住院醫(yī)師臨床學(xué)習(xí)環(huán)境評價量表的編制及實證研究
發(fā)布時間：2018-12-19 17:32
【摘要】：目的:(1)結(jié)合我國住院醫(yī)師規(guī)范化培訓(xùn)管理特點,編制一個科學(xué)的、客觀的住院醫(yī)師臨床學(xué)習(xí)環(huán)境評價量表,并對該量表進(jìn)行信度、效度檢驗。為評估我國住院醫(yī)師臨床學(xué)習(xí)環(huán)境質(zhì)量,進(jìn)一步提高輪轉(zhuǎn)質(zhì)量提供一種科學(xué)、有效的工具;(2)使用編制的量表測評住院醫(yī)師及專業(yè)學(xué)位研究生對臨床學(xué)習(xí)環(huán)境的評價,分析臨床學(xué)習(xí)環(huán)境中存在的問題及不足,為住院醫(yī)師臨床學(xué)習(xí)環(huán)境的改善提供依據(jù),同時為相關(guān)干預(yù)措施的選擇提供參照。方法:(1)對國內(nèi)外住院醫(yī)師臨床學(xué)習(xí)環(huán)境評價工具及護(hù)理臨床學(xué)習(xí)環(huán)境評價工具等相關(guān)文獻(xiàn)進(jìn)行研究,結(jié)合專家訪談法擬定初始量表。(2)召開住院醫(yī)師座談會,結(jié)合我國住院醫(yī)師規(guī)范化培訓(xùn)的實際情況,對維度、條目進(jìn)行篩選,初步形成了住院醫(yī)師臨床學(xué)習(xí)環(huán)境評價量表。(3)運用德爾菲法對16名專家先后進(jìn)行兩輪問卷調(diào)查,采取現(xiàn)場發(fā)放并回收問卷的方式,請專家們對各個維度、條目進(jìn)行評價,并調(diào)查專家對調(diào)查內(nèi)容的判別依據(jù)和了解程度。每輪專家咨詢結(jié)束后,計算專家的積極系數(shù)、權(quán)威系數(shù)、協(xié)調(diào)系數(shù),用界值法刪選維度和條目,經(jīng)過兩輪德爾菲法,最終量表包括指導(dǎo)醫(yī)師、培訓(xùn)氛圍、培訓(xùn)質(zhì)量改善、培訓(xùn)條件、同事關(guān)系、醫(yī)療安全6個維度,共40個條目。(4)選擇北京市8家住院醫(yī)師規(guī)范化培訓(xùn)基地的住院醫(yī)師及專業(yè)學(xué)位研究生,共計960人,進(jìn)行問卷調(diào)查,檢驗量表的信度和效度。其中信度檢驗采用同質(zhì)信度和重測信度為評價指標(biāo),效度檢驗采用內(nèi)容效度和結(jié)構(gòu)效度作為評價指標(biāo)。(5)將有效問卷的調(diào)查數(shù)據(jù)導(dǎo)入SPSS20.0,進(jìn)行統(tǒng)計學(xué)分析。結(jié)果:(1)經(jīng)過兩輪德爾菲問卷調(diào)查,得到專家的積極系數(shù)均為100%,權(quán)威程度系數(shù)分別為:0.858、0.848,說明兩輪問卷調(diào)查專家積極性都很高,對本研究很感興趣,且專家們的權(quán)威性較好,研究結(jié)果可靠。(2)經(jīng)過信度、效度檢測,量表6個維度的Cronbach' s α系數(shù)(同質(zhì)信度)范圍在0.833-0.939,量表總體Cronbach' s α系數(shù)為0.975,Pearson相關(guān)系數(shù)(重測信度)為0.912;平均內(nèi)容效度系數(shù)為0.940,6個公因子累積貢獻(xiàn)率達(dá)67.897%。說明此量表具有較高的信度、效度。(3)經(jīng)實證研究,得到:①住院醫(yī)師臨床學(xué)習(xí)環(huán)境評價量表的總均分為3.46分,各維度均分在3.23-3.67分。其中,平均分最高的維度:同事關(guān)系(3.67±0.66)分,平均分最低的維度:培訓(xùn)質(zhì)量改善(3.23±0.92)分;平均分最高的條目:培訓(xùn)期間,你和醫(yī)院內(nèi)其他在培住院醫(yī)師關(guān)系融洽(4.04土0.64)分;平均分最低的條目:你接受過識別工作疲勞跡象的相關(guān)培訓(xùn)(2.83±1.15)分。②不同性別、學(xué)歷、身份、培訓(xùn)年限的住院醫(yī)師或?qū)I(yè)學(xué)位研究生對臨床學(xué)習(xí)環(huán)境的評分分別進(jìn)行比較,P值均大于0.05,按α =0.05的水準(zhǔn),差異無統(tǒng)計學(xué)意義。③住院醫(yī)師或?qū)I(yè)學(xué)位研究生對于臨床學(xué)習(xí)環(huán)境的評價在輪轉(zhuǎn)科室、培訓(xùn)醫(yī)院兩個方面的比較差異有統(tǒng)計學(xué)意義。結(jié)論:(1)本研究遴選的專家具有代表性,量表涉及的維度、條目篩選合理,研究結(jié)果可靠。(2)該量表具有良好的信度和效度,可以從整體上對住院醫(yī)師臨床學(xué)習(xí)環(huán)境的情況進(jìn)行測評。為評估住院醫(yī)師臨床學(xué)習(xí)環(huán)境的情況,進(jìn)一步提高住院醫(yī)師臨床學(xué)習(xí)環(huán)境的質(zhì)量提供一種科學(xué)、有效的工具。(3)住院醫(yī)師對于臨床學(xué)習(xí)環(huán)境的評價總體較為滿意,其中,影響住院醫(yī)師臨床學(xué)習(xí)環(huán)境得分的主要因素是輪轉(zhuǎn)科室、培訓(xùn)醫(yī)院,與性別、學(xué)歷、培訓(xùn)身份、培訓(xùn)年限無明顯關(guān)系。
[Abstract]:Objective: (1) To develop a scientific and objective resident doctor's clinical study environment evaluation scale in combination with the standardized training management of residents in our country, and to test the reliability and efficiency of the scale. in ord to evaluate that quality of the clinical study of residents in our country and to further improve the quality of the rotation, a scientific and effective tool is provide; and (2) the evaluation of the clinical study environment by the resident doctor and the professional degree graduate student is evaluated by using the compiled scale, To analyze the problems and deficiencies in the clinical study environment, to provide the basis for the improvement of the clinical study environment of residents, and to provide reference for the selection of related interventions. Methods: (1) The relevant documents such as the clinical study environment evaluation tool and the nursing clinical study environment evaluation tool of the resident in the home and abroad were studied, and the initial scale was drawn up with the expert interview method. (2) The hospital doctor's symposium was held, in combination with the actual situation of the standardized training of the residents in our country, the dimension and the entry were selected, and the assessment scale of the resident physician's clinical study environment was preliminarily formed. (3) The Delphi method was used to carry out two rounds of questionnaire survey on 16 experts, and the methods of issuing and recycling the questionnaire on site were adopted. The experts were asked to evaluate each dimension and item, and investigate the basis and degree of the expert's judgment on the content of the investigation. After each expert consultation, the positive coefficient, authority coefficient and coordination coefficient of the expert are calculated, and the dimension and entry are deleted by the boundary value method. After two-wheel Delphi method, the final scale includes the guide physician, the training atmosphere, the training quality improvement, the training condition and the colleague relationship. The medical safety is 6 dimensions, with a total of 40 entries. (4) A total of 960 residents and a total of 960 students from the standardized training base of the eight residents in Beijing were selected, and the reliability and the efficiency of the questionnaire were investigated. The reliability test adopts the reliability of the homogeneity and the retest reliability as the evaluation index, and the effect degree test adopts the content validity and the structure efficiency as the evaluation index. (5) The survey data of the valid questionnaire was introduced into the SPSS10.0 for statistical analysis. Results: (1) After two rounds of Delphi questionnaire, the positive coefficient of the experts was 100% and the degree of authority was: 0.858, 0.848, which indicated that the enthusiasm of the two rounds of questionnaire survey experts was very high, which was of great interest to the study, and the experts' authority was good, and the results of the study were reliable. (2) Cronbach with 6 dimensions of reliability, efficiency detection and scale The's-coefficient (homogeneity) range is in the range of 0.833-0.939, and the scale's overall Cronbach 'The correlation coefficient was 0.975, Pearson correlation coefficient (retest reliability) was 0.912, the average content validity coefficient was 0.940, and the cumulative contribution rate of 6 male factors was 67,897%. It is proved that the scale has a high degree of reliability and efficiency. (3) The results of the empirical study were as follows: the total score of the clinical study environment evaluation scale of the resident physician was 3.46 points, and the dimensions were equally divided in 3.23-3.67 points. Among them, the average score was the highest: the relationship between the co-workers (3.67-0.66) and the lowest average score: the improvement of the training quality (3.23-0.92); the average score was the highest: during the training, you and other residents in the hospital had a good relationship (4.04 to 0.64); Entries with the lowest average score: you have received relevant training to identify signs of work fatigue (2.83 to 1.15). The scores of different sex, education, identity and training life were compared with the scores of the clinical study environment. The value of P was more than 0.05, and the difference was not significant according to the level of P = 0. 05. The difference between the two aspects of the hospital and the training hospital is of statistical significance for the evaluation of the clinical study environment of the resident doctor or the professional degree graduate. Conclusion: (1) The experts selected in this study are representative, the dimensions involved in the scale, the entry selection is reasonable, and the results of the study are reliable. (2) The scale has good reliability and efficiency, and can be used as a whole to measure the situation of the resident's clinical study environment. In order to assess the situation of the resident's clinical study environment, the quality of the hospital's clinical study environment is further improved to provide a scientific and effective tool. (3) The resident physician is generally satisfied with the evaluation of the clinical study environment, among which, the main factors that affect the clinical study environment score of the resident are the rotary department and the training hospital, and there is no obvious relationship with the gender, the education degree, the training status and the training life.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R197.1
本文編號：2387239
[Abstract]:Objective: (1) To develop a scientific and objective resident doctor's clinical study environment evaluation scale in combination with the standardized training management of residents in our country, and to test the reliability and efficiency of the scale. in ord to evaluate that quality of the clinical study of residents in our country and to further improve the quality of the rotation, a scientific and effective tool is provide; and (2) the evaluation of the clinical study environment by the resident doctor and the professional degree graduate student is evaluated by using the compiled scale, To analyze the problems and deficiencies in the clinical study environment, to provide the basis for the improvement of the clinical study environment of residents, and to provide reference for the selection of related interventions. Methods: (1) The relevant documents such as the clinical study environment evaluation tool and the nursing clinical study environment evaluation tool of the resident in the home and abroad were studied, and the initial scale was drawn up with the expert interview method. (2) The hospital doctor's symposium was held, in combination with the actual situation of the standardized training of the residents in our country, the dimension and the entry were selected, and the assessment scale of the resident physician's clinical study environment was preliminarily formed. (3) The Delphi method was used to carry out two rounds of questionnaire survey on 16 experts, and the methods of issuing and recycling the questionnaire on site were adopted. The experts were asked to evaluate each dimension and item, and investigate the basis and degree of the expert's judgment on the content of the investigation. After each expert consultation, the positive coefficient, authority coefficient and coordination coefficient of the expert are calculated, and the dimension and entry are deleted by the boundary value method. After two-wheel Delphi method, the final scale includes the guide physician, the training atmosphere, the training quality improvement, the training condition and the colleague relationship. The medical safety is 6 dimensions, with a total of 40 entries. (4) A total of 960 residents and a total of 960 students from the standardized training base of the eight residents in Beijing were selected, and the reliability and the efficiency of the questionnaire were investigated. The reliability test adopts the reliability of the homogeneity and the retest reliability as the evaluation index, and the effect degree test adopts the content validity and the structure efficiency as the evaluation index. (5) The survey data of the valid questionnaire was introduced into the SPSS10.0 for statistical analysis. Results: (1) After two rounds of Delphi questionnaire, the positive coefficient of the experts was 100% and the degree of authority was: 0.858, 0.848, which indicated that the enthusiasm of the two rounds of questionnaire survey experts was very high, which was of great interest to the study, and the experts' authority was good, and the results of the study were reliable. (2) Cronbach with 6 dimensions of reliability, efficiency detection and scale The's-coefficient (homogeneity) range is in the range of 0.833-0.939, and the scale's overall Cronbach 'The correlation coefficient was 0.975, Pearson correlation coefficient (retest reliability) was 0.912, the average content validity coefficient was 0.940, and the cumulative contribution rate of 6 male factors was 67,897%. It is proved that the scale has a high degree of reliability and efficiency. (3) The results of the empirical study were as follows: the total score of the clinical study environment evaluation scale of the resident physician was 3.46 points, and the dimensions were equally divided in 3.23-3.67 points. Among them, the average score was the highest: the relationship between the co-workers (3.67-0.66) and the lowest average score: the improvement of the training quality (3.23-0.92); the average score was the highest: during the training, you and other residents in the hospital had a good relationship (4.04 to 0.64); Entries with the lowest average score: you have received relevant training to identify signs of work fatigue (2.83 to 1.15). The scores of different sex, education, identity and training life were compared with the scores of the clinical study environment. The value of P was more than 0.05, and the difference was not significant according to the level of P = 0. 05. The difference between the two aspects of the hospital and the training hospital is of statistical significance for the evaluation of the clinical study environment of the resident doctor or the professional degree graduate. Conclusion: (1) The experts selected in this study are representative, the dimensions involved in the scale, the entry selection is reasonable, and the results of the study are reliable. (2) The scale has good reliability and efficiency, and can be used as a whole to measure the situation of the resident's clinical study environment. In order to assess the situation of the resident's clinical study environment, the quality of the hospital's clinical study environment is further improved to provide a scientific and effective tool. (3) The resident physician is generally satisfied with the evaluation of the clinical study environment, among which, the main factors that affect the clinical study environment score of the resident are the rotary department and the training hospital, and there is no obvious relationship with the gender, the education degree, the training status and the training life.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R197.1
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