全科住培医师职业倦怠与离职意愿的相关性研究

黄蕾+胡世钰+汪浩+崔海松+靳令经

摘 要 目的：了解全科規范化培训的住院医师（住培医师）职业倦怠和离职意愿的现状，分析人口社会学因素和职业倦怠对全科住培医师离职意愿的影响。方法：2017年，采用完全随机抽样法在全国10所住院医师规范化培训基地中抽取135名全科住培医师进行职业倦怠和离职意愿问卷调研。结果：135名住培医师的离职意愿总分为（18.07±4.120）分，其中62人（45.92%）离职意愿很高或较高；职业倦怠3个分维度得分依次为情绪枯竭（17.76±6.188）分，去人格化（7.02±3.835）分和个人成就感（26.77±8.098）分。单因素方差分析显示有工作经历和已规培时间长的住培医师离职意愿总分高于无工作经历和规培时间较短者（P<0.05）。离职意愿与情绪枯竭（r=0.393）和去人格化（r=0.310）呈显著正相关（P<0.01）。分层逐步回归分析显示，在与离职意愿总分相关的因素中，工作经历与已规培时间的效应显著；引入职业倦怠的3个分维度后，工作经历和已规培时间对离职意愿总分的预测效益仍显著。在控制人口统计学变量后，情绪枯竭对离职意愿总分所解释的方差变异量为0.130（P<0.001）。结论：中国全科住培医师的离职意愿相对较高，且随工作年限增长而升高，职业倦怠对全科住培医师的离职意愿有显著预测作用。建议从个人层面、组织层面和社会层面三管齐下，提高全科住培医师的职业认同感，从而预防其职业倦怠，降低离职意愿。

关键词 职业倦怠；离职意愿；住院医师规范化培训；全科医学

中图分类号：R192.3 文献标志码：A 文章编号：1006-1533（2017）24-0007-04

Study on the relation of job burnout and turnover intention in the resident physician of general standardized training program

HUANG Lei1，4， HU Shiyu2， WANG Hao3， CUI Haisong4， JIN Lingjing5（1.Department of Medical Education，Tongji Hospital of Tongji University， Shanghai 200065， China； 2.Tongji University School of Medicine， Shanghai 200092， China； 3.Department of Special Medical Services，Tongji Hospital of Tongji University， Shanghai 200065， China； 4.Department of Psychiatry， Tongji Hospital of Tongji University，Shanghai 200065，China； 5.Department of Neurology， Tongji Hospital of Tongji University， Shanghai 200065， China）

ABSTRACT Objective： To investigate the status of job burnout and the turnover intention in the resident physician of general standardized training program and to analyze the influence of demographical and sociological factors and job burnout on the turnover intention of the resident physician of general standardized training program. Methods： The investigation of job burnout and the turnover intention was carried out in 135 resident physicians of general standardized training program selected from ten training bases using random sampling method in 2017. Results： The total score of turnover intention was 18.07±4.120. The relatively or extremely high scores of turnover intention was found in 62 （45.92%） physicians . The scores of three dimensions of burnout were 17.76±6.188 for emotional exhaustion， 7.02±3.835 for depersonalization and 26.77±8.098 for personal accomplishment. One-way analysis of variances showed that higher score of turnover intention was found in the resident physicians with work experience and longer training than those without work experience and with shorter training （P<0.05）. The positive correlation was found between turnover intention and emotional exhaustion （r=0.393， P<0.01） and depersonalization（r=0.310， P<0.01）. Hierarchical stepwise regression analysis showed that work experience and training times had obvious significance on the scores of total turnover intention. After drawing the three dimensions of job burnout into regression， work experience and training time also had prediction on the scores of every dimensions of turnover intention and only emotional exhaustion dimension had positive prediction on the scores of total turnover intention. After controlled the demographic variables， emotional exhaustion explained the variation rate of 0.130 to the score of total turnover intention（P<0.001）. Conclusion： The turnover intention of Chinese resident physician of general standardized training program is relatively high， and with the increase of working years， job burnout has a significant predictive effect on the turnover intention of the resident physician of general standardized training program. It is suggested to improve occupational identity of the resident physician of general standardized training program to prevent the job burnout and reduce turnover intention from individual， organizational and social levels.endprint

KEY WORDS standardized training residents； general practice； turnover intention； job burnout

住院医师规范化培训医师制度（简称住培制度）是医学人才培养制度改革的重要组成部分，其设置的目的是经过标准化培训，培养出质量比较一致的医师，同时提供匹配庞大人口需求的医疗人才以及降低城镇与农村地区的医疗设施的巨大差距。该制度作为我国医学生成为医生的必要之路，最早于2010年在上海及其他几个试点城市实行，并将在2020年前普及到全国其他城市[1]。

为扭转我国专科医学与全科医学发展不平衡、初级卫生保健服务严重不足、基层医疗人才严重不足、医疗资源配置不合理和医疗费用上涨的现况，实现人人享有基层医疗卫生保健的目标，国家提出根据需求分层培养医学人才，出台关于全科医学制度的指导意见，提倡大力推进全科医学教育，培养一批训练有素的全科医师[2]。……