Psychometric Validation and Structural Refinement of Displaced Medical Student Scale (DMSS): Extending Bourdieusian Theory to Quantify Transnational Educational Dislocation

The forced displacement of medical students due to armed conflict presents a profound disruption to the global medical education continuum. Existing research predominantly evaluates individual psychological trauma, leaving a critical gap in measuring the structural and institutional friction displaced learners face when transitioning into host medical schools. This study details the development, structural refinement, and psychometric validation of the Displaced Medical Student Scale (DMSS), a novel 38-item instrument theoretically grounded in Pierre Bourdieus Theory of Practice. Utilising an exploratory sequential mixed-methods design adhering to COSMIN guidelines, initial qualitative items generated from a transnational cohort underwent content validation by an expert panel (Scale-Level Content Validity Index Average = 0.96) and pilot face validation (N = 29) to eliminate linguistic barriers. Subsequent psychometric testing with 156 displaced Gazan medical students confirmed a robust six-factor latent structure: Mechanisms of Conflict, Hysteresis and Dislocation, Agential Coping, The Agents Toolkit, The Institutional Field, and Transition Outcomes. Confirmatory factor analysis using diagonally weighted least squares demonstrated excellent model fit ({chi}2/df = 1.62, Comparative Fit Index = 0.925, Tucker-Lewis Index = 0.918, Root Mean Square Error of Approximation = 0.058, Standardised Root Mean Square Residual = 0.064) and exceptional internal consistency (Cronbachs = 0.892, McDonalds{omega} = 0.898). Structural equation modelling proved that institutional symbolic violence negatively impacts transposed clinical capital ({beta} = [-]0.42, p < 0.001) and that structural hysteresis mathematically mediates the path between symbolic violence and professional attrition fatigue ({beta} = 0.54, p < 0.001). Furthermore, agential coping significantly moderates identity crisis outcomes ({beta} = [-]0.38, p < 0.01). The DMSS provides medical faculties with an evidence-based metric to transition from deficit frameworks to targeted structural interventions that preserve displaced clinical capital.