmatory factor analysis (CFA) on data from eight other Chinese universities (n = 514). Convergent validity (n = 102) and test-retest reliability (n = 86) were evaluated using subsets of respondents.

Results: The EFA retained 21 items, identifying six factors: unreadiness; lack of self-knowledge; lack of options knowledge; external complexity; lack of decision-making competence; and negative mentality. The CFA confirmed the six-factor model, demonstrating satisfactory model fit indices. Convergent validity and test-retest reliability were supported.

Conclusions: The INDECISION Scale exhibits adequate psychometric properties, helping IMSs systematically navigate their decision-making process, allowing for individual challenges to be effectively identified for discussion in counselling. This study serves as a starting point for further research on career indecision and career guidance for IMSs.