Casapulla Sharon L
J Am Osteopath Assoc. 2017 Sep 1;117(9):577-585. doi: 10.7556/jaoa.2017.112.
Self-efficacy has been shown to play a role in medical students' choice of practice location. More physicians are needed in rural and urban underserved communities. Ohio University Heritage College of Osteopathic Medicine has a co-curricular training program in rural and urban underserved practice to address this shortage.
To assess whether participation in the co-curricular program in rural and urban underserved practice affects self-efficacy related to rural and underserved urban practice.
This cross-sectional study explored self-efficacy using Bandura's 5 sources of self-efficacy (vicarious learning, verbal persuasion, positive emotional arousal, negative emotional arousal, and performance accomplishments). A validated scale on self-efficacy for rural practice was expanded to include self-efficacy for urban underserved practice and e-mailed to all 707 medical students across 4 years of medical school. Composite rural and urban underserved self-efficacy scores were calculated. Scores from participants in the rural and urban underserved training program were compared with those who were not in the program.
Data were obtained from 277 students. In the overall sample, students who indicated that they grew up in a rural community reported significantly higher rural self-efficacy scores than those who did not grow up in a rural community (F1,250=27.56, P<.001). Conversely, students who indicated that they grew up in a nonrural community reported significantly higher urban underserved self-efficacy scores than those who grew up in a rural community (F1,237=7.50, P=.007). The participants who stated primary care as their career interest (n=122) had higher rural self-efficacy scores than the participants who reported a preference for generalist specialties (general surgery, general psychiatry, and general obstetrics and gynecology) or other specialties (n=155) (F2,249=7.16, P=.001). Students who participated in the rural and urban underserved training program (n=49) reported higher rural self-efficacy scores (mean [SD], 21.06 [5.06]) than those who were not in the program (19.22 [4.22]) (t65=2.36; P=.022; equal variances not assumed). The weakest source of self-efficacy for rural practice in participants was vicarious experience. The weakest source of urban underserved self-efficacy was verbal persuasion.
Opportunities exist for strengthening weaker sources of self-efficacy for rural practice, including vicarious experience and verbal persuasion. The findings suggest a need for longitudinal research into self-efficacy and practice type interest in osteopathic medical students.
自我效能感已被证明在医学生选择实习地点方面发挥作用。农村和城市服务欠缺社区需要更多医生。俄亥俄大学传统医学院开展了一项针对农村和城市服务欠缺地区实习的课外培训项目，以应对这一短缺问题。
评估参与农村和城市服务欠缺地区实习的课外项目是否会影响与农村及城市服务欠缺地区实习相关的自我效能感。
这项横断面研究使用班杜拉的5种自我效能感来源（替代性学习、言语劝说、积极情绪唤醒、消极情绪唤醒和绩效成就）来探究自我效能感。一个经过验证的农村实习自我效能量表被扩展，以纳入城市服务欠缺地区实习的自我效能感，并通过电子邮件发送给医学院4个年级的所有707名医学生。计算农村和城市服务欠缺地区自我效能感的综合得分。将参与农村和城市服务欠缺地区培训项目的学生得分与未参与该项目的学生得分进行比较。
共获得277名学生的数据。在总体样本中，表明自己在农村社区长大的学生报告的农村自我效能感得分显著高于那些并非在农村社区长大的学生（F1,250 = 27.56，P <.001）。相反，表明自己在非农村社区长大的学生报告的城市服务欠缺地区自我效能感得分显著高于在农村社区长大的学生（F1,237 = 7.50，P =.007）。将初级保健作为职业兴趣的参与者（n = 122）的农村自我效能感得分高于那些表示更喜欢全科专科（普通外科、普通精神病学和普通妇产科）或其他专科的参与者（n = 155）（F2,249 = 7.16，P =.001）。参与农村和城市服务欠缺地区培训项目的学生（n = 49）报告的农村自我效能感得分（均值[标准差]，21.06 [5.06]）高于未参与该项目的学生（19.22 [4.22]）（t65 = 2.36；P =.022；未假定方差齐性）。参与者中农村实习自我效能感最弱的来源是替代性经验。城市服务欠缺地区自我效能感最弱的来源是言语劝说。
存在加强农村实习自我效能感较弱来源的机会，包括替代性经验和言语劝说。研究结果表明需要对整骨医学生的自我效能感和实习类型兴趣进行纵向研究。
