| BackgroundResident training is the key part of post-graduate medical education,after further "polishing"by the resident training,the residents will grow into qualified clinicians,this is the original intention and goal of establishing a standardized training system for residents in China.However,it has not been long for China to establish a standardized training system for residents,the realization of policy objectives must be guaranteed by the implementation links,the degree of implementation of policies in reality is affected by the implementation subject,target population,objective conditions and other conditions,making the implementation of the system not so perfect,there are many problems and weak links that need to be improved.With the in-depth development and promotion of training work,resident training related issues have become a hot research topic.In 2020,the country stressed that the implementation of policies in various regions and training bases should be taken as an important part of the inspection and evaluation.Therefore,the implementation of the standardized training system for residents is crucial to the realization of the goal of the system.In light of the above background,it is very important to study the implementation of the current residence and training system in today’s hospitals.ObjectiveThis research is based on Shandong Province A hospital as an empirical research case,and guided by the requirements of the national training policy,construct a structure-process-outcome analysis framework by sorting out the content of the national training policy.According to the framework,analyze the arrangement and implementation of the resident training system in A hospital.To provide countermeasures and suggestions for the training of resident in A hospital,at the same time,it also provides reference for other similar hospitals in improving the effectiveness of resident training.MethodsFirst of all,by collecting secondary data,obtain domestic and foreign literature related to resident training,obtain the national resident training policy data and resident training system materials of A hospital.By combing and summarizing the national resident training policy and combining with the "structure-process-outcome" evaluation theory,to construct a"structure-process-outcome" analysis framework for the resident training system in this study.Based on this analysis framework,firstly,analyze the arrangement of A hospital resident training system;Secondly,according to the actual situation,design the "Resident Training Questionnaire",the questionnaire survey was conducted between May and October 2020 in Hospital among 400 residents who began to participate in the training in 2016 and 2017,according to the calculation formula of the limited total sample size in the simple random sampling study,the required sample size for this study was 296.In consideration of the 20%loss rate of questionnaire collection and the guarantee of questionnaire quality,400 of the 1000 residents were randomly sampled and the list of respondents was obtained with the help of hospital staff.Residents were sampled through the random number table method and the subjects were contacted to scan the QR code to fill in the questionnaire.Finally,365 valid questionnaires were collected;Thirdly,according to the requirements of policy and literature to design the interview outline,qualitative interviews were conducted with hospital training administrators,teachers and residents.The content analysis method was used to analyze the resident training policy and the arrangement of the A hospital resident training system.The constituent ratio,mean and standard deviation,Kruskal-Wallis test,one-way analysis of variance and least significant difference method were used to conduct descriptive statistical analysis on each dimension of the questionnaire.Qualitative interview data were analyzed using thematic frame method.Researchers sorted out the transcript data,determined the topic,marked the data according to the topic,and finally classified and integrated the data.Fishbone diagram method was used to analyze the problems of the implementation of resident training system in A hospital.Results(1)National resident training policy reviewIn this study,the development history of resident training policy in China was divided into five periods,namely,the exploratory period,the pilot period,the development period,the reform period and the improvement period.And summarized and sorted out the contents of resident training policy during the improvement period,to constructed the "structure-process-outcome" analysis framework,the structure level included:organization,management,guarantee and support;the process level included:training recruitment,training content and training methods;the outcome level included:training assessment and training objectives.(2)Resident training system of A hospitalThe arrangement of resident training system in A hospital was analyzed from the level of structure,process and result,and compared with the national policy requirements.In conclusion,A Hospital had established a sound and feasible management system for resident physician training in accordance with the requirements of national training policy.(3)The status of implementation of hospital resident training systemFirst,among the 365 residents,the majority were in the class of 2017,with 213.Female(58.90%)and resident doctors under 30 years old(83.29%)accounted for the majority(42.74%),followed by people from other units and people from the society.Structure level:In terms of management,the proportion of residents who expressed satisfaction with the management of managers was higher than 70%,and the proportion of clinical professional master was the lowest.Through H test,the difference of residents with different training status on the satisfaction of managers was statistically significant(P<0.001).Pair comparison found that,The difference between the clinical medicine masters and the unit was statistically significant.In terms of salary,only 26.03%residents said that the salary could meet the basic living needs,which was a relatively low proportion,and nearly half(49.59%)thought that the salary could not meet the basic living needs.Said 87.83%ofclinical medicine master’s salary can’t meet their basic living needs of the highest proportion,through inspection,different training status of resident said wages can satisfy basic life to need the difference was statistically significant(P<0.001),Pair comparison found that,there is statistical significance in the difference between the master of clinical medicine and the unit and the society.Process level:In clinical skills,teaching rounds,cases discussion,to participate in lectures on four types of the main training content,basic clinical skills resident said operations to meet the learning needs of lowest,at 66.03%,most of clinical medical department(83.02%)of resident said clinical basic operation times is able to meet their learning needs,the highest proportion;In surgical departments,the proportion was the lowest(50%),and another 20.0%of residents said that they could not meet their learning needs;65.47%of the residents said that the arrangement of department rotation time was very reasonable and reasonable,and about one-fifth(21.1%)of the residents said that the rationality of rotation was general.In addition,Less than half(46.85%)of the residents indicated that the hospital attaches great importance to the cultivation of scientific research ability,and the proportion is relatively low.Outcome level:66.30%and 66.03%of the residents thought that the hospital organized department assessment was standard and could help improve their own ability;In the interview,residents expressed that the department assessment was not standardized enough,and the assessment had little effect on the improvement of their overall ability,Only more than half(53.75%)of surgical residents said the assessment was standard;After the training,the residents’ clinical thinking ability(72.88%),clinical practice ability(64.66%)and disease diagnosis and treatment ability(60.00%)were significantly improved,while the research ability(5.21%)was not significantly improved.Residents with different training status had statistically significant differences in self-rated improvement scores(F=2.767,P<0.05).Through multiple comparisons,it was found that the self-rated improvement scores of residents from other units were higher than those of social and clinical medicine masters.(4)Analysis of existing problemsCombined with quantitative investigation and qualitative interview,on the basis of induction and generalization,the problems of the implementation of resident training system in A hospital were summarized into three levels and five aspects.Structure level:in terms of organization and management,the incentive mechanism was relatively single;In terms of support,the salary of residents was not guaranteed enough,inadequate provision of books and e-learning resources,residents were poorly informed about the use of the library.Process level:in the training process,the rotation arrangement of departments was not reasonable enough,residents had few clinical hands-on operation opportunities,resident’s learning initiative were insufficient and teacher’s awareness of teaching were insufficient,hospital do not pay attention to the cultivation of scientific research ability.Outcome level:training assessment,the assessment of standardization was insufficient;In terms of resident’s perception,the main reason was that the training task was heavy,the residents’ training enthusiasm was not high,and the different training types of residents affected the training ability improvement effect.Conclusion and suggestionsThrough the empirical study of A hospital,it is found that from the three levels of structure,process and outcome,A hospital can formulate a relatively perfect arrangement of resident training system according to the requirements of national policy.In the actual implementation,the hospital has established a complete leadership management structure and provides better training and teaching conditions.However,there are also many factors that hinder the accurate implementation of the training system.The incentive and guarantee measures are not perfect;The phenomenon of"focusing on the use,ignoring the training and neglecting the assessment"exists in the training;There are few clinical operation opportunities for residents;The standardization of examination is insufficient;Lack of attention to the cultivation of scientific research ability;The training identity type affects the ability improvement effect,residents from other hospitals had higher self-rated improvement scores than social people and clinical medicine master students,it needs to be taken seriously.Based on the above conclusions,the following suggestions are proposed:(1)To establish multiple incentive mechanisms,improve the salaries of residents(2)To increase clinical practice opportunities of residents,improve the quality of training(3)Pay attention to the cultivation of resident’s scientific research ability,create a clinical academic atmosphere(4)Improve the assessment standards,,ensure the standardization of assessment(5)Focus on resident needs,enhance their sense of belonging at work... |
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