Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.
Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.
BMJ Open. 2017 Sep 24;7(9):e014462. doi: 10.1136/bmjopen-2016-014462.
Doctors' self-perceived mastery of clinical work might have an impact on their career and patient care, in addition to their own health and well-being. The aim of this study is to identify predictors at medical school of perceived mastery later in doctors' careers.
A cohort of medical students (n=631) was surveyed in the final year of medical school in 1993/1994 (T1), and 10 (T2) and 20 (T3) years later.
Nationwide healthcare institutions.
Medical students from all universities in Norway.
Perceived mastery of clinical work was measured at T2 and T3. The studied predictors measured at T1 included personality traits, medical school stress, perceived medical recording skills, identification with the role of doctor, hazardous drinking and drinking to cope, in addition to age and gender. Effects were studied using multiple linear regression models.
Response rates: T1, 522/631 (83%); T2, 390/522 (75%); and T3, 303/522 (58%). Mean scores at T2 and T3 were 22.3 (SD=4.2) and 24.5 (3.0) (t=8.2, p<0.001), with no gender difference. Adjusted associations at T2 were: role identification (β=0.16; p=0.006; 95% CI 0.05 to 0.28), perceived medical recording skills (β=0.13; p=0.02; 95% CI 0.02 to 0.24) and drinking to cope (β=-2.45; p=0.001; 95% CI -3.88 to -1.03). Adjusted association at T3 was perceived medical recording skills (β=0.11; p=0.015; 95% CI 0.02 to 0.21).
Perceived medical recording skills and role identification were associated with higher perceived mastery. Medical schools should provide experiences, teaching and assessment to enhance students' physician role identification and confidence in their own skills. Drinking to cope was associated with lower perceived mastery, which indicates the importance of acquiring healthier coping strategies in medical school.
医生对临床工作的自我掌握程度除了对其自身的健康和福祉产生影响外，可能还会影响其职业生涯和患者护理。本研究的目的是确定医学生时期哪些因素可以预测医生职业生涯后期的自我掌握程度。
1993/1994 年（T1 期），对 631 名医学生进行了一项队列研究，在他们最后一年的医学院学习中进行了调查，并在 10 年（T2 期）和 20 年（T3 期）后进行了随访。
全国医疗机构。
来自挪威所有大学的医学生。
T2 和 T3 时评估对临床工作的感知掌握程度。T1 时测量的研究预测指标包括人格特质、医学生压力、感知医疗记录技能、对医生角色的认同、危险饮酒和饮酒应对，以及年龄和性别。使用多元线性回归模型研究效应。
T1 期、T2 期和 T3 期的应答率分别为 522/631（83%）、390/522（75%）和 303/522（58%）。T2 期和 T3 期的平均得分分别为 22.3（SD=4.2）和 24.5（3.0）（t=8.2，p<0.001），性别之间无差异。T2 期调整后的关联为：角色认同（β=0.16；p=0.006；95%CI 0.050.28）、感知医疗记录技能（β=0.13；p=0.02；95%CI 0.020.24）和饮酒应对（β=-2.45；p=0.001；95%CI -3.88-1.03）。T3 期调整后的关联为感知医疗记录技能（β=0.11；p=0.015；95%CI 0.020.21）。
感知医疗记录技能和角色认同与更高的感知掌握程度相关。医学院应提供经验、教学和评估，以增强学生对医生角色的认同和对自身技能的信心。饮酒应对与较低的感知掌握程度相关，这表明在医学院获得更健康的应对策略的重要性。
