Investigation and analysis of satisfaction among general practice ordered students in standardized residency training program in Gansu province
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摘要:
目的 调查并分析甘肃省全科住培中存在的问题，并提出改进的建议。 方法 采用问卷调查的方法，对甘肃省2020—2021级全科订单定向生进行调查。发放试卷279份，共收回有效问卷223份。通过SPSS 25.0统计学软件，采用多因素logistic回归分析研究全科订单定向生对住培教学满意度的影响因素；采用χ2检验及Fisher精准检验分析满意度调查结果。 结果 基地的教学设备、临床及基层实践基地教学任务完成情况、教学管理、教学工作等方面的带教满意度差异均有统计学意义(P＜0.05)。满意度调查中，全科订单定向生要求开展多形式的临床教学(68.60%，153/223)、提高待遇及生活保障(74.43%，166/223)等方面占比高。在住培的教学工作中，大家一致认为多方面综合能力有很大提高，特别是临床工作经验(83.41%，186/223)、实践操作及动手能力(76.23%，170/223)等，但在学习积极性的自我评价中有81.61%(182/223)的人认为需进一步提高。调查发现，住培生建议增加临床科室轮转和门诊教学实践(59.19%，132/223)，增加心电图及影像诊断(61.43%，137/223)，提高待遇及绩效分配(60.54%，135/223)。 结论 甘肃省全科住培工作满意度总体为较高水平。本研究在全科住培轮转时间、培训内容、培训模式多样性上提出了可行的建议，并认为加强思想建设及职业认同感，在提升住培的质量内涵中非常必要。 Abstract:Objective To investigate and analyze the existing problems in the residency training for general practice ordered students in Gansu Province and propose corresponding suggestions for improvement. Methods A questionnaire survey was conducted on the general practice ordered students from the 2020-2021 grade in Gansu Province. A total of 279 questionnaires were distributed, with 223 valid questionnaires were collected. Using SPSS 25.0 software, the factors influencing teaching satisfaction were analyzed by multivariate logistic regression. The satisfaction survey results were analyzed using the chi-square test and Fisher ' s exact test. Results The adequacy of teaching equipment, the fulfillment of clinical and community teaching tasks, teaching management quality, and teaching execution significantly influenced the satisfaction of with teaching mentors (P < 0.05). In the satisfaction survey, general practice ordered trainees expressed a strong demand for diversified clinical teaching methods (68.60%, 153/223) and called for improvements in their remuneration and living conditions (74.43%, 166/223). In the residency teaching work, the majority agreed that their overall competencies had improved significantly, especially in their clinical experience (83.41%, 186/223) and practical skills (76.23%, 170/223). However, 81.61% (182/223) of them believed that their learning motivation needs to be further improved. During the investigation, the residents-in-training suggested increasing the rotation in clinical departments and outpatient teaching practice (59.19%, 132/223), increasing electrocardiography and imaging diagnosis (61.43%, 137/223), and improving remuneration and performance-based allocation (60.54%, 135/223). Conclusion The overall satisfaction with the general practice residency training in Gansu Province is relatively high. The article focuses on suggestions for feasible recommendations for optimizing rotation schedules of general practice residency training, enriching training content, and diversifying training modes. In order to improve the quality of residency training, it is necessary to strengthen ideological and political education and foster a stronger sense of professional identity among residents. -
表 1 甘肃省全科订单定向生对培训基地的总体评价
Table 1. The overall evaluation of the training base by the general order oriented students in Gansu Province
条目 不满意(n=56) 满意(n=167) χ2值 P值 本基地的教学设备是否能满足全科教学的需求 37.081 ＜0.001 基本可以 51(91.07) 72(43.11) 完全可以 5(8.93) 95(56.89) 临床科室轮转期间，教学任务完成情况 ＜0.001a 不能完成 3(5.36) 2(1.20) 多数能完成 51(91.07) 104(62.27) 超额完成 2(3.57) 61(36.53) 基层实践基地轮转期间，教学任务完成情况 41.388 ＜0.001 不能完成 13(23.21) 7(4.19) 多数能完成 38(67.86) 72(43.12) 完全可以完成 5(8.93) 88(52.69) 本基地住培教学管理情况 ＜0.001a 不规范 2(3.57) 0 一般 41(73.22) 22(13.17) 很规范 13(23.21) 145(86.83) 您对本基地住培教学工作的总体评价 ＜0.001a 不满意 1(1.79) 0 基本满意 54(96.42) 74(44.31) 很满意 1(1.79) 93(55.69) 注：a为采用Fisher精确检验。本表仅列出差异有统计学意义的条目。 
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表 2 全科订单定向生对提高学习积极性的建议及学习中的收获
Table 2. Suggestions on improving learning enthusiasm and learning gains of general subject order oriented students
条目 人(%) 提高全科规培生学习积极性措施(多选) 开展多形式的临床技能培训或教学模式 153(68.60) 开展各类竞赛，并对优胜者进行奖励 122(54.70) 加强导师负责管理，促进师生间沟通、互动 130(58.29) 给予多鼓励、多动手、多参与临床的机会 169(75.78) 提高待遇、生活保障 166(74.43) 建立学习趣味小组，开展小组内教学活动 98(43.95) 独立管理病人、一线值班，并有绩效体现 135(60.54) 定期进行阶段性考核，并对优秀者进行奖励 103(46.19) 可自主选择自己的带教老师 118(52.91) 提供外出学习、参会的机会 114(51.12) 个性化的培养与对待 111(49.77) 住培学习过程中收获的自我评价(多选) 临床工作经验增加 186(83.41) 实践操作、动手能力提高 170(76.23) 临床沟通能力提高 182(81.61) 常见病、多发病的诊治水平提高 181(81.17) 理论联系实践的转化 139(62.33) 学会换位思考，更多的理解患者 147(65.92) 临床发现问题、分析问题、解决问题的能力提高 158(70.85) 认为需要进一步提高学习的积极性 182(81.61)
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表 3 有序多分类logistic回归分析各变量赋值情况
Table 3. Assignment of variables for ordered multiple logistic regression analysis
变量 赋值方法 住院医师年级 2020级=1，2021级=2 教学中体现全科的特点 完全不能=1，相对较少=2，完全能=3 带教老师临床与教学投入 临床投入多=(0，0)，投入相当=(1，0)，教学投入多=(0，1) 教学任务完成情况(临床、基层) 不能完成=1，多数完成=2，完全可以=3 住培相关政策 不了解=1，部分了解=2，完全了解=3 教学设备与教学 基本满足=1，完全可以满足=2 住培教学管理 不规范=1，一般=2，很规范=3 住培期间待遇 不满意=1，基本满意=2，很满意=3 定向生学习积极性评价 主动与被动学习都不高=1，不主动但被动学习尚可=2，主动学习积极性高=3 全科住培教学的总体评价 不满意=1，基本满意=2，很满意=3 临床实践基地带教满意度 不满意=1，满意=2 基层实践基地带教满意度 不满意=1，满意=2
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表 4 全科订单定向生对临床实践基地带教满意度的logistic影响因素分析
Table 4. Logistic analysis of factors affecting the satisfaction of general practice ordered interns with clinical practice base supervision
条目 B SE Waldχ2 P值 OR(95% CI) 2021级住院医师 -1.633 0.576 -2.833 0.005 0.199(0.061~0.583) 教学中能否体现全科的特点 相对较少 1.421 1.852 0.767 0.443 4.142(0.132~208.295) 完全能 3.713 1.891 1.963 0.047 40.991(1.192~2209.833) 带教老师临床与教学投入 投入相当 0.855 0.904 0.946 0.344 2.348(0.451~18.224) 教学投入多 3.703 1.073 3.451 0.001 40.583(5.832~429.714) 注：本表仅列出差异有统计学意义的变量。
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表 5 全科订单定向生对基层实践基地带教满意度的logistic影响因素分析
Table 5. Logistic analysis of influencing factors of general order oriented students ' satisfaction with basic area teaching in grassroots practice
条目 B SE Waldχ2 P值 OR(95% CI) 在各临床科室轮转期间，教学任务完成情况 多数能完成 3.815 1.322 2.887 0.004 45.382(4.120~770.313) 完全可以 3.654 1.263 2.892 0.004 38.623(3.575~570.822) 注：本表仅列出差异有统计学意义的变量。
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表 6 全科订单定向生对本基地全科住培教学的建议
Table 6. Suggestions for general practice order orientation students on the teaching of general practice residency and training in this base
条目 人(%) 减少社区轮转时间，增加临床科室轮转时间 132(59.19) 增加门诊教学实践 116(52.02) 取消出科手写大病历 144(64.57) 增加实践技能、动手参与的机会 127(56.95) 开展多形式的教学活动 93(41.70) 增加心电图、影像教学及实践 137(61.43) 减少规培办等职能部门对教学的干预 91(40.80) 可自己选择带教老师 102(45.74) 提高待遇，增加绩效分配 135(60.54)
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