在中国住院医师共情与自我感知临床绩效的关系中工作相关认知的中介作用：一项多中心横断面研究。

The mediating role of work-related perceptions in the relationship between empathy and self-perceived clinical performance of residents in China: A multi-center cross-sectional study.

机构信息

Institute for International Health Professions Education and Research, China Medical University, Shenyang 110122, PR China.

Department of Ophthalmology, The First Hospital of China Medical University, Shenyang 110000, PR China.

出版信息

Patient Educ Couns. 2024 Feb;119:108089. doi: 10.1016/j.pec.2023.108089. Epub 2023 Nov 23.

DOI:10.1016/j.pec.2023.108089

PMID:38008646

Abstract

OBJECTIVE

This study aimed to describe the association between empathy and residents' clinical performance and investigate whether work-related perception mediates this relationship.

METHODS

A multi-center cross-sectional study was conducted, including 1160 residents from 10 cities in Liaoning Province between March and October 2020. The participants completed various self-reported questionnaires regarding demographic characteristics, work-related perceptions, self-perceived clinical performance, and empathy. The relationships among empathy, work-related perception, and self-perceived clinical performance were examined using a structural equation model (SEM).

RESULTS

Of the 1160 residents, 961 (82.8 %) completed the questionnaires. The SEM path analysis showed that the direct effect of empathy on self-perceived clinical performance was significant and positive (β = 0.34, P < 0.001). There existed significant effects of empathy on work-related perception (β = 0.26, P < 0.001) and work-related perception on performance (β = 0.31, P < 0.001). The path coefficients of empathy concerning self-perceived clinical performance decreased significantly (β = 0.26, P < 0.001) when work-related perception was modeled as a mediator. The bias-corrected and accelerated bootstrap test revealed that work-related perception significantly mediated the relationship between empathy and self-perceived clinical performance (a*b = 0.08, BCa 95 % CI: 0.05-0.13). However, the correlation between the sub-scales of empathy and the items of self-perceived clinical performance was not substantial, even if most of them were statistically significant. The final SEM produced a good fit to the sample data, with CMIN/DF = 2.07 (P < 0.001), CFI = 0.99, GFI = 0.99, AGFI = 0.98, TLI = 0.98, NFI = 0.97, RMSEA (90 % CI) = 0.033 (0.017, 0.049), and SRMR = 0.024.

CONCLUSION

Empathy might significantly affect self-perceived clinical performance both directly and indirectly through the mediating role of work-related perception.

PRACTICE IMPLICATIONS

Efforts to improve clinical performance among residents might benefit from interventions for cultivating empathy and practices for improving work-related perceptions of residents.

摘要

目的

本研究旨在描述同理心与住院医师临床表现之间的关系，并探讨工作相关感知是否在其中起中介作用。

方法

本研究采用多中心横断面研究，于 2020 年 3 月至 10 月期间选取辽宁省 10 个城市的 1160 名住院医师作为研究对象。参与者完成了各种自我报告问卷，包括人口统计学特征、工作相关感知、自我感知临床表现和同理心。使用结构方程模型（SEM）检验同理心、工作相关感知与自我感知临床表现之间的关系。

结果

在 1160 名住院医师中，有 961 名（82.8%）完成了问卷。SEM 路径分析显示，同理心对自我感知临床表现的直接影响显著且为正（β=0.34，P<0.001）。同理心对工作相关感知（β=0.26，P<0.001）和工作相关感知对表现（β=0.31，P<0.001）均有显著影响。当将工作相关感知建模为中介变量时，同理心对自我感知临床表现的路径系数显著降低（β=0.26，P<0.001）。偏差校正和加速 bootstrap 检验显示，工作相关感知显著中介了同理心与自我感知临床表现之间的关系（a*b=0.08，BCa95%CI：0.05-0.13）。然而，同理心的子量表与自我感知临床表现项目之间的相关性并不显著，即使大多数项目具有统计学意义。最终的 SEM 对样本数据拟合良好，CMIN/DF=2.07（P<0.001），CFI=0.99，GFI=0.99，AGFI=0.98，TLI=0.98，NFI=0.97，RMSEA（90%CI）=0.033（0.017，0.049），SRMR=0.024。