目的 分析住院医师UpToDate临床顾问(简称UpToDate)使用效果的影响因素,为住院医师教学设计提供参考。方法 2021年7月,以甘肃、海南、江苏、山西和浙江5个省份52家住培基地的1 344名住院医师为研究对象,采用基本信息问卷,UpToDate临床顾问使用效果评分问卷及修订版Jefferson医生终身学习量表对其进行调查,采用分位数回归分析其UpToDate使用效果的影响因素,选取0.1~0.9 的9个十分位点建立9个分位数回归方程,其中0.1~0.3分位点、0.4~0.6分位点、0.7~0.9分位点分别为低分位评分组、中分位评分组和高分位评分组。结果 与博士研究生学历住院医师相比,其他学历住院医师在低分位评分组的UpToDate使用效果评分均增加10分以上;在中高分位评分组,与博士研究生学历住院医师相比,其他学历住院医师UpToDate使用效果评分变化均小于0。在3个评分组,住院医师的学习信念和动机每增加1个单位(1分),其UpToDate使用效果评分的变化从-0.33逐渐增加至1.33;在低分位评分组,住院医师的关注学习机会每增加1分,其UpToDate使用效果评分的变化在1.00浮动,而在中高分位评分组,其UpToDate使用效果评分的变化从1.00逐渐减小至0.20;在中低分位评分组,住院医师寻求信息的技能每增加1分,其UpToDate使用效果评分变化均在1.00浮动,而在高分位评分组,其UpToDate使用效果评分的变化从0.40减小到0.01以下。结论 住院医师的学历因素主要在低分位评分组影响其UpToDate使用效果,住院医师的学习信念和动机、关注学习机会、寻求信息的技能几乎在所有评分组影响其UpToDate临床顾问使用效果,可以对不同学历住院医师制定不同的培训方案,并注重培养住院医师的学习信念和动机、为住院医师提供学习机会,提升其寻求信息的技能。

Objective To analyze the influencing factors of residents′ benefit score using UpToDate clinical consultant (hereafter referred to as UpToDate), and to provide reference for the training of residents. Methods In July 2021, a total of 1 344 residents from 52standardized training bases for residents in five provinces of Gansu, Hainan, Jiangsu, Shanxi and Zhejiang were investigated by using the basic information questionnaire, the UpToDate benefit rating questionnaire and the revised Jefferson scale of physician lifelong learning, and quantile regression analysis will be used to analyze the influencing factors of their benefit score using UpToDate. In this study, 9 deciles were selected to establish 9 quantile regression equations, among which 0.1-0.3 quantiles were classified as group of low quantiles score, 0.4-0.6 as group of middle quantiles score, and 0.7-0.9 as group of high quantiles score. Results The UpToDate benefit score of other degrees residents increased by more than 10 points compared with doctor degree in the group of low quantiles score, and in the groups of middle and high quantiles score, the UpToDate benefit score of other degrees residents changed all less than 0 compared with doctor degree. In the all groups, for each additional point of the residents′ ″learning beliefs and motivation″, the change of the UpToDate benefit score gradually increased from -0.33 to 1.33; in the group of low quantiles score, for each additional point of ″attention to learning opportunities″ the change of the UpToDate benefit score fluctuated at 1.00, while in the groups of middle and high quantiles score, the change of the UpToDate benefit score gradually decreased from 1.00 to 0.20; in the groups of low and middle quantiles score, for each additional point of ″technical skills in seeking information″, the change of the benefit score was around 1.00, while in the group of high quantiles score, the change of the UpToDate benefit score decreased from 0.70 to less than 0.01. Conclusions Residents′ degrees mainly affected the UpToDate benefit score in group of low quantiles score, ″learning beliefs and motivation″, ″attention to learning opportunities″ and ″technical skills in seeking information″ affected the UpToDate benefit score in all groups. Different training programs can be developed for residents with different educational background, and measures should be taken to increase residents′ learning beliefs and motivation, to provide residents learning opportunities and to improve technical skills in seeking information.