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A generalisability coefficient is similar to an intraclass correlation. This analysis gives an investigator the estimated number of assessors required to obtain a reliable assessment per assessee. Assessors are nested with assessed doctors in this study. Each doctor was rated by unequal numbers of assessors. Epigenetics inhibitor variance components were calculated using VARCOMP (Minimum Norm Quadratic Unbiased Estimation��the MINQUE procedure) in SPSS using SPSS syntax.15 The estimated variance components for both assessees and the interaction of assessees and assessors (error) were extracted to generate a generalisability coefficient (Ep2)=a ratio of the estimated variance components for assessees over the sum of the estimated variance components for assesses, plus the interaction of assessees and assessors (error).16 Mushquash and O'Connor17 provide a more in-depth discussion about generalisability theory analysis. We attained a measure of precision by producing the 95% CI around each mean rating as described below. We used the square root of the measurement error as the SE of measurement (SEM), and determined the SEM for 2�C13 assessors (��error/number of assessors). The 95% CIs were equal to the SEM multiplied by 1.96, and were added to and subtracted from a mean rating.12 18 If the 95% CI around this score was still above or below the cut-off score, then we can be 95% certain that they have indeed ��passed�� or ��failed��. Free-text comments We analysed free-text comments using EKWords V.2.0.1 (DJ Soft Co, Ltd), a type of free software for qualitative text analysis of the Japanese language. Frequent words were counted ?rst, and then synonyms and related terms for the top three frequent words were extracted to generate themes of keywords. Results Back-translation and expert panels No major difference was observed between the back-translation and the original English instrument. Although the expert panel had some questions that they did not map directly to any of the documents, the panel considered that all items of the Japanese tool were relevant, and therefore no items were removed and no new items were developed. However, the panel members agreed that some items needed to be rephrased and reworded to be faithful to the original text as well as to incorporate more natural phrasing in Japanese. For example, two similar terms were used for ��ability�� in the Japanese translation, so for consistency we ensured that only one single term was used throughout. Also, the panel decided that the term ��self-improvement�� was more suitable than the term ��learning�� in the context of the Japan Pediatric Association training handbook, which encourages paediatricians to actively improve and develop their professional skills throughout their working life. Panellists generated footnotes for five items of the tool to help assessors better understand the items, and discussed the validity of the scale.