Professional identity among Chinese medical graduates: a cross-sectional survey
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摘要:
目的 深入分析中国本科临床医学生毕业前的职业认同现状及其群体差异,为加强医学院校对医学生职业认同重视、提升医学生职业认同水平、稳定医学人才队伍提供科学依据。 方法 于2019年7月在全国19个省(直辖市)分层抽样选取全国33所高校的临床医学专业本科毕业生11 596人,发放自设标准化纸质问卷进行调查。 结果 回收有效问卷10 062份,有效率为86.77%。医学生职业认同总平均分为(3.61 ± 0.63)分,其中职业认知、职业情感、职业承诺、职业行为、职业期望、职业价值观平均得分分别为(3.17 ± 0.60)、(3.60 ± 0.71)、(3.68 ± 1.01)、(4.08 ± 0.75)、(3.70 ± 0.90)、(3.45 ± 0.74)分。多元线性回归分析结果显示,东部(β = 0.034,P = 0.013)和中部地区(β = 0.092,P < 0.001)、男性(β = 0.025,P = 0.019)、农村生源(β = 0.023,P = 0.045)、家庭收入中等水平(β = 0.025,P = 0.028)、第一志愿录取(β = 0.031,P = 0.002)、非双一流院校(β = 0.085,P < 0.001)、高中时职业理想为医生(β = 0.249,P < 0.001)、5年制的医学生[相比8年制(β = – 0.065,P < 0.001),“5 + 3”一体化长学制(β = – 0.098,P < 0.001)]和毕业前学业排名靠前的医学生[排名前25%(β = 0.136,P < 0.001),排名26%~75%(β = 0.082,P < 0.001)]具有更高的职业认同感。 结论 中国本科临床医学专业医学生的职业认同处于中等水平,且受生源地区、性别、城乡属性、家庭收入、第一志愿录取、院校层次、学制、毕业前的学业表现等多种因素影响。 Abstract:Objective To examine the status quo of and group disparity in professional identity among Chinese medical graduates for providing evidence to develop relevant intervention programs. Methods Using stratified cluster sampling and China Medical Students Survey (CMSS) designed by National Center for Health Professionals Education Development, an onsite self-administered questionnaire survey was conducted among 11 596 medical graduates in 33 universities in 19 provincial-level administrative divisions across China during July 2019. Results For the 10 062 (86.77% of all graduates) valid respondents, the overall average score for professional identity was 3.61 ± 0.63 and the average scores of dimensional professional identity were 3.17 ± 0.60 for cognition, 3.60 ± 0.71 for emotion, 3.68 ± 1.01 for commitment, 4.08 ± 0.75 for behavior, 3.70 ± 0.9 for expectation, and 3.45 ± 0.74 for values, respectively. The results of multivariate regression analysis showed that the respondents with following characteristics were more likely to have a higher professional identity: studying at universities in eastern China (β = 0.034, P = 0.013) and in central China (β = 0.092, P < 0.001), being male (β = 0.025, P = 0.019), from rural regions before entering university (β = 0.023, P = 0.045), with medium family income (β = 0.025, P = 0.028), studying at a university being first choice for admission (β = 0.031, P = 0.002), studying at universities not belonging to double first-class university (β = 0.085, P < 0.001), with the career ideal of to be a doctor while being a senior high school student (β = 0.249, P < 0.001), being a five-year-system medical student (β = – 0.065, P < 0.001), being an integrated long school system (5 + 3 years) student (β = – 0.098, P < 0.001), and with a higher academic performance shortly by the graduation (β = 0.136, P < 0.001 and β = 0.082, P < 0.001 for those with the academic score of highest quartile and second/third quartile in ranking). Conclusion The professional identity is at a medium level and affected by multiple individual and academic environment factors among Chinese medical graduates. -
Key words:
- clinical medical students /
- professional identity /
- status quo /
- disparity
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表 1 不同特征临床医学专业本科生职业认同得分情况比较(
$\bar x \pm s$ ,分)特征 职业认同各维度平均分 总平均分 职业认知 职业情感 职业承诺 职业行为 职业期望 职业价值观 院校地区 东部省份 3.17 ± 0.62 3.60 ± 0.73 3.70 ± 1.02 4.10 ± 0.74 3.70 ± 0.91 3.46 ± 0.76 3.62 ± 0.64 中部省份 3.22 ± 0.60 3.65 ± 0.71 3.73 ± 1.00 4.12 ± 0.75 3.76 ± 0.90 3.49 ± 0.74 3.66 ± 0.62 西部省份 3.18 ± 0.59 3.57 ± 0.71 3.66 ± 0.99 4.00 ± 0.77 3.68 ± 0.91 3.42 ± 0.72 3.58 ± 0.63 直辖市 3.08 ± 0.58 a 3.57 ± 0.69 a 3.59 ± 1.03 a 4.08 ± 0.72 a 3.59 ± 0.89 a 3.38 ± 0.72 a 3.55 ± 0.62 a 性别 男性 3.19 ± 0.60 3.50 ± 0.70 3.70 ± 1.00 4.06 ± 0.76 3.77 ± 0.90 3.44 ± 0.75 3.61 ± 0.63 女性 3.16 ± 0.60 a 3.68 ± 0.71 a 3.67 ± 1.01 4.09 ± 0.74 3.63 ± 0.90 a 3.46 ± 0.73 3.61 ± 0.63 高考前生源地 农村 3.18 ± 0.59 3.61 ± 0.71 3.69 ± 0.97 4.04 ± 0.73 3.70 ± 0.88 3.46 ± 0.72 3.61 ± 0.61 城市 3.17 ± 0.60 3.60 ± 0.72 3.68 ± 1.02 4.10 ± 0.75 a 3.69 ± 0.91 3.44 ± 0.75 3.61 ± 0.63 是否独生子女 是 3.17 ± 0.60 3.61 ± 0.71 3.69 ± 1.03 4.11 ± 0.75 3.71 ± 0.91 3.44 ± 0.75 3.62 ± 0.63 否 3.17 ± 0.59 3.60 ± 0.71 3.67 ± 0.99 4.04 ± 0.74 a 3.68 ± 0.89 3.45 ± 0.73 3.60 ± 0.62 家中是否有医务工作者 是 3.18 ± 0.61 3.61 ± 0.71 3.71 ± 1.01 4.13 ± 0.74 3.74 ± 0.90 3.48 ± 0.76 3.64 ± 0.63 否 3.17 ± 0.60 3.60 ± 0.72 3.67 ± 1.00 a 4.06 ± 0.75 a 3.67 ± 0.90 a 3.44 ± 0.73 a 3.60 ± 0.63 a 家庭年收入(万元) ≤ 10 3.17 ± 0.60 3.61 ± 0.72 3.68 ± 1.00 4.06 ± 0.75 3.68 ± 0.90 3.44 ± 0.74 3.61 ± 0.63 (10, 40] 3.18 ± 0.60 3.61 ± 0.70 3.69 ± 1.01 4.11 ± 0.74 3.72 ± 0.90 3.46 ± 0.73 3.62 ± 0.62 > 40 3.14 ± 0.60 3.60 ± 0.73 3.73 ± 1.06 4.18 ± 0.76 a 3.79 ± 0.91 a 3.45 ± 0.82 3.65 ± 0.66 第一志愿录取 是 3.18 ± 0.60 3.62 ± 0.71 3.71 ± 1.00 4.09 ± 0.74 3.71 ± 0.91 3.46 ± 0.74 3.63 ± 0.63 否 3.14 ± 0.59 a 3.57 ± 0.71 a 3.60 ± 1.01 a 4.05 ± 0.75 a 3.64 ± 0.88 a 3.41 ± 0.74 a 3.57 ± 0.62 a 院校层次 双一流 3.09 ± 0.60 3.58 ± 0.73 3.56 ± 1.04 4.06 ± 0.74 3.61 ± 0.89 3.40 ± 0.76 3.55 ± 0.63 非双一流 3.23 ± 0.59 a 3.62 ± 0.71 a 3.77 ± 0.97 a 4.08 ± 0.75 3.76 ± 0.91 a 3.48 ± 0.72 a 3.66 ± 0.62 a 学制 8年制 3.07 ± 0.59 3.56 ± 0.72 3.55 ± 1.05 4.08 ± 0.73 3.60 ± 0.89 3.40 ± 0.76 3.54 ± 0.63 “5 + 3”一体化 3.19 ± 0.58 3.57 ± 0.70 3.69 ± 0.98 4.04 ± 0.75 3.68 ± 0.90 3.42 ± 0.70 3.60 ± 0.61 5年制 3.28 ± 0.61 a 3.68 ± 0.72 a 3.82 ± 0.96 a 4.10 ± 0.77 a 3.82 ± 0.90 a 3.53 ± 0.73 a 3.71 ± 0.63 a 高中职业理想 医生 3.27 ± 0.58 3.80 ± 0.68 4.00 ± 0.91 4.23 ± 0.69 3.89 ± 0.86 3.61 ± 0.71 3.80 ± 0.58 非医生 3.10 ± 0.60 a 3.46 ± 0.71 a 3.44 ± 1.01 a 3.96 ± 0.77 a 3.55 ± 0.91 a 3.33 ± 0.74 a 3.47 ± 0.63 a 毕业前学业排名 前25% 3.21 ± 0.60 3.69 ± 0.70 3.80 ± 0.95 4.15 ± 0.72 3.78 ± 0.87 3.51 ± 0.74 3.69 ± 0.61 26%~75% 3.15 ± 0.59 3.59 ± 0.70 3.65 ± 1.00 4.07 ± 0.73 3.67 ± 0.89 3.44 ± 0.73 3.59 ± 0.61 后25% 3.13 ± 0.62 a 3.40 ± 0.76 a 3.45 ± 1.12 a 3.92 ± 0.85 a 3.56 ± 1.00 a 3.34 ± 0.75 a 3.47 ± 0.69 a 注:各组内比较,a P < 0.05。 表 2 影响本科临床医学生职业认同的多元线性回归结果
变量 比较组 参照组 回归系数B $S_{\bar x}$ 标准化β t 值 P 值 常量 3.353 0.031 0.000 107.530 < 0.001 院校地区 东部 西部 0.044 0.018 0.034 2.471 0.013 中部 0.129 0.019 0.092 6.658 < 0.001 直辖市 0.020 0.025 0.011 0.821 0.412 性别 男性 女性 0.031 0.013 0.025 2.350 0.019 高考前生源地 农村 城市 0.030 0.015 0.023 2.005 0.045 家庭年收入 (10, 40] ≤ 10 0.034 0.015 0.025 2.194 0.028 > 40 0.068 0.036 0.020 1.902 0.057 是否第一志愿录取 是 否 0.046 0.015 0.031 3.042 0.002 院校层次 双一流(一流院校和一流学科) 非双一流 – 0.108 0.023 – 0.085 – 4.652 < 0.001 不同学制医学生 8年制 5年制 – 0.083 0.022 – 0.065 – 3.695 < 0.001 “5 + 3”一体化长学制 – 0.134 0.018 – 0.098 – 7.315 < 0.001 (高中阶段)职业理想 医生 非医生 0.314 0.013 0.249 23.882 < 0.001 毕业前学业排名 前25% 后25% 0.176 0.023 0.136 7.694 < 0.001 26%~75% 0.102 0.022 0.082 4.682 < 0.001 -
[1] Erikson EH. Identity, youth, and crisis[M]. New York: WW Norton, 1968. [2] Erikson EH. Identity and the life cycle[M]. New York: WW Norton, 1980. [3] Lien SS, Kosik RO, Fan AP, et al. 10-year trends in the production and attrition of Chinese medical graduates: an analysis of nationwide data[J]. The Lancet, 2016, 388(S1): S11. [4] The Lancet. Taking China’s health professional education into the future[J]. The Lancet, 2014, 384(9945): 715. doi: 10.1016/S0140-6736(14)61420-3 [5] 张丽莉. 医学生职业认同现状及影响因素研究[D]. 上海: 华东师范大学, 2010. [6] 王文广. 西部某高校农村订单定向医学生职业认同现状调查分析[D]. 昆明: 昆明医科大学, 2015. [7] 于晨. 临床医学实习对医学生职业认同形成的影响研究[D]. 北京: 北京大学, 2020. [8] 侯建林, 蔡景一, 董哲, 等. 6129名医学本科生生源及择业意愿研究[J]. 中华医学教育杂志, 2012, 32(6): 826 – 830. doi: 10.3760/cma.j.issn.1673-677X.2012.06.009 [9] 王凤前, 曲乃强, 牛启超. 医学生职业认同现状调查[J]. 中国公共卫生, 2018, 37(9): 1260 – 1262. doi: 10.11847/zgggws1116615 [10] 于晨, 刘霞, 陶立元, 等. 新型冠状病毒肺炎疫情背景下公共卫生与预防医学专业本科生职业认同现状调查[J]. 中国公共卫生, 2021, 37(6): 986 – 989. doi: 10.11847/zgggws1134642 [11] 刘泽豫, 翟玥, 段茗玉, 等. 医学生从医意愿现状调查及其与医疗执业环境的相关性分析[J]. 中华医学教育杂志, 2018, 38(1): 17 – 21. doi: 10.3760/cma.j.issn.1673-677X.2018.01.004 [12] AAMC. Graduation Questionnaire (GQ)[EB/OL]. [2021 – 02 – 01]. https://www.aamc.org/data-reports/students-residents/report/graduation-questionnaire-gq. [13] 王雄伟. 医学生职业认同现状与影响因素研究[J]. 中国社会医学杂志, 2018, 35(5): 495 – 498. doi: 10.3969/j.issn.1673-5625.2018.05.017 [14] Côté JE, Levine CG. Identity formation, agency, and culture: a social psychological synthesis[M]. Mahwah: L. Erlbaum Associates, 2002. [15] Goldie J. The formation of professional identity in medical students: considerations for educators[J]. Medical Teacher, 2012, 34(9): e641 – e648. doi: 10.3109/0142159X.2012.687476 [16] 茅佳欢. 医学专业大学生职业认同现状研究[J]. 社会心理科学, 2015, 30(1): 45 – 50. -

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