中国医学研究生辍学意向的高发生率及其影响因素。
High prevalence and risk factors of dropout intention among Chinese medical postgraduates.
机构信息
National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Hunan, Changsha, China.
Department of Psychological Sciences, Texas Tech University, Lubbock, Tx, USA.
出版信息
Med Educ Online. 2022 Dec;27(1):2058866. doi: 10.1080/10872981.2022.2058866.
BACKGROUND
A high attrition rate in medical students has exacerbated the physician shortage in China. However, few studies have explored the risk factors of dropout intention in medical postgraduates. This study compared the prevalence of dropout intention and mental distress between medical and non-medical postgraduates in China and investigated risk factors for dropout intention. This study also explored the impact of medical postgraduates' perception of the Chinese healthcare environment on their mental status and dropout intention.
METHODS
This cross-sectional study was conducted using online questionnaires from October 2020 to April 2021. Convenience sampling was used to recruit postgraduates in different majors. Outcomes included dropout intention and potential risk factors, including mental distress, quality of life, and fatigue. Medical postgraduates were additionally assessed for healthcare environment satisfaction, burnout, career choice regret, and experiences of workplace violence. A logistic regression model was constructed to evaluate the association between dissatisfaction, mental distress, and turnover intention.
RESULTS
A total of 740 medical and 670 non-medical postgraduates participated in the survey. The rates of depression symptoms (33.8% vs. 39.0%, p < 0.001), anxiety symptoms (22.2% vs. 32.4%, p < 0.001), and somatic symptoms (34.7% vs. 42.4%, p = 0.004) were lower in medical postgraduates, while more medical postgraduates (58.4% vs. 48.4%, p < 0.001) reported dropout intention. Dissatisfaction with the healthcare environment (odds ratio [OR]: 1.65; 95% confidence interval [CI]: 1.17-2.34, p = 0.005), career choice regret (OR: 6.23; 95% CI: 4.42-8.78, p < 0.001), and high perceived stress (OR: 2.74; 95%CI: 1.90-3.94, p < 0.001) remained independently associated with turnover intention.
CONCLUSIONS
Mental distress is common among postgraduates, calling for timely interventions. Medical postgraduates reported higher turnover intention. Healthcare environment perception also affected the mental health and dropout intentions of medical students. A decent future income, reduced workload, shorter duration medical training, and better doctor-patient relationships are urgently needed.
背景
中国医学生的高淘汰率加剧了医生短缺。然而，很少有研究探讨医学研究生辍学意向的风险因素。本研究比较了中国医学和非医学研究生辍学意向和精神困扰的发生率，并探讨了辍学意向的风险因素。本研究还探讨了医学研究生对中国医疗环境的看法对其精神状态和辍学意向的影响。
方法
本横断面研究于 2020 年 10 月至 2021 年 4 月采用在线问卷进行。便利抽样招募不同专业的研究生。结果包括辍学意向和潜在的风险因素，包括精神困扰、生活质量和疲劳。还评估了医学研究生对医疗环境满意度、职业倦怠、职业选择后悔和工作场所暴力经历的满意度。构建逻辑回归模型评估不满、精神困扰与离职意愿的关系。
结果
共有 740 名医学和 670 名非医学研究生参与了调查。医学研究生的抑郁症状（33.8%比 39.0%，p<0.001）、焦虑症状（22.2%比 32.4%，p<0.001）和躯体症状（34.7%比 42.4%，p=0.004）发生率较低，而更多的医学研究生（58.4%比 48.4%，p<0.001）报告有辍学意向。对医疗环境的不满（比值比[OR]：1.65；95%置信区间[CI]：1.17-2.34，p=0.005）、职业选择后悔（OR：6.23；95%CI：4.42-8.78，p<0.001）和高感知压力（OR：2.74；95%CI：1.90-3.94，p<0.001）与离职意愿仍独立相关。
结论
研究生中精神困扰很常见，需要及时干预。医学研究生报告的离职意向较高。医疗环境感知也影响医学生的精神健康和辍学意向。急需更好的未来收入、减轻工作量、缩短医学培训时间和改善医患关系。
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