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中国医学生对医疗工作场所暴力和资源改革下降的工作意愿。

Working intentions of medical students in response to healthcare workplace violence and descending resources reform in China.

机构信息

Department of Stomatology, Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine (Preparatory Stage), Shanghai, China.

School of Finance and Business, Shanghai Normal University, No. 100, Guilin Road, Xuhui District, Shanghai, 200234, China.

出版信息

BMC Med Educ. 2022 May 9;22(1):351. doi: 10.1186/s12909-022-03428-1.

Abstract

BACKGROUND

In order to curb healthcare workplace violence (WPV) and better allocate healthcare resources, China launched the descending resources reform in 2013 and tightened the anti-violence legal environment simultaneously. Medical students are expected to reconsider their working intentions of entering the medical market (inter-market effect) and choosing high- or low-level hospitals (intra-market effect) in response to the evolving WPV. The goal of this study was to explore the link between the perceived WPV incidence and medical students' willingness to practice medicine in the context of China's descending resources reform.

METHOD

Medical students were selected with cluster sampling from 8 medical colleges in Zhejiang Province, China, and 1497 valid questionnaires were collected by using a five-point unbalanced scale, to perform cross-sectional empirical research using the ordered logit model (OLM).

RESULTS

The perceived WPV incidence negatively correlate with the willingness of medical students to practice medicine but positively correlate with their willingness to practice in low-level hospitals, indicating the existence of inter- and intra-market effects. The anti-violence legal environment has no direct link with working intention but contributes to the perceived decline in the incidence of violence. Descending resources reform has simultaneous opposite effects on medical students, with the coexistence of prudent motives driven by reform costs and optimistic expectations of sharing external benefits.

CONCLUSIONS

Safety needs and risk aversion motive play an important role in medical students' career choice when facing severe WPV. Tightening of the anti-violence legal environment and the descending resources reform could drive medical students to low-level hospitals.

摘要

背景

为了遏制医疗职场暴力(WPV)并更好地分配医疗资源,中国于 2013 年启动了资源下沉改革,同时加强了反暴力法律环境。预计医学生会重新考虑他们进入医疗市场的工作意向(市场间效应)和选择高低级别医院的意向(市场内效应),以应对不断变化的 WPV。本研究的目的是探讨在中国资源下沉改革背景下,感知到的 WPV 发生率与医学生从事医学工作的意愿之间的联系。

方法

采用整群抽样法,从中国浙江省的 8 所医学院中抽取医学生作为研究对象,采用五点非平衡量表收集了 1497 份有效问卷,采用有序逻辑回归模型(OLM)进行横断面实证研究。

结果

感知到的 WPV 发生率与医学生从事医学工作的意愿呈负相关,但与他们在低级别医院工作的意愿呈正相关,表明存在市场间和市场内效应。反暴力法律环境与工作意向没有直接联系,但有助于感知暴力发生率的下降。资源下沉改革对医学生同时产生了相反的影响,改革成本带来的谨慎动机和分享外部利益的乐观预期并存。

结论

在面临严重 WPV 时,安全需求和风险规避动机在医学生的职业选择中起着重要作用。加强反暴力法律环境和资源下沉改革可能会促使医学生流向低级别医院。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cc7a/9088100/19092ba483f2/12909_2022_3428_Fig1_HTML.jpg

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