目的 了解住院医师规范化培训(简称住培)学员医学叙事能力现状及其影响因素,为提高住培学员的医学叙事能力提供参考。方法 2022年2至3月,采用便利抽样方法,选取广东省某三级甲等医院住院医师规范化培训基地2019至2021年参加住培的220名学员为研究对象,采用一般资料调查问卷、医学叙事能力量表进行调查。采用多元线性回归方法分析相关数据。结果 共回收有效问卷206份。住培学员医学叙事能力评分为(141.39±22.94)分;多元线性回归分析结果显示,叙事知识储备程度(b=7.66,P=0.007)、职业满意程度(b=-5.23,P=0.003)评分越高的住培学员,医学叙事能力越强;与未婚和未参与志愿者服务的住培学员相比,婚姻状况为已婚(b=10.74,P=0.029)和参与志愿者服务(b=-7.20,P =0.025)的住培学员医学叙事能力越高。学员的婚姻状况、叙事知识储备程度、职业满意程度和是否参与志愿者服务4个变量共可以解释医学叙事能力评分总变异的21%。结论 住培学员医学叙事能力处于较弱水平。叙事知识储备程度和职业满意程度对住培学员的医学叙事能力产生正向影响。住培管理者应多关注未婚学员,积极组织住培学员参加志愿者服务活动和叙事医学知识的培训,提高职业满意度,从而进一步提高住培学员的医学叙事能力。
Objective To understand the current status of medical narrative ability and influencing factors for trainees receiving standardized residency training, and to inform the medical narrative ability of resident trainees. Methods From February to March 2022, a convenient sampling method was used to select 220 trainees who participated in standardized residency training from 2019 to 2021 in a third-level A hospital in Guangdong Province as the research participants, and general data questionnaire and medical narrative ability scale were used. Multiple linear regression was used to analyze the relevant data. Results A total of 206 valid questionnaires were collected.The score of medical narrative ability was (141.39±22.94). The results of multiple linear regression analysis showed that residents with higher levels of narrative knowledge reserve (b=7.66, P=0.007) and occupational satisfaction (b=-5.23, P=0.003) had stronger medical narrative abilities; Compared with unmarried and non-volunteer trainees, those who were married (b=10.74, P=0.029) and those who participate in volunteer services (b=-7.20, P=0.025) have higher medical narrative abilities. The four variables of trainees marital status, narrative knowledge reserve, occupational satisfaction, and participation in volunteer services can collectively explain 21% of the total variation in medical narrative ability scores. Conclusions The medical narrative ability status of resident trainees is at a low level. The degree of narrative knowledge reserve and occupational satisfaction have a positive impact. Educational managers for residency training should pay more attention to unmarried trainees, actively organize them to participate in volunteer service activities and narrative medical knowledge training, so as to improve career satisfaction, and further improve the medical narrative ability of resident trainees.
[1] Langellier K, Peterson E.Storytelling in daily life:performing narrative[M].Philadelphia, Temple University Press, 2004:1-5.
[2] 闫丹凤, 张宇娇, 曹小清. 叙事医学视角下的临床研究生医患沟通能力培养[J].基础医学教育,2019,21(5):417-420. DOI: 10.13754/j.issn2095-1450.2019.05.26.
[3] 马婉贞, 顾平, 张晶晶, 等. 医护人员医学叙事能力量表的编制及信效度检验[J].中华护理杂志,2020,55(4):578-583. DOI: 10.3761/j.issn.0254-1769.2019.04.019.
[4] 杨晓霖. 美国叙事医学课程对我国医学人文精神回归的启示[J].西北医学教育,2011,19(2):219-221,226. DOI: 10.3969/j.issn.1006-2769.2011.02.002.
[5] 陈汉白, 肖燕, 李昆秀, 等. 临床与基础医学博士生叙事医学认知、态度及态度转变对比研究[J].教育观察,2021(45):13-16.
[6] 崔金锐, 胡露红, 旷婉, 等. 临床护理人员人文关怀品质与医学叙事能力的相关性研究[J].护理学杂志,2021,36(9):58-60. DOI: 10.3870/j.issn.1001-4152.2021.09.058.
[7] 蒋玭露, 陈锐, 单仁飞, 等. 叙事医学在急诊科住院医师规范化培训教学中的应用研究[J].中国高等医学教育,2022(11):75-76. DOI: 10.3969/j.issn.1002-1701.2022.11.035.
[8] 李峥,刘宇.护理学研究方法[M].北京:人民卫生出版社,2018:65.
[9] 马婉贞.医护人员医学叙事能力量表的开发及信效度检验[D].南京:南京医科大学,2019.
[10] 田洁, 田丽, 张莉, 等. 肿瘤专科护士医学叙事能力的现状调查及影响因素分析[J].天津护理,2021,29(4):383-386. DOI: 10.3969/j.issn.1006-9143.2021.04.002.
[11] 王一方, 郭莉萍. 我国广义叙事医学发展的文献研究[J].中国医学伦理学,2019,32(2):153-159. DOI: 10.12026/j.issn.1001-8565.2019.02.04.
[12] 贾俊君, 陈韶华, 曹青, 等. 叙事医学在住院医师规范化培训教学和实践中的应用[J].叙事医学,2021,4(4):267-269.
[13] Biagioli V, Prandi C, Nyatanga B, et al. The role of professional competency in influencing job satisfaction and organizational citizenship behavior among palliative care nurses[J]. J Hosp Palliat Nurs, 2018,20(4):377-384. DOI: 10.1097/NJH.0000000000000454.
[14] Edwards SL. Narrative analysis: how students learn from stories of practice[J]. Nurse Res, 2016,23(3):18-25. DOI: 10.7748/nr.23.3.18.s5.
[15] 刘小珍, 李奕慧, 唐宏. 医护人员共情能力及影响因素调查分析[J].护理学杂志,2017,32(4):54-57. DOI: 10.3870/j.issn.1001-4152.2017.04.054.
[16] Kliszcz J, Nowicka-Sauer K, Trzeciak B, et al. Empathy in health care providers--validation study of the Polish version of the Jefferson Scale of Empathy[J]. Adv Med Sci, 2006,51:219-225.
[17] 陶俊杰, 邹明明, 杨晓霖, 等. 990名医务人员叙事医学认知调查报告之二[J].医学与哲学,2021,42(22):7-12. DOI: 10.12014/j.issn.1002-0772.2021.22.02.
[18] 王萍, 颜文贞, 黄秀凤, 等. 成人教育护生共情能力现状调查及影响因素分析[J].中华现代护理杂志,2016,22(35):5147-5149,5150. DOI: 10.3760/cma.j.issn.1674-2907.2016.35.032.
[19] 赵楚艺.长春市某三甲医院护士心理弹性及共情疲劳的调查研究[D].长春:长春中医药大学,2020.
