目的 了解儿科住院医师规范化培训(以下简称住培)学员和指导医师对住培实施环境的感知,分析住培实施存在的问题,为优化住培实施方案提供依据。方法 2024年1至2月,采用整群抽样方法,以复旦大学附属儿科医院2021至2023年进入儿科基地和儿外科基地接受住培的118名学员和70名指导医师为研究对象,采用一致性平行设计的混合研究方法。量性研究采用问卷调查方法,数据分析采用t检验、潜在剖面分析、χ²检验和单因素分析;质性研究以最大差异化抽样选取量性研究中的20名住培学员和8名指导医师进行一对一半结构式访谈。结果 共有115名住培学员和65名指导医师参与本研究。住培学员和指导医师对住培实施环境感知评分分别为(60.04±9.88)分和(62.57±7.47)分(满分均为80分),其差异无统计学意义(P=0.110)。住培学员在工作维度和学习维度的条目评分均低于指导医师[(3.44±0.77)分比(4.14±0.43)分,(3.58±0.85)分比(3.98±0.58)分],其差异均具有统计学意义(均P＜0.001)。住培学员的住培实施环境感知评分分为2个类别:高感知组[53.0%(61/115)]和低感知组[47.0%(54/115)];指导医师的住培实施感知评分分为3个类别:高感知组[30.8%(20/65)]、低感知组[55.4%(36/65)]、极低感知组[13.8%(9/65)]。不同感知类别住培学员的所属基地人数比较,其差异具有统计学意义(P=0.002),儿外科基地住培学员在高感知组中人数多于低感知组(20人比5人);不同感知类别指导医师的职称比较,其差异具有统计学意义(P=0.041),主任医师职称的指导医师在低感知组中的人数多于高感知组 (13人比2人)。根据访谈结果,提炼4个主题:培训内容丰富、形式多样;工作设施设备配置不足;工作负荷高,激励机制缺乏;存在科研压力,但科研支持不足。结论 住培学员和指导医师对住培实施环境的感知评分有待提高,工作、学习和科研支持是需要改善的主要方面,应当建立精细化制度,支持住培学员实现工作、学习与科研之间的平衡,并根据住培学员和指导医师的住培实施感知类别和特征优化住培实施方案。

Objective To understand the perceptions and evaluations of pediatric residency trainees and supervising physicians regarding the implementation environment of residency training, analyze existing problems in the training implementation, and provide evidence for optimizing the implementation of residency training. Methods From January to February 2024, using cluster sampling method, 118 residents who entered the pediatrics base and pediatric surgery base from 2021 to 2023 and 70 supervising physicians at the Children′s Hospital of Fudan University enrolled in the study. A convergent parallel mixed-methods design was adopted. The quantitative research portion employed a questionnaire survey, with data analysis using t-tests, latent profile analysis, chi-square tests, and univariate analysis. The qualitative research used maximum variation sampling to select 20 residents and 8 supervising physicians from the quantitative study for one-on-one semi-structured interviews. Results A total of 115 residents and 65 supervising physicians participated in this study. The resident trainees and supervising physicians scored (60.04±9.88) and (62.57±7.47) points respectively for their perception of the residency training implementation environment (with a maximum score of 80 points for both), and the difference was not statistically significant (P=0.110). The resident trainees scored lower than the supervising physicians in both the work dimension and learning dimension [(3.44±0.77) vs. (4.14±0.43), (3.58±0.85) vs. (3.98±0.58)], and the differences were statistically significant (all P<0.001). The perception scores of resident trainees for the residency training implementation environment were divided into 2 categories: high perception group [53.0% (61/115)] and low perception group [47.0% (54/115)]; the perception scores of supervising physicians for the residency training implementation were divided into 3 categories: high perception group [30.8% (20/65)], low perception group [55.4% (36/65)], and extremely low perception group [13.8% (9/65)]. The comparison of the number of resident trainees in different perception categories by their affiliated training base showed a statistically significant difference (P=0.002), with more trainees from the pediatric surgery base in the high perception group than in the low perception group (20 vs. 5). The comparison of professional titles among supervising physicians in different perception categories showed a statistically significant difference (P=0.041), with more supervising physicians holding the title of chief physician in the low perception group than in the high perception group (13 vs. 2). Based on the interview results, four themes were extracted: diverse and rich training content and formats; insufficient allocation of work facilities and equipment; high workload with lack of incentive mechanisms; research pressure exists but research support is insufficient. Conclusions From the perception among resident trainees and supervising physicians, the implementation environment of residency training requires enhancement, with work conditions, learning opportunities, and research support being the primary areas needing improvement. A refined institutional support system should be established to balance clinical work, learning, and research in residency training, and the residency training implementation plan should be optimized according to the perception category characteristics of residents and supervising physicians.