住院医师临床学习环境评价量表的编制及实证研究

发布时间：2018-12-19 17:32

【摘要】：目的:(1)结合我国住院医师规范化培训管理特点,编制一个科学的、客观的住院医师临床学习环境评价量表,并对该量表进行信度、效度检验。为评估我国住院医师临床学习环境质量,进一步提高轮转质量提供一种科学、有效的工具;(2)使用编制的量表测评住院医师及专业学位研究生对临床学习环境的评价,分析临床学习环境中存在的问题及不足,为住院医师临床学习环境的改善提供依据,同时为相关干预措施的选择提供参照。方法:(1)对国内外住院医师临床学习环境评价工具及护理临床学习环境评价工具等相关文献进行研究,结合专家访谈法拟定初始量表。(2)召开住院医师座谈会,结合我国住院医师规范化培训的实际情况,对维度、条目进行筛选,初步形成了住院医师临床学习环境评价量表。(3)运用德尔菲法对16名专家先后进行两轮问卷调查,采取现场发放并回收问卷的方式,请专家们对各个维度、条目进行评价,并调查专家对调查内容的判别依据和了解程度。每轮专家咨询结束后,计算专家的积极系数、权威系数、协调系数,用界值法删选维度和条目,经过两轮德尔菲法,最终量表包括指导医师、培训氛围、培训质量改善、培训条件、同事关系、医疗安全6个维度,共40个条目。(4)选择北京市8家住院医师规范化培训基地的住院医师及专业学位研究生,共计960人,进行问卷调查,检验量表的信度和效度。其中信度检验采用同质信度和重测信度为评价指标,效度检验采用内容效度和结构效度作为评价指标。(5)将有效问卷的调查数据导入SPSS20.0,进行统计学分析。结果:(1)经过两轮德尔菲问卷调查,得到专家的积极系数均为100%,权威程度系数分别为:0.858、0.848,说明两轮问卷调查专家积极性都很高,对本研究很感兴趣,且专家们的权威性较好,研究结果可靠。(2)经过信度、效度检测,量表6个维度的Cronbach' s α系数(同质信度)范围在0.833-0.939,量表总体Cronbach' s α系数为0.975,Pearson相关系数(重测信度)为0.912;平均内容效度系数为0.940,6个公因子累积贡献率达67.897%。说明此量表具有较高的信度、效度。(3)经实证研究,得到:①住院医师临床学习环境评价量表的总均分为3.46分,各维度均分在3.23-3.67分。其中,平均分最高的维度:同事关系(3.67±0.66)分,平均分最低的维度:培训质量改善(3.23±0.92)分;平均分最高的条目:培训期间,你和医院内其他在培住院医师关系融洽(4.04土0.64)分;平均分最低的条目:你接受过识别工作疲劳迹象的相关培训(2.83±1.15)分。②不同性别、学历、身份、培训年限的住院医师或专业学位研究生对临床学习环境的评分分别进行比较,P值均大于0.05,按α =0.05的水准,差异无统计学意义。③住院医师或专业学位研究生对于临床学习环境的评价在轮转科室、培训医院两个方面的比较差异有统计学意义。结论:(1)本研究遴选的专家具有代表性,量表涉及的维度、条目筛选合理,研究结果可靠。(2)该量表具有良好的信度和效度,可以从整体上对住院医师临床学习环境的情况进行测评。为评估住院医师临床学习环境的情况,进一步提高住院医师临床学习环境的质量提供一种科学、有效的工具。(3)住院医师对于临床学习环境的评价总体较为满意,其中,影响住院医师临床学习环境得分的主要因素是轮转科室、培训医院,与性别、学历、培训身份、培训年限无明显关系。
[Abstract]:Objective: (1) To develop a scientific and objective resident doctor's clinical study environment evaluation scale in combination with the standardized training management of residents in our country, and to test the reliability and efficiency of the scale. in ord to evaluate that quality of the clinical study of residents in our country and to further improve the quality of the rotation, a scientific and effective tool is provide; and (2) the evaluation of the clinical study environment by the resident doctor and the professional degree graduate student is evaluated by using the compiled scale, To analyze the problems and deficiencies in the clinical study environment, to provide the basis for the improvement of the clinical study environment of residents, and to provide reference for the selection of related interventions. Methods: (1) The relevant documents such as the clinical study environment evaluation tool and the nursing clinical study environment evaluation tool of the resident in the home and abroad were studied, and the initial scale was drawn up with the expert interview method. (2) The hospital doctor's symposium was held, in combination with the actual situation of the standardized training of the residents in our country, the dimension and the entry were selected, and the assessment scale of the resident physician's clinical study environment was preliminarily formed. (3) The Delphi method was used to carry out two rounds of questionnaire survey on 16 experts, and the methods of issuing and recycling the questionnaire on site were adopted. The experts were asked to evaluate each dimension and item, and investigate the basis and degree of the expert's judgment on the content of the investigation. After each expert consultation, the positive coefficient, authority coefficient and coordination coefficient of the expert are calculated, and the dimension and entry are deleted by the boundary value method. After two-wheel Delphi method, the final scale includes the guide physician, the training atmosphere, the training quality improvement, the training condition and the colleague relationship. The medical safety is 6 dimensions, with a total of 40 entries. (4) A total of 960 residents and a total of 960 students from the standardized training base of the eight residents in Beijing were selected, and the reliability and the efficiency of the questionnaire were investigated. The reliability test adopts the reliability of the homogeneity and the retest reliability as the evaluation index, and the effect degree test adopts the content validity and the structure efficiency as the evaluation index. (5) The survey data of the valid questionnaire was introduced into the SPSS10.0 for statistical analysis. Results: (1) After two rounds of Delphi questionnaire, the positive coefficient of the experts was 100% and the degree of authority was: 0.858, 0.848, which indicated that the enthusiasm of the two rounds of questionnaire survey experts was very high, which was of great interest to the study, and the experts' authority was good, and the results of the study were reliable. (2) Cronbach with 6 dimensions of reliability, efficiency detection and scale The's-coefficient (homogeneity) range is in the range of 0.833-0.939, and the scale's overall Cronbach 'The correlation coefficient was 0.975, Pearson correlation coefficient (retest reliability) was 0.912, the average content validity coefficient was 0.940, and the cumulative contribution rate of 6 male factors was 67,897%. It is proved that the scale has a high degree of reliability and efficiency. (3) The results of the empirical study were as follows: the total score of the clinical study environment evaluation scale of the resident physician was 3.46 points, and the dimensions were equally divided in 3.23-3.67 points. Among them, the average score was the highest: the relationship between the co-workers (3.67-0.66) and the lowest average score: the improvement of the training quality (3.23-0.92); the average score was the highest: during the training, you and other residents in the hospital had a good relationship (4.04 to 0.64); Entries with the lowest average score: you have received relevant training to identify signs of work fatigue (2.83 to 1.15). The scores of different sex, education, identity and training life were compared with the scores of the clinical study environment. The value of P was more than 0.05, and the difference was not significant according to the level of P = 0. 05. The difference between the two aspects of the hospital and the training hospital is of statistical significance for the evaluation of the clinical study environment of the resident doctor or the professional degree graduate. Conclusion: (1) The experts selected in this study are representative, the dimensions involved in the scale, the entry selection is reasonable, and the results of the study are reliable. (2) The scale has good reliability and efficiency, and can be used as a whole to measure the situation of the resident's clinical study environment. In order to assess the situation of the resident's clinical study environment, the quality of the hospital's clinical study environment is further improved to provide a scientific and effective tool. (3) The resident physician is generally satisfied with the evaluation of the clinical study environment, among which, the main factors that affect the clinical study environment score of the resident are the rotary department and the training hospital, and there is no obvious relationship with the gender, the education degree, the training status and the training life.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1

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