全科医师规范化培训学员的满意度及影响因素研究
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摘要
背景全科医师作为规范化培训工作的参与主体,其满意度直接影响规范化培训的质量和效果。目的基于山西省全科医师规范化培训情况,了解全科医师规范化培训学员的满意度及影响因素,为优化全科医师规范化培训、提高培训质量提供参考依据。方法选取在山西省12家住院医师规范化培训基地进行全科医师规范化培训的2014、2015、2016、2017级全体学员1 009名为调查对象。于2018年4—6月,采用自行设计的问卷对纳入学员进行调查,主要内容包括:学员的基本人口学特征,学员对全科医师规范化培训的认知(对培训的了解程度、培训的必要性、培训对自身的帮助程度、培训过程中的压力状态),学员对全科医师规范化培训的满意度(采用5级评分,"非常不满意"～"非常满意"分别计为1～5分)。共发放问卷1 009份,回收有效问卷820份,问卷的有效回收率为81.27%。结果 820名学员对全科医师规范化培训的满意度评分为(3.62±0.73)分。其中,满意度评分较高的3项依次为"带教教师的自身为人素质""带教教师的指导能力和水平""带教教师的带教积极性",评分分别为(3.86±0.73)、(3.70±0.76)、(3.61±0.82)分,得分最低的1项为"住院医师规范化培训期间的薪酬",评分为(3.02±0.99)分。多因素Logistic回归分析结果显示,学员年龄、期望就业医院级别、对培训的了解程度、对培训的必要性认知、对培训对自身帮助程度的认知、培训过程中的压力状态是其对全科医师规范化培训满意度的影响因素(P<0.05)。结论全科医师规范化培训学员对培训的总体满意度为"一般"满意范畴。对培训满意度的影响因素集中体现在学员对全科医师及其规范化培训的认知上,建议在培训中增加学员对全科医师培训目的与意义的认知教育培训。
Background General practitioners(GPs) make up the bulk of the participants of standardized GP training.Their satisfaction with the training is directly related to the quality and effectiveness of this training.Objective To obtain an understanding of the trainees' satisfaction with standardized GP training and associated factors by analyzing a related survey conducted in Shanxi Province,to provide a reference for optimizing the procedure and improving the quality of the training.Methods In this study conducted from April to June 2018,we enrolled all the trainees(n=1 009) who received the standardized GP training carried out in 12 standardized resident physician training bases in Shanxi Province in four years(2014,2015,2016 and 2017) and surveyed them using a self-designed questionnaire consisting of general demographic characteristics,level of understanding of standardized GP training,the necessity and assistance levels of receiving this training,the stress status during the training,and satisfaction with the training.The satisfaction evaluation was scored by 5 grades,form "very unsatisfactory" to "very satisfied" were scored 1-5,respectively.Overall,820 of them handed in responsive questionnaires,generating an 81.27% response rate.Results The overall mean satisfaction score for the training evaluated by the respondents was(3.62 ± 0.73).In terms of the mean satisfaction score,the three top-ranked items were "Trainers' personal quality" "Trainers' teaching capability level" "Trainers' teaching enthusiasm",the corresponding scores were(3.86 ±0.73)(3.70 ±0.76)(3.61±0.82),respectively,while the bottom-ranked one was "Resident physician's salary during the period of standardized GP training",the corresponding score was(3.02±0.99).Multivariate Logistic regression analysis showed that age,the level of hospital expected to be employed,level of understanding of standardized GP training,the necessity and assistance levels of receiving this training,and the stress status during the training were the factors associated with the overall mean satisfaction score for the training(P<0.05).Conclusion In general,the level of trainees' satisfaction with the standardized GP training was "fair".And it was influenced most by trainees' level of understating of the training.In view of this,purpose and significance of the training are suggested to be added to the contents of the perception of the training,besides strengthening the GP knowledge and skills training.
Background General practitioners(GPs) make up the bulk of the participants of standardized GP training.Their satisfaction with the training is directly related to the quality and effectiveness of this training.Objective To obtain an understanding of the trainees' satisfaction with standardized GP training and associated factors by analyzing a related survey conducted in Shanxi Province,to provide a reference for optimizing the procedure and improving the quality of the training.Methods In this study conducted from April to June 2018,we enrolled all the trainees(n=1 009) who received the standardized GP training carried out in 12 standardized resident physician training bases in Shanxi Province in four years(2014,2015,2016 and 2017) and surveyed them using a self-designed questionnaire consisting of general demographic characteristics,level of understanding of standardized GP training,the necessity and assistance levels of receiving this training,the stress status during the training,and satisfaction with the training.The satisfaction evaluation was scored by 5 grades,form "very unsatisfactory" to "very satisfied" were scored 1-5,respectively.Overall,820 of them handed in responsive questionnaires,generating an 81.27% response rate.Results The overall mean satisfaction score for the training evaluated by the respondents was(3.62 ± 0.73).In terms of the mean satisfaction score,the three top-ranked items were "Trainers' personal quality" "Trainers' teaching capability level" "Trainers' teaching enthusiasm",the corresponding scores were(3.86 ±0.73)(3.70 ±0.76)(3.61±0.82),respectively,while the bottom-ranked one was "Resident physician's salary during the period of standardized GP training",the corresponding score was(3.02±0.99).Multivariate Logistic regression analysis showed that age,the level of hospital expected to be employed,level of understanding of standardized GP training,the necessity and assistance levels of receiving this training,and the stress status during the training were the factors associated with the overall mean satisfaction score for the training(P<0.05).Conclusion In general,the level of trainees' satisfaction with the standardized GP training was "fair".And it was influenced most by trainees' level of understating of the training.In view of this,purpose and significance of the training are suggested to be added to the contents of the perception of the training,besides strengthening the GP knowledge and skills training.
引文
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[12]王圆圆,王荣英,张金佳,等.全科医师规范化培训学员对综合性医院全科医学科培训的满意度研究[J].中国全科医学,2018,21(13):1598-1602.DOI:10.3969/j.issn.1007-9572.2018.13.018.WANG Y Y,WANG R Y,ZHANG J J,et al.Satisfaction of trainees with the standardized general practitioner training delivered by the general practice department of a general hospital[J].Chinese General Practice,2018,21(13):1598-1602.DOI:10.3969/j.issn.1007-9572.2018.13.018.
[13]刘小艳,黄海.全科医生规范化培训存在的问题及对策[J].医学与社会,2016,29(11):88-91.DOI:10.13723/j.yxysh.2016.11.028.LIU X Y,HUANG H.Problems and countmermeasures of general practitioners standardized training[J].Medicine and Society,2016,29(11):88-91.DOI:10.13723/j.yxysh.2016.11.028.
[14]赵明月,孙骞,尹爱田,等.全科医生培养机制中的问题与解决路径[J].中国卫生事业管理,2017,34(7):534-536.ZHAO M Y,SUN Q,YIN A T,et al.Problems and solutions in the cultivation mechanism of general practitioners[J].Chinese Health Service Management,2017,34(7):534-536.
[15]肖铮,张水华,杨滨滨,等.住院医师规范化培训学员的心理压力分析及心理干预[J].中国继续医学教育,2018,10(18):3-5.DOI:10.3969/j.issn.1674-9308.2018.18.002.XIAOZ,ZHANGSH,YANGBB,etal.Analysisof psychological stress and psychological intervention of standardized training students for resident doctors[J].China Continuing Medical Education,2018,10(18):3-5.DOI:10.3969/j.issn.1674-9308.2018.18.002.
[2]中华人民共和国国务院.国务院关于建立全科医生制度的指导意见[Z].2011.
[3]葛运运,徐静,周亚夫,等.我国全科医学发展历史与现状分析[J].中国全科医学,2013,16(19):2201-2203.DOI:10.3969/j.issn.1007-9572.2013.19.004.GE Y Y,XUE J,ZHOU Y F,et al.History and present situation of development of general practice in China[J].Chinese General Practice,2013,16(19):2201-2203.DOI:10.3969/j.issn.1007-9572.2013.19.004.
[4]孙加强,黄凤茜,申玉杰.广东省住院医师规范化培训现状调查[J].医学与社会,2016,29(5):81-84.DOI:10.13723/j.yxysh.2016.05.025.SUN J Q,HUANG F Q,SHEN Y J.Investigation of the situation ofresidentphysiciansstandardizedtraininginGuangdong Province[J].Medicine and Society,2016,29(5):81-84.DOI:10.13723/j.yxysh.2016.05.025.
[5]陈艾艾,刘仕方,郑华,等.贵州省住院医师规范化培养现状调查与分析[J].辽宁医学院学报(社会科学版),2016,14(3):62-65.CHEN A A,LIU S F,ZHENG H,et al.Study on the status of the standardized residents training in Guizhou Province[J].Journal of Liaoning Medical University(Social Science Edition),2016,14(3):62-65.
[6]齐艳,孙丽娟,周宪春.延边地区住院医师对规范化培训制度认知度及影响因素的调查[J].中国医学创新,2016,13(35):131-134.QI Y,SUN L J,ZHOU X C,et al.The research of the awareness and influencing factors of resident physicians to the standardized training program for resident in Yanbian[J].Medical Innovation of China,2016,13(35):131-134.
[7]国家卫生计生委办公厅关于印发住院医师规范化培训基地认定标准(试行)和住院医师规范化培训内容与标准(试行)的通知[Z].2014.
[8]潘天园,杜亚平,李兰娟.浙江省全科医师规范化培训学员对培训制度及工作现状满意度的研究[J].中国全科医学,2015,18(7):801-806.DOI:10.3969/j.issn.1007-9572.2015.07.22.PAN T Y,DU Y P,LI L J.Satisfaction survey on training system and current status of trained general practice residents in Zhejiang Province[J].Chinese General Practice,2015,18(7):801-806.DOI:10.3969/j.issn.1007-9572.2015.07.22.
[9]朱小凤,何玉霞,梁春蕾,等.住院医师规范化培训学员的培训状况与心理健康的关系[J].重庆医学,2017,46(14):2006-2007,2016.DOI:10.3969/j.issn.1671-8348.2017.14.047.ZHUXF,HEYX,LIANGCL,etal.Therelationship between training status and mental health of resident standardized trainees[J].Chongqing Medicine,2017,46(14):2006-2007,2016.DOI:10.3969/j.issn.1671-8348.2017.14.047.
[10]陆媛,于德华,潘莹,等.国内外全科医学师资标准现状及建设设想[J].中国全科医学,2015,18(21):2493-2497.DOI:10.3969/j.issn.1007-9572.2015.21.001.LU Y,YU D H,PAN Y,et al.Status of general practice faculty standard home and abroad and suggestions for faculty development[J].Chinese General Practice,2015,18(21):2493-2497.DOI:10.3969/j.issn.1007-9572.2015.21.001.
[11]王荣英,贺振银,赵稳稳,等.全科医学师资培训研究进展[J].中国全科医学,2017,20(25):3144-3148.DOI:10.3969/j.issn.1007-9572.2017.25.017.WANG R Y,HE Z Y,ZHAO W W,et al.Research progress of teacher training in general practice[J].Chinese General Practice,2017,20(25):3144-3148.DOI:10.3969/j.issn.1007-9572.2017.25.017.
[12]王圆圆,王荣英,张金佳,等.全科医师规范化培训学员对综合性医院全科医学科培训的满意度研究[J].中国全科医学,2018,21(13):1598-1602.DOI:10.3969/j.issn.1007-9572.2018.13.018.WANG Y Y,WANG R Y,ZHANG J J,et al.Satisfaction of trainees with the standardized general practitioner training delivered by the general practice department of a general hospital[J].Chinese General Practice,2018,21(13):1598-1602.DOI:10.3969/j.issn.1007-9572.2018.13.018.
[13]刘小艳,黄海.全科医生规范化培训存在的问题及对策[J].医学与社会,2016,29(11):88-91.DOI:10.13723/j.yxysh.2016.11.028.LIU X Y,HUANG H.Problems and countmermeasures of general practitioners standardized training[J].Medicine and Society,2016,29(11):88-91.DOI:10.13723/j.yxysh.2016.11.028.
[14]赵明月,孙骞,尹爱田,等.全科医生培养机制中的问题与解决路径[J].中国卫生事业管理,2017,34(7):534-536.ZHAO M Y,SUN Q,YIN A T,et al.Problems and solutions in the cultivation mechanism of general practitioners[J].Chinese Health Service Management,2017,34(7):534-536.
[15]肖铮,张水华,杨滨滨,等.住院医师规范化培训学员的心理压力分析及心理干预[J].中国继续医学教育,2018,10(18):3-5.DOI:10.3969/j.issn.1674-9308.2018.18.002.XIAOZ,ZHANGSH,YANGBB,etal.Analysisof psychological stress and psychological intervention of standardized training students for resident doctors[J].China Continuing Medical Education,2018,10(18):3-5.DOI:10.3969/j.issn.1674-9308.2018.18.002.