中医住院医师规培效果的影响因素分析:基于睡眠质量、职业倦怠的柯氏四级评估模型

    Analysis of influencing factors on the effectiveness of traditional standardized training for Chinese medicine residents: a kirkpatrick four-level evaluation model based on sleep quality and occupational burnout

    • 摘要:
      目的: 探讨规培学员睡眠质量、职业倦怠与中医住院医师规范化培训效果之间的关联,并分析其主要影响因素。
      方法: 采用整群调查方法,对安徽省6家国家级中医住院医师规范化培训基地的在培学员开展横断面调查,使用柯氏四级评估问卷、匹兹堡睡眠质量指数(PSQI)简化版及职业倦怠量表(MBI–GS)中文版进行测评。采用Mann–Whitney U检验、Kruskal–Wallis H检验、Spearman相关及线性回归等方法进行数据分析。
      结果: 学员睡眠质量差(PSQI>7分)者占31.9%,职业倦怠的学员占71.6%。相关分析显示,睡眠质量与柯氏评估各层级(反应层、学习层、行为层、结果层)评分均呈负相关关系(P < 0.01);职业倦怠与柯氏评估各层级(反应层、学习层、行为层、结果层)评分均呈负相关关系(P < 0.01)。多重线性回归分析进一步表明,去人格化(P < 0.01)与低个人成就感(P < 0.05)是培训整体效果(柯氏总分)的影响因素。
      结论: 中医规培学员的职业倦怠问题普遍且与培训效果显著负相关,去人格化与低个人成就感是损害培训效果的核心因素,应重视学员身心健康管理以提升培训质量。

       

      Abstract:
      Objective To explore the asscosiation between sleep quality, occupational burnout, and the effectiveness of standardized training for resident doctors in Traditional Chinese Medicine (TCM), and to analyze the main influencing factors.
      Methods Cluster sampling method was used to conduct a cross-sectional survey among the trainees of 6 national standardized training bases of TCM residents in Anhui Province. The Kirkpatrick Four-Level evaluation Questionnaire, the simplified Pittsburgh Sleep Quality Index (PSQI) and the Chinese version Maslach Burnout Inventory-General Survey (MBI-GS) were used for assessment. Data analysis was performed using the Mann-Whitney U test, Kruskal-Wallis H test, Spearman correlation, and linear regression methods.
      Results 31.9% of trainees had poor sleep quality (PSQI > 7), and 71.6% experienced occupational burnout. Correlation analysis showed that sleep quality was negatively correlated with scores at all Kirkpatrick evaluation levels (reaction, learning, behaviour, and results) (P < 0.01); occupational burnout was also negatively correlated with scores at all Kirkpatrick evaluation levels (P < 0.01). Multiple linear regression analysis further indicated that depersonalization (P < 0.01) and low sense of personal accomplishment (P < 0.05) were significant factors influencing overall training effectiveness (total Kirkpatrick score).
      Conclusions Occupational burnout is common among residents in the standardize TCM training programme and is significantly negatively correlated with training effectiveness. Depersonalization and low sense of personal accomplishment are key factors impairing training effectiveness. Attention should be paid to the management of residents' physical and mental health to enhance training quality.

       

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