Tackett Sean, Wright Scott, Lubin Robert, Li Jianing, Pan Hui
Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, USA.
Department of Student Services, Technion American Medical Students Program, Haifa, Israel.
Med Educ. 2017 Mar;51(3):280-289. doi: 10.1111/medu.13120. Epub 2016 Nov 29.
To assess whether favourable perceptions of the learning environment (LE) were associated with better quality of life, less burnout and more empathy across three undergraduate medical education programmes in Israel, Malaysia and China.
Cross-sectional surveys were administered at the end of the 2013-2014 academic year at three medical schools: Technion American Medical Students Program (TAMS) in Israel, Perdana University-Royal College of Surgeons in Ireland School of Medicine (PURCSI) in Malaysia and Peking Union Medical College (PUMC) in China. LE perceptions were assessed using the Johns Hopkins Learning Environment Scale (JHLES). Well-being was assessed using validated items for quality of life and the depersonalisation and emotional exhaustion domains of burnout. The 20-item Jefferson Empathy Scale assessed empathy. Statistical analyses included bivariate regressions and multivariate regressions that adjusted for gender, school, class year and perceived academic rank.
Overall, 400/622 (64.3%) students responded, with the following rates by site: TAMS 92/121 (76.0%), PURCSI 160/198 (80.1%) and PUMC 148/303 (48.8%). In multivariate models, favourable overall LE perceptions were associated with higher odds of good quality of life (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.8-5.8; p < 0.001) and lower odds of emotional exhaustion (OR, 0.34; 95% CI, 0.24-0.50; p < 0.001) and depersonaliation (OR, 0.30; 95% CI, 0.24-0.37; p = 0.001). 'Community of Peers', one of seven factors in the JHLES, was the only one to be independently associated with better quality of life and less emotional exhaustion and depersonalisation. After adjusting for covariates, there was not a statistically significant association between overall LE and empathy (OR, 1.4; 95% CI, 0.91-2.2; p = 0.12).
Students' LE perceptions are closely associated with their well-being, and fostering peer community may hold promise for enhancing quality of life and protecting against burnout. Across these three settings, LE and empathy were not closely related, suggesting that any influence of learning environment on empathy would be modest.
评估在以色列、马来西亚和中国的三个本科医学教育项目中，对学习环境（LE）的良好认知是否与更好的生活质量、更少的职业倦怠以及更强的同理心相关。
在2013 - 2014学年末，对三所医学院进行了横断面调查：以色列的以色列理工学院美国医学生项目（TAMS）、马来西亚的马来西亚普特拉大学 - 爱尔兰皇家外科医学院医学系（PURCSI）以及中国的北京协和医学院（PUMC）。使用约翰霍普金斯学习环境量表（JHLES）评估对学习环境的认知。使用经过验证的生活质量项目以及职业倦怠的去个性化和情感耗竭领域的项目评估幸福感。使用20项杰斐逊同理心量表评估同理心。统计分析包括双变量回归和多变量回归，并对性别、学校、年级和感知到的学术排名进行了调整。
总体而言，622名学生中有400名（64.3%）做出了回应，各地点的回应率如下：TAMS为92/121（76.0%），PURCSI为160/198（80.1%），PUMC为148/303（48.8%）。在多变量模型中，对学习环境的总体良好认知与更高的良好生活质量几率（优势比[OR]，3.2；95%置信区间[CI]，1.8 - 5.8；p < 0.001）以及更低的情感耗竭几率（OR，0.34；95% CI，0.24 - 0.50；p < 0.001）和去个性化几率（OR，0.30；95% CI，0.24 - 0.37；p = 0.001）相关。JHLES七个因素之一的“同伴群体”是唯一与更好的生活质量以及更少的情感耗竭和去个性化独立相关的因素。在对协变量进行调整后，学习环境总体与同理心之间没有统计学上的显著关联（OR，1.4；95% CI，0.91 - 2.2；p = 0.12）。
学生对学习环境的认知与他们的幸福感密切相关，培养同伴群体可能有望提高生活质量并预防职业倦怠。在这三种情况下，学习环境与同理心没有密切关系，这表明学习环境对同理心的任何影响都将是适度的。
