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2 5 Even though individual factors, context of feedback and administration of the survey have a fundamental effect on assessees�� responses, MSF can lead to performance improvement.6 A recent systematic review7 has shown that MSF, if implemented correctly, can have a positive effect on performance. The Sheffield Peer Review Assessment Tool (SPRAT) was originally developed to assess the competencies of paediatricians based on good medical practice (GMP)8 in the UK. SPRAT informs the quality assurance process when assessing doctors�� work-based performance. The tool encompasses five domains of GMP: good clinical care; maintaining GMP; teaching and training, assessing and appraising; relationships with patients and working with colleagues. SPRAT consists of 24 questions with a six-point scale ranging from ��very poor�� to ��very good�� and includes the option to select ��unable to comment��. A space for ��strengths�� and ��suggestions for development�� is also provided. A tool modelled on SPRAT was introduced in Japan to assess doctors�� clinical skills. However, validity and reliability assessments of the tool for Japanese subjects were not performed prior to its introduction. We believe it is important to take cultural adaptivity into account when any established instrument is introduced into a different culture. In this study, we went beyond a simple translation and examined the validity (including reliability) evidence of the Japanese version of SPRAT as part of the Improvement of NICU Practice and Team-Approach Cluster randomised controlled trial (INTACT).9 Translation and validation were conducted in three phases. In the first phase, we conducted back-translation of the existing Japanese SPRAT tool into English. In the second phase, a panel of experts met to assess the content validity of the instrument. In the third phase, we performed pilot testing of the MSF survey for Japanese patients, and tested the validity and reliability of the Japanese version using psychometric methods. This paper mainly focuses on the statistical results of the pilot testing. Methods Ethics approval This study did not involve patients, and Oxygenase therefore written consent was not required. Author HS and collaborators of the participating hospitals gave all participants an explanation of the pilot study and an instruction sheet of MSF. Participating in the study was voluntary and consent was obtained orally or by email. Anonymity and confidentiality of the data were assured to all participants. Translation and back-translation Permission to use an existing SPRAT Japanese translation was obtained from the translator. In order to assess the quality of the translation, back-translation into English was performed by a professional translator.