基于结构方程模型的全科医生职业认同感的形成机制研究
|
摘要
背景全科医生职业认同感的形成有助于激发其对基层医疗卫生工作的积极性和主动性。科教驱动和职业期望可以影响全科医生职业认同感的形成,但三者之间的相关性及全科医生职业认同感的具体形成机制尚不明确。目的探索全科医生职业认同感的形成机制,为提高全科医生职业认同感提供有效的科教激励策略。方法采用分层抽样法于2017年9—11月选取上海市区、城郊结合部、郊区社区卫生服务中心的全科医生397例,采用全科医生个人基本信息调查表、全科医生科教驱动感知量表、职业期望量表、职业认同感量表进行问卷调查,根据调查结果,构建全科医生职业认同感形成机制的结构方程模型,并进行检验。结果共发放问卷397份,有效问卷383份,有效回收率为96.5%。科教驱动感知量表:资源保障得分为(10.3±3.0)分,组织管理得分为(11.4±2.9)分,绩效激励得分为(6.1±2.2)分,创新支持得分为(11.3±2.7)分;职业期望量表:职业发展得分为(9.5±3.1)分,职业成就得分为(6.7±1.9)分,工作生活平衡得分为(6.8±1.8)分;职业认同感量表:职业认知得分为(10.5±3.0)分,职业行为得分为(8.6±1.6)分,职业价值观得分为(8.4±1.7)分。除职业发展得分与绩效激励得分、工作生活平衡得分无直线相关关系(P>0.05)外,其余各量表维度得分间均呈正相关(P<0.05)。中介效应显著性检验的Bootstrap分析结果显示,以职业成就、工作生活平衡为中介变量,组织管理、绩效激励和创新支持对职业认知路径的95%CI均未包括0,中介效应显著。结构方程建模结果显示职业期望在组织管理对职业认同感的影响过程中起完全中介作用,在绩效激励、创新支持对职业认同感的影响过程中起部分中介作用。组织管理因素对职业认同感有较弱的正向影响;绩效激励因素对职业认知存在正向影响,对职业行为和职业价值观存在负向影响;创新支持因素对职业认同感的各维度有较强的正向影响。结论科教驱动可通过职业期望的部分中介作用影响全科医生职业认同感。社区应大力支持全科医生的科教创新工作,保证资源分配和管理制度公平,并完善绩效考核机制。
Background Professional identity of general practitioners(GPs)can stimulate enthusiasm and initiative of GPs in primary health care.Driving forces of research and teaching and career expectations can affect the professional identity of GPs.However,their relationship and formation mechanism of professional identity are unclear.Objective To explore the formation mechanism of professional identity of GPs,in order to provide effective incentive approaches of research and teaching for the improvement of GPs' professional identity.Methods From September to November 2017,using stratified random sampling,we selected 397 GPs from community health centers in urban area,urban and rural intersections and suburbs of Shanghai.All of them were surveyed with 4 self-administered questionnaires,GPs' Basic Personal Characteristics Questionnaire,GPs' Selfperceived Driving Forces of Research and Teaching Scale(SDFRT),Career Expectation Scale(CES) and Professional Identity Scale(PIS).On the basis of the survey results,we constructed a structural equation model(SEM) and tested it for the analysis of the formation mechanism of GPs' professional identity.Results A total of 397 questionnaires were issued,383 of which were valid.The effective recovery rate was 96.5%.The mean scores of 4 dimensions of the SDFRT,resource support,organization management,performance incentive and innovation support,were(10.3±3.0),(11.4±2.9),(6.1±2.2),and(11.3±2.7),respectively.The mean scores of dimensions of career development,career achievement and work-life balance of the CES were(9.5±3.1),(6.7±1.9),and(6.8±1.8),respectively.The mean scores of 3 dimensions of the PIS,professional cognition,professional behavior and professional values were(10.5±3.0),(8.6±1.6),and(8.4±1.7),respectively.The mean scores of all the dimensions of the scales showed positive correlations(P<0.05) except that the mean score of career development presented no linear correlation with that of performance incentive and work-life balance(P>0.05).Bootstrap analysis for the test of mediating effect showed that path coefficients from organization management,performance incentive and innovation support to professional cognition with career achievement,work-life balance as mediating variables did not include 0 in the 95% confidence interval(CI),indicating that mediating effects were significant.The results extracted from SEM showed that career expectation played a mediator role between organization management and professional identity completely,and played a mediator role between performance incentive,innovation support and professional identity partly.Organization management had mild positive effects on professional identity.Performance incentive positively influenced professional cognition,but negatively influenced both professional behavior and professional values.Innovation support produced strong positive effects on each dimensions of the PIS.Conclusion The career expectation plays a mediator role between research and teaching driving forces and professional identity partly.Community health centers are suggested to strongly support the innovative research and teaching work of GPs,ensure the equity of resource allocation and management system,and improve the performance evaluation mechanism.
Background Professional identity of general practitioners(GPs)can stimulate enthusiasm and initiative of GPs in primary health care.Driving forces of research and teaching and career expectations can affect the professional identity of GPs.However,their relationship and formation mechanism of professional identity are unclear.Objective To explore the formation mechanism of professional identity of GPs,in order to provide effective incentive approaches of research and teaching for the improvement of GPs' professional identity.Methods From September to November 2017,using stratified random sampling,we selected 397 GPs from community health centers in urban area,urban and rural intersections and suburbs of Shanghai.All of them were surveyed with 4 self-administered questionnaires,GPs' Basic Personal Characteristics Questionnaire,GPs' Selfperceived Driving Forces of Research and Teaching Scale(SDFRT),Career Expectation Scale(CES) and Professional Identity Scale(PIS).On the basis of the survey results,we constructed a structural equation model(SEM) and tested it for the analysis of the formation mechanism of GPs' professional identity.Results A total of 397 questionnaires were issued,383 of which were valid.The effective recovery rate was 96.5%.The mean scores of 4 dimensions of the SDFRT,resource support,organization management,performance incentive and innovation support,were(10.3±3.0),(11.4±2.9),(6.1±2.2),and(11.3±2.7),respectively.The mean scores of dimensions of career development,career achievement and work-life balance of the CES were(9.5±3.1),(6.7±1.9),and(6.8±1.8),respectively.The mean scores of 3 dimensions of the PIS,professional cognition,professional behavior and professional values were(10.5±3.0),(8.6±1.6),and(8.4±1.7),respectively.The mean scores of all the dimensions of the scales showed positive correlations(P<0.05) except that the mean score of career development presented no linear correlation with that of performance incentive and work-life balance(P>0.05).Bootstrap analysis for the test of mediating effect showed that path coefficients from organization management,performance incentive and innovation support to professional cognition with career achievement,work-life balance as mediating variables did not include 0 in the 95% confidence interval(CI),indicating that mediating effects were significant.The results extracted from SEM showed that career expectation played a mediator role between organization management and professional identity completely,and played a mediator role between performance incentive,innovation support and professional identity partly.Organization management had mild positive effects on professional identity.Performance incentive positively influenced professional cognition,but negatively influenced both professional behavior and professional values.Innovation support produced strong positive effects on each dimensions of the PIS.Conclusion The career expectation plays a mediator role between research and teaching driving forces and professional identity partly.Community health centers are suggested to strongly support the innovative research and teaching work of GPs,ensure the equity of resource allocation and management system,and improve the performance evaluation mechanism.
引文
[1]康凤浇,广章,刘天,等.基层医生职业认同现状及其影响因素研究[J].成都医学院学报,2015,10(5):635-637.DOI:10.3969/j.issn.1674-2257.2015.05.031.KANG F J,GUANG Z,LIU T,et al.Present situation of primary care physicians'professional identity and influencing factors[J].Journal of Chengdu Medical College,2015,10(5):635-637.DOI:10.3969/j.issn.1674-2257.2015.05.031.
[2]谢庆文,朱静芬,施榕,等.影响上海市全科医生参加继续职业教育的因素分析[J].中国全科医学,2013,16(7):778-780.DOI:10.3969/j.issn.1007-9572.2013.07.020.XIE Q W,ZHU J F,SHI R,et al.Factors influencing participation in continuing occupation education of general practitioners in Shanghai[J].Chinese General Practice,2013,16(7):778-780.DOI:10.3969/j.issn.1007-9572.2013.07.020.
[3]张冬莹,郑婵娇,黄翔,等.全科医生职业认同感影响因素分析及策略研究[J].中华全科医学,2014,12(11):1836-1838.ZHANG D Y,ZHENG C J,HUANG X,et al.Research of factors affecting professional identity of general practitioner and strategy[J].Chinese Journal of General Practice,2014,12(11):1836-1838.
[4]彭保艳,李晓敏,刘莹,等.我国护理硕士研究生职业期望与社会需求分析[J].解放军医院管理杂志,2015,22(5):490-491,496.PENG B Y,LI X M,LIU Y,et al.Occupation expectation and social demands of postgraduate nursing students in China[J].Hospital Administration Journal of Chinese People's Liberation Army,2015,22(5):490-491,496.
[5]罗伯特·F·德威利斯.量表编制:理论与应用(第2版)[M].魏勇刚,席仲恩,龙长权,译.重庆:重庆大学出版社,2010:97.DEVELLIS R F.Scale development:theory and applications(2nd edition)[M].WEI Y G,XI Z E,LONG C Q,translator.Chongqing:Chongqing University Press,2010:97.
[6]李茂能.结构方程模式软件AMOS之简介及其在测验编制上之应用[M].台北:心理出版社,2006:83-89.LI M N.AMOS the introduction and the test preparation applications[M].Taipei:Psychological Press,2006:83-89.
[7]KAISER H F.An index of factorial simplicity[J].Psychometrika,1974,39(1):31-36.
[8]STEPHENS G K,SZAJNA B,BROOME K M.The career success expectations scale:an exploratory and confirmatory factor analysis[J].Educational&Psychological Measurement,1998,58(1):129-141.DOI:10.1177/0013164498058001011.
[9]冯婉,王小合,钱宇,等.社区医生职业认同量表的初步研制及实证分析[J].卫生软科学,2017,31(5):47-52.DOI:10.3969/j.issn.1003-2800.2017.05.013.FENG W,WANG X H,QIAN Y,et al.Development and empirical analysis of professional identity scale for community doctors[J].Soft Science of Health,2017,31(5):47-52.DOI:10.3969/j.issn.1003-2800.2017.05.013.
[10]张丽莉.医学生职业认同现状及影响因素研究[D].上海:华东师范大学,2010.ZHANG L L.An investigation of professional identity of medical students[D].Shanghai:East China Normal University,2010.
[11]SHROUT P E,BOLGER N.Mediation in experimental a n d n o n e x p e r i m e n t a l s t u d i e s:n e w p r o c e d u r e s a n d recommendations[J].Psychol Methods,2002,7(4):422-445.
[12]温忠麟,侯杰泰,马什赫伯特.结构方程模型检验:拟合指数与卡方准则[J].心理学报,2004,36(2):186-194.WEN Z L,HOU J T,MARSH H.Structural equation model testing:cutoff criteria for goodness of fit indices and chi-square test[J].Acta Psychologica Sinica,2004,36(2):186-194.
[13]吴明隆.结构方程模型:AMOS的操作与应用[M].2版.重庆:重庆大学出版社,2010:37-62.WU M L.SEM:the operation and application of AMOS[M].2nd ed.Chongqing:Chongqing University Press,2010:37-62.
[14]舒之群,荆丽梅,孙晓明,等.上海市浦东新区家庭医生职业认同与满意度调查[J].中华全科医师杂志,2015,14(12):938-941.DOI:10.3760/cma.j.issn.1671-7368.2015.12.011.SHU Z Q,JING L M,SUN X M,et al.Career identity and satisfaction of family doctors in Pudong New Area of Shanghai municipality[J].Chinese Journal of General Practitioners,2 0 1 5,1 4(1 2):9 3 8-9 4 1.D O I:1 0.3 7 6 0/c m a.j.issn.1671-7368.2015.12.011.
[15]俞甬丽,钱月娇,袁瑶琼,等.浙江省城市社区全科医生工作现状调查[J].现代医院,2016,16(6):898-902.DOI:10.3969/j.issn.1671-332X.2016.06.039.YU Y L,QIAN Y J,YUAN Y Q,et al.Investigation on the status quo of general practitioners in the city community health service in Zhejiang Province[J].Modern Hospital,2016,16(6):898-902.DOI:10.3969/j.issn.1671-332X.2016.06.039.
[16]李婷,成雅琴,密一恺,等.社区卫生服务中心全科医学人才培养的探索与实践[J].中华全科医师杂志,2017,16(9):664-667.DOI:10.3760/cma.j.issn.1671-7368.2017.09.003.LI T,CHENG Y Q,MI Y K,et al.Experience on general practitioner training in community health care center[J].Chinese Journal of General Practitioners,2017,16(9):664-667.DOI:10.3760/cma.j.issn.1671-7368.2017.09.003.
[17]谢建平,杜勇,罗菲,等.西部区域基层医生职业认同及职业规划现状[J].川北医学院学报,2015,30(6):882-885.DOI:10.3969/j.issn.1005-3697.2015.06.38.XIE J P,DU Y,LUO F,et al.An investigation on professional identity and development plan of practi-tioners of Western China basic-level medical institutions[J].Journal of North Sichuan Medical College,2015,30(6):882-885.DOI:10.3969/j.issn.1005-3697.2015.06.38.
[2]谢庆文,朱静芬,施榕,等.影响上海市全科医生参加继续职业教育的因素分析[J].中国全科医学,2013,16(7):778-780.DOI:10.3969/j.issn.1007-9572.2013.07.020.XIE Q W,ZHU J F,SHI R,et al.Factors influencing participation in continuing occupation education of general practitioners in Shanghai[J].Chinese General Practice,2013,16(7):778-780.DOI:10.3969/j.issn.1007-9572.2013.07.020.
[3]张冬莹,郑婵娇,黄翔,等.全科医生职业认同感影响因素分析及策略研究[J].中华全科医学,2014,12(11):1836-1838.ZHANG D Y,ZHENG C J,HUANG X,et al.Research of factors affecting professional identity of general practitioner and strategy[J].Chinese Journal of General Practice,2014,12(11):1836-1838.
[4]彭保艳,李晓敏,刘莹,等.我国护理硕士研究生职业期望与社会需求分析[J].解放军医院管理杂志,2015,22(5):490-491,496.PENG B Y,LI X M,LIU Y,et al.Occupation expectation and social demands of postgraduate nursing students in China[J].Hospital Administration Journal of Chinese People's Liberation Army,2015,22(5):490-491,496.
[5]罗伯特·F·德威利斯.量表编制:理论与应用(第2版)[M].魏勇刚,席仲恩,龙长权,译.重庆:重庆大学出版社,2010:97.DEVELLIS R F.Scale development:theory and applications(2nd edition)[M].WEI Y G,XI Z E,LONG C Q,translator.Chongqing:Chongqing University Press,2010:97.
[6]李茂能.结构方程模式软件AMOS之简介及其在测验编制上之应用[M].台北:心理出版社,2006:83-89.LI M N.AMOS the introduction and the test preparation applications[M].Taipei:Psychological Press,2006:83-89.
[7]KAISER H F.An index of factorial simplicity[J].Psychometrika,1974,39(1):31-36.
[8]STEPHENS G K,SZAJNA B,BROOME K M.The career success expectations scale:an exploratory and confirmatory factor analysis[J].Educational&Psychological Measurement,1998,58(1):129-141.DOI:10.1177/0013164498058001011.
[9]冯婉,王小合,钱宇,等.社区医生职业认同量表的初步研制及实证分析[J].卫生软科学,2017,31(5):47-52.DOI:10.3969/j.issn.1003-2800.2017.05.013.FENG W,WANG X H,QIAN Y,et al.Development and empirical analysis of professional identity scale for community doctors[J].Soft Science of Health,2017,31(5):47-52.DOI:10.3969/j.issn.1003-2800.2017.05.013.
[10]张丽莉.医学生职业认同现状及影响因素研究[D].上海:华东师范大学,2010.ZHANG L L.An investigation of professional identity of medical students[D].Shanghai:East China Normal University,2010.
[11]SHROUT P E,BOLGER N.Mediation in experimental a n d n o n e x p e r i m e n t a l s t u d i e s:n e w p r o c e d u r e s a n d recommendations[J].Psychol Methods,2002,7(4):422-445.
[12]温忠麟,侯杰泰,马什赫伯特.结构方程模型检验:拟合指数与卡方准则[J].心理学报,2004,36(2):186-194.WEN Z L,HOU J T,MARSH H.Structural equation model testing:cutoff criteria for goodness of fit indices and chi-square test[J].Acta Psychologica Sinica,2004,36(2):186-194.
[13]吴明隆.结构方程模型:AMOS的操作与应用[M].2版.重庆:重庆大学出版社,2010:37-62.WU M L.SEM:the operation and application of AMOS[M].2nd ed.Chongqing:Chongqing University Press,2010:37-62.
[14]舒之群,荆丽梅,孙晓明,等.上海市浦东新区家庭医生职业认同与满意度调查[J].中华全科医师杂志,2015,14(12):938-941.DOI:10.3760/cma.j.issn.1671-7368.2015.12.011.SHU Z Q,JING L M,SUN X M,et al.Career identity and satisfaction of family doctors in Pudong New Area of Shanghai municipality[J].Chinese Journal of General Practitioners,2 0 1 5,1 4(1 2):9 3 8-9 4 1.D O I:1 0.3 7 6 0/c m a.j.issn.1671-7368.2015.12.011.
[15]俞甬丽,钱月娇,袁瑶琼,等.浙江省城市社区全科医生工作现状调查[J].现代医院,2016,16(6):898-902.DOI:10.3969/j.issn.1671-332X.2016.06.039.YU Y L,QIAN Y J,YUAN Y Q,et al.Investigation on the status quo of general practitioners in the city community health service in Zhejiang Province[J].Modern Hospital,2016,16(6):898-902.DOI:10.3969/j.issn.1671-332X.2016.06.039.
[16]李婷,成雅琴,密一恺,等.社区卫生服务中心全科医学人才培养的探索与实践[J].中华全科医师杂志,2017,16(9):664-667.DOI:10.3760/cma.j.issn.1671-7368.2017.09.003.LI T,CHENG Y Q,MI Y K,et al.Experience on general practitioner training in community health care center[J].Chinese Journal of General Practitioners,2017,16(9):664-667.DOI:10.3760/cma.j.issn.1671-7368.2017.09.003.
[17]谢建平,杜勇,罗菲,等.西部区域基层医生职业认同及职业规划现状[J].川北医学院学报,2015,30(6):882-885.DOI:10.3969/j.issn.1005-3697.2015.06.38.XIE J P,DU Y,LUO F,et al.An investigation on professional identity and development plan of practi-tioners of Western China basic-level medical institutions[J].Journal of North Sichuan Medical College,2015,30(6):882-885.DOI:10.3969/j.issn.1005-3697.2015.06.38.