目的 探讨医患纠纷风险情境和职业认同对农村订单定向医学生(简称定向医学生)基层服务意愿的影响,为培养定向医学生提供参考。方法 采用试验对照方法和问卷调查方法开展本研究。于2021年5月,通过整群抽样方法选取广州市某高校200名2020级五年制临床医学专业定向医学生为研究对象,采用2×2组间设计,其中情境(医患纠纷风险情境与中性情境)和职业认同水平(高与低)为自变量,定向医学生的基层服务意愿为因变量。采用方差分析、t检验和简单效应分析对相关数据进行统计分析。结果 最终有193名定向医学生参与本研究。①情境的主效应显著(η2=0.074,P=0.029),医患纠纷风险情境下,定向医学生的基层服务意愿(6.37±1.63)分低于中性情境(7.62±2.14)分;②职业认同的主效应显著(η2=0.396,P<0.001),高职业认同的定向医学生基层服务意愿(8.19±1.63)分高于低职业认同的定向医学生(5.67±1.54)分;③情境和职业认同的交互作用显著(η2=0.133,P<0.001)。高职业认同定向医学生的基层服务意愿在医患纠纷风险情境下降低[(8.91±1.24)分比(7.00±1.49)分,P<0.001],而低职业认同定向医学生的基层服务意愿没有显著变化[(5.50±1.51)分比(5.81±1.60)分,P=0.588]。结论 高职业认同定向医学生表现出更高的基层服务意愿,但容易受医患纠纷风险的影响。建议医学院校通过提升定向医学生的职业认同并引导定向医学生理性看待职业风险来稳定其基层服务意愿。
Objective To explore the influence of risk situations of doctor-patient dispute and professional identity on the willingness for grassroots service of rural-oriented tuition-waived medical students in a medical college in Guangzhou, so as to inform the cultivation of rural-oriented tuition-waived medical students. Methods This study was conducted experimental control method and questionnaire survey method. A total of 200 rural-oriented tuition-waived medical students majoring in five-year clinical medicine enrolled in 2020 were selected as research participants from a medical college in Guangzhou in May 2021 through cluster sampling, and 2×2 between-subject design was conducted, in which the situation (risk situations of doctor-patient dispute vs. neutral situations) and the level of professional identity (high vs. low) were the independent variables, and willingness for grassroots service was the dependent variable. Analysis of variance, t test and simple effect analysis were used for statistical analysis. Results A total of 193 rural-oriented tuition-waived medical students participated in this study. (1) The main effect of the situation was significant (η2=0.074,P=0.029). In the doctor-patient dispute risk situation, the willingness of rural-oriented tuition-waived medical students to serve at the primary level (6.37±1.63) was significantly lower than that in the neutral situation (7.62±2.14); (2) The main effect of professional identity was significant (η2=0.396,P<0.001). The intention of primary service of rural-oriented tuition-waived medical students with high professional identity (8.19±1.63) was significantly higher than that of rural-oriented tuition-waived medical students with low professional identity (5.67±1.54); (3) Doctor-patient dispute risk situation and occupational identity have a significant interactive effect on the willingness for grassroots service of rural-oriented tuition-waived medical students (η2=0.133,P<0.001). Among those with high professional identity significantly, the willingness for grassroots service decreased when the doctor-patient dispute risk situation was presented [(8.91±1.24) vs. (7.00±1.49), P<0.001], while no significant change was observed for those with low professional identity [(5.50±1.51) vs. (5.81±1.60), P=0.588]. Conclusions Rural-oriented tuition-waived medical students with high-level professional identity show a higher willingness for grassroots service, but it is easily affected by the risk of doctor-patient disputes. It is suggested that medical universities and colleges improve the willingness to serve at the grassroots by improving professional identity and guide rural-oriented tuition-waived medical students to analyze and look upon occupational risks rationally.
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