Wang Huihui, Ying Xinxin, Zhang Lujin, Yang Tingzhong, Zhang Weifang
Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Hangzhou 310006, China.
Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou 310006, China.
Healthcare (Basel). 2025 May 6;13(9):1080. doi: 10.3390/healthcare13091080.
BACKGROUND/OBJECTIVES: Medical students experience significant mental stress during clinical internships. This study aimed to assess the levels of uncertainty stress among medical interns, evaluate its temporal changes and associations with doctor-patient conflict and reference norm, and provide insights for stress-alleviating policies and educational initiatives.
A prospective longitudinal panel study was conducted; 131 medical students preparing for clinical internships were recruited via WeChat social media groups from June 2023 to June 2024. Data were collected at three time points using an online survey on Wenjuanxing: before the internship, three months into the internship, and after the internship. Variables such as uncertainty stress, doctor-patient conflict, and reference norm were measured, and data were analyzed using GEE and the GLMM program.
A total of 122 students completed all three waves of the study. Uncertainty stress decreased over the internship period (W = 7.25, < 0.05), while doctor-patient conflict increased (W = 6.65, < 0.05). Uncertainty stress was positively associated with the reference norm from teachers (β = 0.856, < 0.05) and doctor-patient conflict (β = 1.068, < 0.05).
Although uncertainty stress reduces as internships progress, doctor-patient conflict rises. A supportive learning environment, especially from teachers, is crucial for mitigating stress. Medical schools and hospitals should implement comprehensive strategies to address individual stressors and institutional factors, considering the associations between uncertainty stress, doctor-patient conflict, and reference norm. However, the study has limitations such as a small sample size and reliance on self-reported measures, indicating a need for further research.
背景/目的：医学生在临床实习期间会经历巨大的精神压力。本研究旨在评估医学实习生的不确定性压力水平，评估其随时间的变化以及与医患冲突和参照标准的关联，并为减轻压力的政策和教育举措提供见解。
进行了一项前瞻性纵向队列研究；2023年6月至2024年6月通过微信社交媒体群组招募了131名准备临床实习的医学生。使用问卷星在线调查在三个时间点收集数据：实习前、实习三个月后和实习结束后。测量了不确定性压力、医患冲突和参照标准等变量，并使用广义估计方程（GEE）和广义线性混合模型（GLMM）程序进行数据分析。
共有122名学生完成了研究的所有三个阶段。在实习期间，不确定性压力有所下降（W = 7.25，P < 0.05），而医患冲突有所增加（W = 6.65，P < 0.05）。不确定性压力与教师的参照标准呈正相关（β = 0.856，P < 0.05），与医患冲突也呈正相关（β = 1.068，P < 0.05）。
尽管随着实习的推进不确定性压力会降低，但医患冲突会增加。一个支持性的学习环境，尤其是来自教师的支持，对于减轻压力至关重要。医学院校和医院应实施综合策略来应对个体压力源和机构因素，同时考虑不确定性压力、医患冲突和参照标准之间的关联。然而，本研究存在样本量小和依赖自我报告测量等局限性，表明需要进一步研究。
