计划行为理论视域下医师职业行为形成机制与教育策略的研究与启示

doi:10.3760/cma.j.cn115259-20230626-00620

中华医学教育杂志 ›› 2024, Vol. 44 ›› Issue (5): 325-329.DOI: 10.3760/cma.j.cn115259-20230626-00620

计划行为理论视域下医师职业行为形成机制与教育策略的研究与启示

辛春雨¹, 丁宁², 李鸿鹤¹, 闻德亮³

¹中国医科大学国际医学教育研究院课程与教学研究室,沈阳 110122;
²中国医科大学国际医学教育研究院教育技术研究室,沈阳 110122;
³中国医科大学国际医学教育研究院,沈阳 110122

收稿日期:2023-06-26 出版日期:2024-05-01 发布日期:2024-04-30
通讯作者: 闻德亮,Email:dlwen@cmu.edu.cn
基金资助:
2021年度辽宁省社会科学规划基金教育学项目(L21DED010);2022年度辽宁省教育厅基本科研项目(LJKMR20221216)

Research and implications on formation mechanism and educational strategies of physicians′ professional behavior through the lens of the theory of planned behavior

Xin Chunyu¹, Ding Ning², Li Honghe¹, Wen Deliang³

¹Department of Curriculum and Teaching, Institute for International Health Professions Education and Research, China Medical University, Shenyang 110122, China;
²Department of Educational Technology, Institute for International Health Professions Education and Research, China Medical University, Shenyang 110122, China;
³Institute for International Health Professions Education and Research, China Medical University, Shenyang 110122, China

Received:2023-06-26 Online:2024-05-01 Published:2024-04-30
Contact: Wen Deliang, Email: dlwen@cmu.edu.cn
Supported by:
Education Program of Social Science Planning Fund of Liaoning Province in 2021 (L21DED010); Fundamental Research Fund of Liaoning Provincial Department of Education in 2022 (LJKMR20221216)

摘要/Abstract

摘要： 医师的职业行为对于医疗服务质量和患者健康至关重要,是继续医学教育的重要关注点。深入探究医师职业行为背后的主观决策机制,是理解和预测职业行为的关键所在。计划行为理论作为广泛应用且验证有效的理论框架,为职业行为研究拓展了视野。本文在系统梳理国内外相关研究的基础上,运用计划行为理论,基于态度、主观规范和知觉行为控制3个模块,剖析职业行为的影响因素和形成机制。研究表明,医师对于职业行为能否改善患者健康的评估,患者及其家属施加的社会压力,以及医师自身的专业知识技能和对职业行为过程的控制能力,均对医师职业行为产生重要影响。基于此,总结了医师职业行为的教育策略,旨在为未来医师职业行为的继续医学教育提供理论和实践依据。

关键词: 医师, 计划行为理论, 职业行为, 形成机制, 教育策略

Abstract: Physician′s professional behavior, a significant focus of continuing medical education, greatly impacts the quality of healthcare and the health outcomes of patients. Exploring the subjective decision-making mechanisms of physicians′ professional behavior is key to understanding and predicting them. The theory of planned behavior is a theoretical framework commonly used and widely proven effective, which broadened the theoretical perspective for professional behavior research. Drawing from a systematic review of relevant research, the study analyzed the influencing factors and formation mechanisms of professional behaviors from three perspectives: attitudes toward professional behavior, subjective norms, and perceived behavioral control based on the theory of planned behavior. Findings indicated that physicians′ assessment of whether their professional behaviors can improve patients′ health, the social pressure from patients and their families, as well as physicians′ knowledge and skills and control over the practice process exerted significant influence on their professional behaviors. Based on the above three perspectives, the study summarized the educational strategies for professional behaviors, aiming to provide theoretical and practical basis for future research on the continuing medical education of physicians′ professional behavior.

Key words: Physician, Theory of planned behavior, Professional behavior, Formation mechanism, Educational strategy

中图分类号:

辛春雨, 丁宁, 李鸿鹤, 闻德亮. 计划行为理论视域下医师职业行为形成机制与教育策略的研究与启示[J]. 中华医学教育杂志, 2024, 44(5): 325-329.

Xin Chunyu, Ding Ning, Li Honghe, Wen Deliang. Research and implications on formation mechanism and educational strategies of physicians′ professional behavior through the lens of the theory of planned behavior[J]. Chinese Journal of Medical Education, 2024, 44(5): 325-329.

参考文献

[1] 孙杨. 社会认知理论视角下医生职业行为研究的制约和突破[J].中国医院管理,2015,35(12):100-102.
[2] 白琳茹, 叶梅, 何欢, 等. 医院继续医学教育管理现状与对策[J].中国继续医学教育,2023,15(19):147-152. DOI: 10.3969/j.issn.1674-9308.2023.19.034.
[3] 郭远美, 贾雪梅, 朱俊勇, 等. 我国全科医师继续教育的现状及对策[J].中华医学教育杂志,2020,40(9):717-720. DOI: 10.3760/cma.j.cn115259-20191023-00882.
[4] Yip WC, Hsiao W, Meng Q, et al. Realignment of incentives for health-care providers in China[J]. Lancet, 2010,375(9720):1120-1130. DOI: 10.1016/S0140-6736(10)60063-3.
[5] Godin G,Bélanger-Gravel A, Eccles M, et al. Healthcare professionals′ intentions and behaviours: a systematic review of studies based on social cognitive theories[J]. Implement Sci, 2008,3:36. DOI: 10.1186/1748-5908-3-36.
[6] Ajzen I. The theory of planned behavior[J].Organ Behav Hum Decis Process, 1991, 50(2):179-211. DOI:10.1016/0749-5978(91)90020-T.
[7] 段文婷, 江光荣. 计划行为理论述评[J].心理科学进展,2008,16(2):315-320.
[8] Hrisos S, Eccles MP, Francis JJ, et al. Using psychological theory to understand the clinical management of type 2 diabetes in primary care: a comparison across two European countries[J]. BMC Health Serv Res, 2009,9:140. DOI: 10.1186/1472-6963-9-140.
[9] Taylor CG Jr, Taylor G,Atherley A, et al. Barbados insulin matters (BIM) study: perceptions on insulin initiation by primary care doctors in the Caribbean island of Barbados[J]. Prim Care Diabetes, 2017,11(2):140-147. DOI: 10.1016/j.pcd.2016.10.001.
[10] Leng Y, Wu Y, Wang Z, et al. A qualitative study exploring barriers and facilitators to establishing nurse-led, multidisciplinary psychological care for trauma patients: experiences from doctors and nurses[J]. BMC Nurs, 2022,21(1):191. DOI: 10.1186/s12912-022-00971-6.
[11] Pierce D, Gunn J. GPs′ use of problem solving therapy for depression: a qualitative study of barriers to and enablers of evidence based care[J]. BMC Fam Pract, 2007,8:24. DOI: 10.1186/1471-2296-8-24.
[12] Ponnet K, Wouters E, Van Hal G, et al. Determinants of physicians′ prescribing behaviour of methylphenidate for cognitive enhancement[J]. Psychol Health Med, 2014,19(3):286-295. DOI: 10.1080/13548506.2013.802361.
[13] Tsiantou V, Shea S, Martinez L, et al. Eliciting general practitioners′ salient beliefs towards prescribing: a qualitative study based on the theory of planned behaviour in Greece[J]. J Clin Pharm Ther, 2013,38(2):109-114. DOI: 10.1111/jcpt.12037.
[14] 朱玄, 陈高洁, 褚淑贞. 基于计划行为理论的医师处方基本药物行为实证研究[J].中国药房,2014,25(32):2977-2979. DOI: 10.6039/j.issn.1001-0408.2014.32.01.
[15] Cruess RL, Cruess SR, Steinert Y. Amending Miller′s pyramid to include professional identity formation[J]. Acad Med, 2016,91(2):180-185. DOI: 10.1097/ACM.0000000000000913.
[16] Zielińska-Tomczak, Cerbin-Koczorowska M, Przymusza a P, et al. How to effectively promote interprofessional collaboration? -a qualitative study on physicians′ and pharmacists′ perspectives driven by the theory of planned behavior[J]. BMC Health Serv Res, 2021,21(1):903. DOI: 10.1186/s12913-021-06903-5.
[17] 朱艳梅. 医师处方行为分析:基于计划行为理论模型的构建[J].药品评价,2012,9(17):16-19. DOI: 10.3969/j.issn.1672-2809.2012.17.003.
[18] McNulty CA, Hogan AH, Ricketts EJ, et al. Increasing chlamydia screening tests in general practice: a modified Zelen prospective cluster randomised controlled trial evaluating a complex intervention based on the theory of planned behaviour[J]. Sex Transm Infect, 2014,90(3):188-194. DOI: 10.1136/sextrans-2013-051029.
[19] Lionis C, Petelos E, Shea S, et al. Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries[J]. BMC Fam Pract, 2014,15:34. DOI: 10.1186/1471-2296-15-34.
[20] Perkins MB, Jensen PS, Jaccard J, et al. Applying theory-driven approaches to understanding and modifying clinicians′ behavior: what do we know?[J]. Psychiatr Serv, 2007,58(3):342-348. DOI: 10.1176/ps.2007.58.3.342.
[21] Casper ES. The theory of planned behavior applied to continuing education for mental health professionals[J].Psychiatr Serv, 2007,58(10):1324-1329. DOI: 10.1176/ps.2007.58.10.1324.
[22] 曹志辉, 臧春光, 赵燕, 等. 医师医院感染病例报告意愿的影响机制及干预策略[J].中国消毒学杂志,2016,33(3):298-300. DOI: 10.11726/j.issn.1001-7658.2016.03.039.
[23] Rhodes RE, Yao CA. Models accounting for intention-behavior discordance in the physical activity domain: a user′s guide, content overview, and review of current evidence[J]. Int J Behav Nutr Phys Act, 2015,12:9. DOI: 10.1186/s12966-015-0168-6.
[24] Rich A,Brandes K, Mullan B, et al. Theory of planned behavior and adherence in chronic illness: a meta-analysis[J]. J Behav Med, 2015,38(4):673-688. DOI: 10.1007/s10865-015-9644-3.
[25] 王雯沁, 吴敏娟, 花芸, 等. 时限性自我调节理论在健康行为中的应用现状及展望[J].护理学报,2023,30(4):43-48. DOI: 10.16460/j.issn1008-9969.2023.04.043.
[26] Ajzen I, Fishbein M. Questions raised by a reasoned action approach: comment on Ogden (2003)[J]. Health Psychol, 2004,23(4):431-434. DOI: 10.1037/0278-6133.23.4.431.
[27] Sassen B, Kok G, Vanhees L. Predictors of healthcare professionals′ intention and behaviour to encourage physical activity in patients with cardiovascular risk factors[J]. BMC Public Health, 2011,11:246. DOI: 10.1186/1471-2458-11-246.
[28] Siddiqui ZS. Exploring the career maze:an investigation of career intentions of medical graduates in Pakistan: a qualitative study[J]. Pak J Med Sci, 2019,35(5):1456-1460. DOI: 10.12669/pjms.35.5.465.

计划行为理论视域下医师职业行为形成机制与教育策略的研究与启示

Research and implications on formation mechanism and educational strategies of physicians′ professional behavior through the lens of the theory of planned behavior

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