目的 基于结构方程模型分析医学生职业素养影响因素,以期为促进医学生职业素养发展提供参考。方法 选取汕头大学医学院2015至2019级临床医学、护理学和口腔医学专业606名本科生为研究对象,采用问卷调查方法调查影响其职业素养发展水平自我认知的因素,并采用IBM SPSS 26.0和AMOS 24.0进行分析并构建结构方程模型。结果 课程满意度、朋辈交流、自我效能感、临床实践、教师素质、社会环境评价和学业负担等7个维度的得分分别为(50.28±7.26)分、(28.53±3.78)分、(15.53±2.88)分、(35.30±4.63)分、(35.04±4.73)分、(10.72±4.08)分和(18.75±4.40)分。课程满意度(β=0.36,P＜0.001)、朋辈交流(β=0.36,P＜0.001)、自我效能感(β=0.18,P=0.002)和临床实践(β=0.13,P=0.011)4项为医学生职业素养的直接正向影响因素;教师素质(β=0.30,P＜0.001)以课程满意度和临床实践为中介因素起间接正向作用;社会环境评价(β=-0.16,P＜0.001)以朋辈交流和课程满意度为中介因素起间接负向作用;学业负担(β=-0.09,P＜0.001)以自我效能感和朋辈交流为中介因素起间接负向作用。结论 课程满意度、朋辈交流、自我效能感和临床实践为医学生职业素养的直接正向影响因素;教师素质为间接正向影响因素;社会环境评价和学业负担为间接负向影响因素。以7个影响因素之间的作用路径为依据进行教学改革,可以促进医学生职业素养发展。

Objective To explore and evaluate the influencing factors on medical students' professionalism development based on a structural equation model so as to advance the professionalism development of medical students. Methods A total of 606 undergraduates majoring in clinical medicine, nursing and stomatology from 2015 to 2019 in Shantou University Medical School were selected as the research objects to identify seven influencing factors on self-perception of professionalism development. IBM SPSS 26.0 and AMOS 24.0 were used for data analysis and model construction. Results The scores of curriculum satisfaction, peers' communication, self-efficacy, clinical practice, teachers' professionalism, social environment assessment and academic burden were (50.28±7.26), (28.53±3.78), (15.53±2.88), (35.30±4.63), (35.04±4.73), (10.72±4.08) and (18.75±4.40) respectively. Curriculum satisfaction (β=0.36,P＜0.001),peers' communication (β=0.36,P＜0.001), self-efficacy(β=0.18,P=0.002) and clinical practice (β=0.13,P=0.011) are the direct positive influence factors to medical students' professionalism. Teachers' professionalism (β=0.30,P＜0.001) plays an indirect positive role through mediating factors of curriculum satisfaction and clinical practice. Social environment assessment (β=-0.16,P＜0.001) plays an indirect negative role through the mediating factors of peer communication and curriculum satisfaction. Academic burden (β=-0.09,P＜0.001) plays an indirect negative role through the mediating factors of self-efficacy and peer communication. Conclusions Course satisfaction, peer communication, self-efficacy and clinical practice are the direct and positive influencing factors of medical students' professionalism; teacher quality is the indirect positive influencing factor; social environment evaluation and academic burden are indirect negative influencing factors. Implementing reform measuresaccording to the role path of the 7 influencing factors in this study, can promote medical students' professionalism.