背景:尽管新千年的医疗专业精神已经过去了近15年:提出了《医师宪章》(《医师宪章》),以重申医疗专业精神,以应对新的挑战。世纪,中国医学生同意并履行《医师章程》中定义的专业原则和责任的方式仍然未知。
方法:2016年3月,中国医科大学(CMU)的748名五年级医学生参加了一项调查,他们使用10点Likert量表表明了他们对《医师宪章》中定义的原则和责任的一致性和履行方式。然后通过t检验对数据进行分析,探索性因素分析,和多元线性回归。
结果:与医师章程一致的总分明显高于履行的总分(p<0.001)。协议和履行分数之间的最大差异是社会正义原则(P3),承诺改善获得护理的机会(R6),和有限资源的公正分布(R7)。探索性因素分析在协议与实现之间的差距方面区分了两个原则-患者福利(P1)和患者自主权(P2)。部分原因是,将协议评分低于P1或P2的学生比例远高于任何其他原则或责任。此外,多元线性回归表明,在五年制课程中注册或注册为农村居民(即持有农村户口)的学生的协议分数明显较高,但不能实现。
结论:中国医学生赞同《医师章程》及其医学专业精神的核心价值观,尽管他们觉得在实践中很难实现。医学教育工作者和卫生当局应共同行动,以支持和培养专业价值观。
BACKGROUND: Although it has been nearly 15 years since the Medical Professionalism in the New Millennium: A Physician Charter (the Physician Charter) was proposed to reaffirm medical professionalism in response to the new challenges in healthcare delivery in the new century, the manner in which Chinese medical students agree with and fulfill the principles and responsibilities of professionalism defined in the Physician Charter still remains unknown.
METHODS: In March 2016, 748 fifth-year medical students from
China Medical University (CMU) participated in a survey in which they indicated their rate of agreement with and manner of fulfillment of the principles and responsibilities defined in the Physician Charter using a 10-point Likert scale. The data were then analyzed by t-tests, exploratory factor analysis, and multiple linear regressions.
RESULTS: The total score of agreement with the Physician Charter was significantly higher than that of fulfillment (p < 0.001). The largest difference between agreement and fulfillment scores were with the principle of social justice (P3), commitments to improving access to care (R6), and a just distribution of finite resources (R7). Exploratory factor analysis distinguished two principles - primacy of patient welfare (P1) and patient autonomy (P2) - from the others in terms of the gap between agreement and fulfillment. This is partially because the proportion of students who rated agreement lower than fulfillment of P1 or P2 was much higher than it was for any other principle or responsibility. Additionally, multiple linear regressions show that students who are enrolled in a five-year program or who was registered as a rural resident (i.e. holding a rural Hukou) had significantly higher scores of agreement, but not fulfillment.
CONCLUSIONS: Chinese medical students endorsed the Physician Charter and its core values of medical professionalism, although they felt difficult to fulfill in practice. Medical educators and the health authority should act together to support and foster professional values.