目的 探讨江苏省住院医师规范化培训(简称住培)保障因素对培训质量的影响机制,为优化住培管理体系提供参考。方法 采用问卷调查方法。2024年4至6月,通过分层随机整群抽样方法,选取江苏省13个地级市的543名住院医师为研究对象,调查江苏省住培保障和培训质量的现状,通过因子分析明确住培保障因素,构建结构方程模型分析住培保障因素对培训质量的影响路径,并运用Bootstrap方法检验住院医师学习投入在保障因素和培训质量之间的中介效应。结果 探索性因子分析结果显示,住培保障因素包含结构保障、过程保障与教学保障3类核心因子;结构方程模型分析结果显示,结构保障(β=0.340)、过程保障(β=0.155)、教学保障(β=0.261)均对培训质量具有显著正向影响(均P<0.05);中介效应分析发现,学习投入在结构保障对培训质量的影响中起到了部分中介作用(间接效应48.3%),在过程保障对培训质量的影响中起到了完全中介作用(间接效应84.7%),但在教学保障对培训质量的影响中无中介效应。结论 提升住培质量需要优先强化结构保障(如资源配置),完善过程管理(如工资待遇),提升教学水平(如师资培训),并激活学习投入的传导机制,从而提高住培质量,推动医疗卫生事业高质量发展。

Objective To explore the influence mechanisms of assurance factors within Jiangsu Province′s Standardized residency training (SRT) on training quality, and to inform future optimization of the management framework of Standardized residency training. Methods A questionnaire-based study was conducted from April to June 2024. Using stratified random cluster sampling, 543 residents from 13 prefecture-level cities in Jiangsu Province were selected to assess the current status of SRT assurance factors and training quality. Factor analysis was conducted to identify critical components of the assurance factors, followed by structural equation modeling (SEM) to analyze their impact pathways on training quality. Bootstrap testing was applied to examine the mediating role of residents′ learning engagement between safeguarding factors and training outcomes. Results Exploratory factor analysis (EFA) revealed three core safeguarding dimensions: structural safeguards, process safeguards, and pedagogical safeguards. SEM demonstrated that structural assurance (β=0.340), process assurance (β=0.155), and teaching assurance (β=0.261) all have significant positive effects on training quality (all P<0.05). Mediation analysis showed: Partial mediation by learning engagement for structural safeguards (indirect effect: 48.3%); Full mediation for process safeguards (indirect effect: 84.7%); No mediation observed for pedagogical safeguards. Conclusions Optimizing residency training requires prioritized structural assurance (such as resource allocation), refined process management (such as salary and benefits), enhanced teaching quality (such as teacher training), and activation of learning engagement mechanisms, offering evidence-based policy pathways for sustainable quality improvement.