Analysis On Influencing Factors Of Resident Standardized Training Of A Grade-A Tertiary Hospital Of Yunnan Province

Objective:This research aims at studying the resident standardized training status of a Grade-A tertiary hospital in Yunnan Province so as to effectively learn their current training status,ability improvement and satisfaction with training,analyze and summarize factors influencing the resident standardized training status.Concerning problems arising from the training process,countermeasures for improvement are provided as references for improvement of the resident standardized training system and work in Yunnan ProvinceMethod:A Grade-A tertiary hospital in Yunnan Province is chosen as the research object.The training plan,test results of the graduation examinations,current curriculum system,rotary plans an materials are collected.Cluster sampling is used to carry out a questionnaire of single-identity resident training students of Grade 2016 and combined training graduate students of Grade 2016 and trained for the postgraduate program.The number of former is 101,and the number of the latter is 139.Convenient sampling is adopted to withdraw single-identity resident training students of Grade 2016,five combined training graduate students of Grade 2016 and involved in the postgraduate program,and four teachers for an personal in-depth individual interview.The questionnaire consists of basic situations,overall cognition,training process management,curriculum settings,self-evaluation of the degree of occupational quality improvement and resident training students' satisfaction.The interview content covers respondents' opinions on the implementations status of resident standardized training,internship tutors,training content,and problems existing in the training process.EpiData 3.1 is used to build the database,with two persons entering the data obtained from the questionnaire.SPSS22.0 is used for statistical analysis of the data,and the statistical methods include the independent sample T-test,Chi-square test,Wilcoxon rank-sum test,binary logistic regression and multiple linear regression.Result:1.Resident training students score(3.30 ± 0.97)at the dimension of the resident system,and(3.39±0.93)at the dimension of pressure subjective and objective support.Both scores indicate an evaluation that is "relatively good".Resident training students' understanding of the training system and cognition of its necessity are favorable.And they think that the rotation plan is relatively rational and that the clinical rotation is important to training.In the process of training,resident training students demonstrate a positive occupational mentality and great stress.Family members show favorable support,and the recognition of physicians of a superior level and patients is high.As to the cognition that the resident system is helpful to the society,industry and individual,major problems existing in the process of training include“different payments for learners of different identities"(71.24%),"long working hours and heavy workload"(52.21%),"lack of guarantee for training quality"(51.77%),and "difficulty in balancing the relationship between daily work and various examinations"(53.98%).Learners are faced with growing economic stress(84.51%),employment stress(63.27%),and examination stress(57.08%).Variance analysis shows that the difference of the total scores of resident learners of different genders(t=-1.94,p=0.05),with different children(t=2.33,p=0.02),of different identities(t=2.00,p=0.05),and undergraduate graduating time(t=-2.46,p=0.01)as to their overall cognition is statistically significant.At the dimension of subjective and objective support,the difference between learners with the single identity and learners who are mutually trained for the postgraduate program is statistically significant(t=2.24,p=0.03).2.During the process of training,the implementation of rotation management scores(3.39 ±1.01),which suggests a favorable evaluation."Recall"(75.86%)and "stay"(47.12%)are two major reasons for students' failure to act in accordance with the plan.The clinical ability training management scores(3.51±1.15),which also means a favorable evaluation.Specifically,students show a good evaluation of the arrangement frequency of most training projects.The arrangement of independent ward round by the department for students is relatively satisfactory.The main reasons for the failure of arranging independent ward rounds include failure of the clinical teacher to provide arrangement(75.80%)and the clinical teacher thinking the students are not yet capable(38.85%).The teaching implementation management dimension scores(3.56±1.15),meaning that the training content can well satisfy students' demand,trainees can satisfactorily finish the required operations,and the clinical teacher designated by the department for every learner is relatively satisfactory.The training content that learners hope to increase include the scientific research qualities(61.95%)and professional theoretical knowledge(59.29%).Results of variance analysis suggest that the difference of the clinical ability management of students graduating at different time in the undergraduate years(t=-2.0,p=0.047)is statistically significant.Among them,the clinical ability training management of learners who have graduated for more than three years from their undergraduate university is higher than that of learners who have graduated within three years.3.As to the evaluation of curriculum provision,the evaluation averages at(3.38±0.91),meaning the evaluation is generally favorable.The evaluation of different statements can be ranked from higher ones to lower ones,including the subject advancement and development tendency reflected by the curriculum content,coverage of the curriculum content,practicability of clinical practices,and satisfaction degree of training needs.Variance analysis results indicate that the curriculum setting evaluation difference of resident learners with different academic degrees(t=1.95,p=0.037)and of different identities(t=1.92,p=0.047)is statistically significant,with the evaluation of learners holding an undergraduate degree is higher than those holding a postgraduate degree,and the evaluation of learners with a single identity higher than that of learners also trained for the postgraduate program.4.The total scores of students' occupational quality improvement average at(3.42 ± 0.94),and the improvement is significant.The improvement of occupational quality at different dimensions can be ranked in a descending order,including professionalism(3.68±1.02),medical ethics(3.60±0.98),interpersonal communication ability(3.41±0.99),teaching and scientific research ability(3.31±0.91),and theoretical knowledge of medicine(3.16±0.94),respectively.Among all entries,the ability to correctly judge the auxiliary examination,ability to correctly provide physical examination,ability to operate basic skills,ability to formulate treatment plan combining diagnosis results with the patient's practical conditions,and awareness of teamwork significantly improve.Results of variance analysis show that the occupational abilities of resident learners with different numbers of children(t=1.99,p=0.047),academic degrees(t=-3.07,p=0.002),identities(t=-3.31,p=0.001),graduating from the undergraduate school at different periods of time(t=2.32,p=0.021),and whether holding the physician's practice license(t=2.81,p=0.005)are improved to different degrees.The occupational ability improvement of resident learners without children,holding a master's degree,jointly developed for the postgraduate program,graduating from the undergraduate school within three years,and holding the practitioner's qualification certificate is more significant than those with children,graduating from the undergraduate college,of the single identity,graduating for more than three years,and without the physician's practice license.5.The overall satisfaction of learners with the with the resident doctor standardized training scores(3.37±0.93),and the satisfaction degree is relatively high,and can be ranked in terms of different dimensions in a descending order as conditions of the training base,clinical teacher's qualifications,process management,training evaluation,and guarantee mechanism.Results of the single factor analysis show that the different numbers of children have no influence on the general satisfaction degree but can influence the dimension of training base conditions(t=2.98,p=0.004)and guarantee system(t=2.78,p=0.006).Academic degree(t=3.18,p=0.002),identity(t=3.45,p=0.001),and graduation time(t=-3.76,p<0.001)can influence resident learners' satisfaction degree.The overall satisfaction of learners with an undergraduate degree,of a single identity and having graduated from the undergraduate school for more than three years is higher than that-of learners holding a master's degree and having graduated from the undergraduate school within three years.Multilinear regression analysis shows that curriculum setting evaluation(p=0.021),cognition of the resident system(p=0.027)and pressure subjective and objective support(p=0.006)can influence resident learners' satisfaction.6.The total pass rate of resident learners in graduation examinations is 91.2%.There is no difference in terms of the pass rate of resident learners with different demographic characteristics.The binary Logistic regression analysis results indicate that clinical ability management(OR=0.349,p=0.027),teaching implementation management(OR=0.539,p<0.039)will influence resident learners' pass of graduation examinations.Conclusion:1.The overall cognition of resident training cadets is favorable and their stress during their training period is huge;2.The overall training quality is favorable but the training process management has not yet been standardized;3.The resident training base should further improve its curriculum system;4.The enthusiasm of clinical teachers is lacking,and their clinical teaching process has not yet been standardized;5.The examination standards have not yet been clarified,and the examination forms lack diversification and standards;6.The concept of the cultural care is lacking in the management processSuggestion:1.Improve various management systems for the resident training base;2 Optimize the training process and training content oriented towards competency;3.Better the current curriculum system construction,and optimize and adjust the curriculum content and structure;4.Strengthen the faculty team construction,and effectively improve the teacher's teaching ability;5.Improve the evaluation system,adopt flexible examination forms,and emphasize on the evaluation of medical ethics;6.Explore the combination between various teaching models and teaching methods,and improve the teaching quality and learners' enthusiasm;7.Build a human-oriented management mechanism.