目的 探讨内科住院医师对老年医学的执业意愿及其可能的影响因素。方法 选取北京大学3所附属医院的106名内科住院医师为研究对象。采用问卷调查法收集其对未来从事老年医学的意愿、对老年人态度(中文版加州大学洛杉矶分校的老年人态度量表,University of California at Los Angeles Geriatrics Attitudes Scale, UCLA-GAS)。采用多因素logistic回归分析可能影响执业意愿的因素。结果 106名内科住院医师中,55名(51.9%)内科住院医师选择未来从事老年医学。选择未来从事老年医学的住院医师UCLA-GAS评分为50.0(46.0,54.0)分,高于不选择从事老年医学的住院医师[46.0(43.0,50.0)]分,其差异具有统计学意义(Z=-3.72,P＜.001)。年龄越大(OR=1.536, 95%CI=1.203-1.963, P=0.001)、UCLA-GAS评分越高(OR=1.143, 95%CI=1.028-1.271, P=0.013)是住院医师选择从事老年医学的积极因素,对老年医学执业前景不乐观(OR=0.058, 95%CI=0.011-0.317, P=0.001)则是消极因素。结论 内科住院医师对老年医学的执业意愿尚可。年龄、对老年人的态度以及对老年医学执业前景不乐观的认知,将影响其从事老年医学的意愿。
Objective To explore the willingness of internal medicine residents to practice geriatrics and the possible influencing factors. Methods A cross-sectional questionnaire survey was conducted among the internal medicine residents in three affiliated hospitals of Peking University. The general information, willingness to engage in geriatrics in the future and attitude towards the elderly (UCAL-GAS scale) were collected. Multivariate logistic regression analysis was used to screen out the factors that may affect the willingness to practice. Results A total of 106 residents completed the questionnaire, of which 55 (51.9%) chose to engage in geriatrics in the future. The UCLA-GAS score of residents who chose to engage in geriatrics in the future was 50.0 (46.0,54.0), higher than those of residents who did not choose to engage in geriatrics [46.0 (43.0,50.0)], with a statistically significant difference (Z=-3.72, P=0.001). Higher age (OR=1.536, 95%CI=1.203-1.963, P=0.001), higher UCLA-GAS score (OR=1.143, 95%CI=1.028-1.271, P=0.013) were the positive factors for residents to engage in geriatrics, while the negative factor was being pessimistic about the prospect of geriatrics (OR=0.058, 95%CI=0.011-0.317, P=0.001). Conclusions Internal medicine residents in general have a high willingness to practice geriatrics. Age, attitude towards the elderly and pessimism about the prospect of geriatrics will affect the willingness of internal medicine residents to engage in geriatrics.
[1] 施小明. 我国老年流行病学研究进展[J]. 中华流行病学杂志,2021,42(10):1713-1721. DOI:10.3760/cma.j.cn112338-20210723-00582.
[2] 王秋梅, 王倩, 刘晓红, 等. 中国医学生对老年医学的执业意愿调查及干预研究[J].中华老年医学杂志,2021,40(2):232-236. DOI:10.3760/cma.j.issn.0254-9026.2021.02.021.
[3] Zhao H, Wu B, Shi J, et al. Chinese medical students' attitudes toward older adults and willingness to consider a career in geriatric medicine: A cross-sectional survey[J]. Teach Learn Med, 2020, 32(5):486-493. DOI:10.1080/10401334.2020.1784739.
[4] 程玲,张会君,李广,等. 中文版加利福尼亚大学老年患者态度量表的信效度[J]. 中国老年学杂志,2017,37(18):4641-4643. DOI:10.3969/j.issn.1005-9202.2017.18.100.
[5] 郭青, 覃巍. 临床医学专业学生对老年人的态度及其影响因素分析[J].中国社会医学杂志,2019,36(1):25-28. DOI:10.3969/j.issn.1673-5625.2019.01.008.
[6] 韩春蕾, 崔倩倩, 何然, 等. 医学生儿科就业意愿的影响因素分析[J].中华医学教育杂志,2018,38(1):28-31,49. DOI:10.3760/cma.j.issn.1673-677X.2018.01.006.
[7] Karikari G, Lohrmann DK, Huber L. Stimulators of medical students' interest in geriatric medicine-A Systematic Review[J]. Australas J Ageing, 2020,39(3):e226-e238. DOI:10.1111/ajag.12825.
[8] Liu YE, While AE, Norman IJ, et al. Health professionals' attitudes toward older people and older patients: a systematic review[J]. J Interprof Care, 2012, 26(5):397-409. DOI:10.3109/13561820.2012.702146.
[9] Lee M, Reuben DB, Ferrell BA. Multidimensional attitudes of medical residents and geriatrics fellows toward older people[J]. J Am Geriatr Soc, 2005,53(3):489-494. DOI:10.1111/j.1532-5415.2005.53170.x.
[10] Samra R, Cox T, Gordon AL, et al. Factors related to medical students' and doctors' attitudes towards older patients: a systematic review[J]. Age Ageing, 2017,46(6):911-919. DOI:10.1093/ageing/afx058.
[11] Leung S, Logiudice D, Schwarz J, et al. Hospital doctors' attitudes towards older people[J]. Intern Med J, 2011,41(4):308-314. DOI:10.1111/j.1445-5994.2009.02140.x.
[12] Hughes NJ, Soiza RL, Chua M, et al. Medical student attitudes toward older people and willingness to consider a career in geriatric medicine[J]. J Am Geriatr Soc, 2008,56(2):334-338. DOI:10.1111/j.1532-5415.2007.01552.x.
[13] Chua MP, Tan CH, Merchant R, et al. Attitudes of first-year medical students in Singapore towards older people and willingness to consider a career in geriatric medicine[J]. Ann Acad Med Singap, 2008,37(11):947-951.
[14] Wang CC, Liao WC, Kao MC, et al. Taiwanese medical and nursing student interest levels in and attitudes towards geriatrics[J]. Ann Acad Med Singap, 2009,38(3):230-236.
[15] Fitzgerald JT, Wray LA, Halter JB, et al. Relating medical students' knowledge, attitudes, and experience to an interest in geriatric medicine[J]. Gerontologist, 2003,43(6):849-855. DOI:10.1093/geront/43.6.849.
[16] Ní Chróinín D, Cronin E, Cullen W, et al. Would you be a geriatrician? Student career preferences and attitudes to a career in geriatric medicine[J]. Age Ageing, 2013,42(5):654-657. DOI:10.1093/ageing/aft093.
[17] 侯建林, 刘东明, 闫明辉, 等. 英国临床医学专业本科阶段老年医学教育与启示[J].中华医学教育探索杂志,2019,18(4):337-341. DOI:10.3760/cma.j.issn.2095-1485.2019.04.003.
[18] 侯建林, 刘东明, 闫明辉, 等. 美国医学生老年医学教育的特征与启示[J].中华医学教育杂志,2018,38(3):468-473. DOI:10.3760/cma.j.issn.1673-677X.2018.03.034.
[19] 邓琳子, 施红, 奚桓. 老年医学科医师继续医学教育现状与思考[J].中华医学教育杂志,2022,42(2):175-179. DOI:10.3760/cma.j.cn115259-20210924-01206.
[20] 王晓春, 卢明. 分层级目标培训对不同技术职称护理人员心理资本的影响研究[J].中华医学教育杂志,2016,36(5):698-701. DOI:10.3760/cma.j.issn.1673-677X.2016.05.016.
[21] 韩启德. 中国老年医学发展的方向[J].中华老年医学杂志,2015,34(7):697. DOI:10.3760/cma.j.issn.0254-9026.2015.07.001.
