| Research BackgroundAs a new paradigm of medical research and practice that adapts to the changes of the human disease spectrum,the Evidence-based Medicine(EBM)is believed to be the model of clinical medicine in the 21 st century and has gained rapid development in recent years.However,the current development of clinical practice of EBM is still not ideal,which restricts the improvement of the quality of clinical work.Through research,scholars believed that the quality of the clinical practice of EBM mainly depends on the evidence-based practice ability of clinicians,that is,the level of explicit and implicit knowledge they possess.So they proposed to promote the construction of the EBM knowledge of the clinicians through training.The effects of the EBM knowledge training for the clinicians mainly depend on the profound cognition and continuous optimization of the contextal elements of their knowledge construction.Therefore it is necessary to develop tools to evaluate the EBM knowledge construction context,so as to find out problems and make targeted improvements of the context in hospitals and improve the ability of the clinicians.Although scholars home and abroad have developed some tools to evaluate the learning environment of medical knowledge,there is still a lack of tools based on the knowledge construction context theory and aimed at the specific connotation of the learning environment for the EBM knowledge,which greatly restricts the systematic cognition and improvement of the problems related to its clinical practice.Research ObjectivesThe main purpose of this research is to develop an evaluation tool that can reflect the characteristics of EBM learning environment in hospitals,which is based on the knowledge construction context theory and takes resident doctors as the research subjects.By determining the main dimensions and specific indicators of the knowledge construction context and giving weight to each dimension and indicator,an evaluation index system of EBM knowledge construction context for resident doctors is completely constructed and verified.At the same time,the evaluation index system is applied to evaluate the context of EBM knowledge construction in hospitals,to discuss the problems existing in the mechanism of EBM knowledge learning and practice guarantee,and to put forward relative improvement suggestions,so as to promote healthy development of EBM clinical practice.Research Content and Methods(1)Extraction and Selection of Evaluation Indicators.Based on the EBM theory and the knowledge construction context theory,some evaluation indexes were extracted with the research synthesis method;the evaluation indexes were extracted by interviewing 19 insiders;240 resident doctors were surveyed and some evaluation indicators were extracted with the open questionnaire method.To screen the extracted evaluation indicators,31 experts were surveyed and asked for advice with the Delphi Method.(2)Preliminary Construction of the Evaluation Index System.After screening the evaluation indicators,we applied the questionnaire method to survey the resident doctors and analyze the exploratory factors and validation factors of the collected data.Based on this,the structural framework and specific dimensions and indicators of the evaluation index system were determined,the overall fitting degree of the measurement model was calculated and the evaluation index system was initially constructed.(3)Determination of the Weight of Each Indicator of the Evaluation Index System.Via the analytic hierarchy process method,9 experts compared and assigned the value according to the importance of the indexes,and determined the weight of each index in the evaluation index system by calculating the values given by the experts,and thus the evaluation index system is constructed completely.(4)Empirical Test of the Evaluation Index System.Resident doctors were surveyed through questionnaires.Firstly,the empirical examination of demography variables was carried out,and the research hypothesis and conceptual model were verified by analyzing the obtained data.Secondly,the practical application test was carried out to evaluate the contextal level of the EBM knowledge construction of residents in a hospital.Two representative hospitals were selected to conduct a comparative empirical test on the contextal level of the EBM knowledge construction,which verified the innovative,scientific and practical nature of the index system.At the same time,the level of the EBM knowledge construction context of the hospitals was evaluated and the primary problems available in the mechanism of the EBM knowledge learning and practice in the hospitals were analyzed.Research Results(1)Extraction and Screening Results of the Evaluation Indexes.Through relevant research methods,44 evaluation indexes were extracted and 39 of them were screened.(2)Preliminary Construction Results of the Evaluation Index System.The evaluation index system is divided into three layers,in which the contextal evaluation of EBM knowledge construction is the target layer;the five indexes of teaching guarantee,resource guarantee,activity guarantee,organization guarantee and cultural guarantee are the criterion layer.The five criterion layers are decomposed and refined and 34 scheme layer indexes are formed.The total variance explanation rate of the five leading indicators is 86.778%;the internal consistency reliability coefficient of the scale is 0.743;the retesting reliability coefficient is 0.756.The overall fitting results of the measurement model show that χ2/df is3.25;GFI and AGFI are close to 0.8;the fitting degrees of other data indexes are above 0.9;RMSEA and RMR values are less than or equal to 0.05;and the ECVI value is 4.23 which indicates that the fitting degree is good for its small value.(3)Results Determined by Evaluation Index Weight.In the process of determining the weight,the judgment matrix is constructed,and the expert’s assignment is calculated.The weight of each index is obtained and the consistency test is carried out,forming a complete evaluation index system.The weight of the teaching guarantee index is 0.4162;the weight of the resource guarantee index is 0.2618;the weight of the activity guarantee index is 0.1611;the weight of the organization guarantee index is 0.0986;the weight of the cultural guarantee index is 0.0624.The weight of each index objectively reflects the reality of the context.(4)Validation Results of demographic variables.According to the 5 extracted fundamental evaluation indexes,we put forward the research hypothesis and carried on the empirical test of the demographic variables to verify the influences of gender,education background,training identity,training years,rotation departments and training hospitals on the overall context level of EBM knowledge construction and five main indicators.There is a significant positive correlation between the five factors and the overall level of the knowledge construction context.According to the confirmatory factor analysis results,the standardized factor load range of all the measurement indexes is 0.646-0.756,which is of high reliability.The fitting results: χ2/df is 4.031,RMSEA is 0.076,GFI is 0.913,AGFI is 0.942,NFI is0.919,IFI is 0.903,CFI is 0.897,which shows that the overall fitting degree is good.This research makes a regression analysis of the evaluation indexes and gets the standard regression equation: EBM knowledge construction context level = constant(18.949)+(0.301×teaching guarantee factor + 0.252×resource guarantee factor +0.189×activity guarantee factor + 0.246×organization guarantee factor + 0.173×cultural guarantee factor).From the analysis of standardized regression coefficient,it can be found that the influence of each variable on the contextal level of EBM knowledge construction is different,among which the influence of the teaching guarantee index is the most obvious one(the standardized partial regression coefficient is 0.301);the influence of the cultural guarantee index is the least obvious(the standardized partial regression coefficient is 0.173).The empirical test of the demographic variables shows that the evaluation index system constructed in this study has a strong influence effect.(5)Example Validation for Practical Application.In this research,two methods are used to test the practical application of the evaluation index system.For the first method,we selected a famous hospital in China and used the comprehensive fuzzy evaluation method to evaluate the contextal level of its EBM knowledge construction.The research shows that the EBM knowledge construction context level for resident doctors in this hospital is 2.72214(5is excellent),and the corresponding evaluation level is medium.Through calculation,it is concluded that the score for the teaching guarantee dimension of the EBM knowledge construction context in this hospital is 2.7934,the score for the resource guarantee dimension is 2.5648,the score for the activity guarantee dimension is 2.7338,the score for the cultural guarantee dimension is 2.9207,and the score for the organization guarantee dimension is2.6881.The results are consistent with the actual context of the hospital reflected in the investigation and interviews,and the validity of the index system constructed in this paper has been verified to some extent.For the second method,we chose Hospital A in Tianjin,famous in the north,and Hospital B,well-known in Shanxi Province,for empirical comparative analysis.It can be concluded through calculation that the contextal level of EBM knowledge construction in Hospital A and Hospital B is in below the average level respectively,with the level of Hospital A higher than that of Hospital B,and the result is consistent with the status and level of the two hospitals.The above tests can explain that the evaluation index system of EBM knowledge for resident doctors constructed in this research is scientific,reasonable and practical,which guaranteed the passing of the validation.Research Conclusions and Suggestions(1)This research constructs an evaluation index system of EBM knowledge construction context for resident doctors,including 5 dimensions of teaching guarantee,resource guarantee,activity guarantee,organization guarantee and cultural guarantee and 34 specific indexes,and the result shows that the evaluation index system is innovative,reasonable and practical through the empirical test of the population and organization variables as well as practical application.(2)Through the application of the evaluation index system for questionnaire survey and data analysis,it can be concluded that the current level of the EBM knowledge construction context in hospitals is generally low,and that the knowledge guarantee mechanism of EBM clinical practice is imperfect,both of which are the fundamental factors restricting the improvement of clinicians’ practical ability and the development of EBM clinical practice.(3)According to the characteristics of the evaluation index system of EBM knowledge construction constructed in this study,suggestions on how to apply the evaluation index system are put forward.According to the practical problems found in the application of the evaluation index system,suggestions are put forward on how to optimize the context and mechanism of EBM knowledge learning and practice in hospitals. |
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