标准化住院医师培训计划(SRTP)是深化中国等发展中国家卫生系统和医学教育的重要举措。尽管在全国范围内推广了SRTP,并对其实施进行了各种改进,中国的继续医学教育仍处于起步阶段。与居民相比,在中国,对SRTP下的临床教师知之甚少。然而,临床教师作为知识的关键传播者,有效地确定培训质量,技能,以及医疗实践中的价值观。因此,该研究旨在分析影响他们认知工作满意度的关键因素,并为SRTP提供持续改进.
2018年12月1日至2019年5月31日,我们对绍兴市13个SRTP(包括培训基地和专业基地)进行了自行设计的问卷,以评估临床教师的满意度。总之,574名临床教师对调查做出了回应,总体满意度很高。采用卡方检验和Fisher精确检验对影响临床教师满意度的单因素进行评价。多因素分析采用Logistic回归模型。
男临床教师对教学内容的满意度存在显著差异(OR:0.675,[95%CI:0.477~0.953]),学习与工作之间的冲突(OR:0.542,[95CI:0.371~0.791]),领导人的注意(OR:0.403,[95CI:0.252~0.645]),和教师补贴(OR:0.527,[95CI:0.347~0.805])。与内科相比,来自外科(OR:2.396,[95CI:1.365-4.206])和其他科室(OR:2.409,[95CI:1.406-4.129])的临床教师认为住院医师有很高的参加培训的积极性时,他们更满意.此外,与主治医生相比,副主任医师(OR:0.493,[95CI:0.310-0.783])和主任医师(OR:0.683,[95CI:0.471-0.991])在居民工资是否足够好方面存在更多分歧。
临床教师广泛认可SRTP。然而,教师的满意度因性别不同而不同,工作部门,和专业头衔。该研究还讨论了这些发现背后的可能原因和策略含义,结合了中国独特的社会特征。Further,我们相信分析和解释提醒我们其他西方国家的住院医师培训方法的应用,这也应该考虑到独特的社会文化挑战。
The Standardized Residency Training Program (SRTP) is a significant initiative to deepen health systems and medical education in developing countries like
China. Despite the promotion of the SRTP nationwide and its implementation with various improvements, Chinese continuous medical education is still in its infancy. Compared with the residents, little is known about clinical teachers under the SRTP in
China. However, clinical teachers effectively determine the training quality as critical disseminators of knowledge, skills, and values in medical practice. Thus, the study aims to analyze critical factors affecting their cognitive job satisfaction and provide continuous improvements for SRTP.
From 1 December 2018 to 31 May 2019, we conducted a self-designed questionnaire with 13 SRTPs (including both training bases and professional bases) in Shaoxing city to evaluate clinical teachers\' satisfaction. Altogether, 574 clinical teachers responded to the survey expressing generally high overall satisfaction. We adopted a Chi-square test and Fisher\'s Exact Test to evaluate the single impact factors affecting the satisfaction of clinical teachers. The multiple factors analysis applied the logistic regression model.
The male clinical teachers had significant differences in satisfaction with the teaching content (OR: 0.675, [95% CI: 0.477~0.953]), conflicts between study and work (OR: 0.542, [95%CI: 0.371~0.791]), the attention of leaders (OR: 0.403, [95%CI: 0.252~0.645]), and the subsidies of teachers (OR: 0.527, [95%CI: 0.347~0.805]). Compared with internal medicine, clinical teachers from surgery (OR: 2.396, [95%CI: 1.365-4.206]) and other departments (OR: 2.409, [95%CI: 1.406-4.129]) were more satisfied when they considered that residents have high motivation to attend training. In addition, compared with the attending physicians, the deputy chief physicians (OR: 0.493, [95%CI: 0.310-0.783]) and the chief physicians (OR: 0.683, [95%CI: 0.471-0.991]) disagreed more regarding the residents\' wage being good enough.
Clinical teachers widely recognize the SRTP. However, teachers\' satisfaction varied due to different genders, working departments, and professional titles. The study also discussed possible reasons and strategy implications behind these findings, which combined unique Chinese society characteristics. Further, we believe the analysis and interpretations remind us of the applications of residency training methods from other Western countries, which should also consider the unique socio-cultural challenges.