医患信任对医学生临床实习与职业规划的影响

Impact of doctor-patient trust on clinical clerkship and career plan in medical students

目的 临床实习是医学生培养计划中的重要组成部分.本研究于2004年、2014年2次开展问卷调查,以了解医学生对临床实习教学的满意度以及医患信任的变化,分析新形势下医患信任对医学生临床实习与职业规划的影响,为临床实习教育的改革提供科学依据.方法 以在同济大学医学院3所附属医院中实习时间超过3个月的临床医学专业学生作为研究对象,于2004年和2014年采用随机抽样问卷调查方式,就医学生对实习教学、医患信任与临床实习、职业规划等问题的认识进行调查分析.结果 共计227名实习学生完成了问卷调查（2004年128名,2014年99名）.超过50％的实习学生对实习教学表示满意,2014年的满意率较2004年有明显升高,P=0.013,差异具有统计学意义.2014年有更大比例的实习学生认为医患关系紧张,但其中认为医患关系影响了临床实习人数比例较10年前降低,P=0.000,差异具有统计学意义.超过60％的实习学生表示医患信任不足对职业规划有影响.结论 实习学生对临床实习教学的总体满意度较10年前升高;临床实习教学中医患信任障碍的发生率有所降低但仍然常见;医患信任是影响医学生职业规划的因素之一.

Objective Clinical clerkship is an important session for medical student education.The present survey analyzed the interns＇ comments about the clinical clerkship and doctor-patient relationship in 2004 and 2014,in order to investigate the impact of doctor-patient trust on clinical clerkship and career plan of medical students in the recent decade.Methods Medical students from three teaching hospitals of Shanghai and had been on clinical clerkship for longer than 3 months were recruited in the questionnaire survey.The questionnaire included muhiple-choice questions about assessment about clerkship education,doctor-patient trust and relationship,as well as career plan.Results 227 interns finished the questionnaires with 128 in 2004 and 99 in 2014,respectively.More than 50% interns were satisfied with their clinical clerkship education and the percentage increased significantly in 2014 （81.8%in 2014 vs.64.1% in 2004,P=0.013）.There were more interns in 2014 assessed the current doctorpatient relationship as ‘ not so good’ or ‘ bad’,however,less interns thought the bad doctor-patient relationship had influenced their clinical clerkship （22.2% in 2014 vs.37.5% in 2004,P=0.000）.Lack of trust between doctor and patient had influenced the career plan in more than 60% interns in both 2004 and 2014.Conclusions More interns are satisfied with the clinical clerkship education compared to 10 years ago.Less interns experienced rejection from patients in 2014 but it is still common during clinical clerkship.Lack of trust between the doctor and patient is one determinates of career plan in medical students.