我国不同地区临床医学专业研究生导师职业倦怠现状及影响因素的调查与分析

Survey on burnout of clinical medicine postgraduate supervisors in different regions of China and analysis of influencingfactors

目的:了解我国不同地区临床医学专业研究生导师职业倦怠的现状及其影响因素,为缓解导师职业倦怠提供参考。方法:2021年11至12月,选取我国东、中、西部36所院校的4 276名临床医学专业研究生导师作为自愿样本进行调查,采用Kruskal-Wallis秩和检验和卡方检验探究不同地区研究生导师职业倦怠的差异;采用多元线性逐步回归方法分析影响因素。结果:临床医学专业研究生导师职业倦怠检出率为28.8%(1 230/4 276),轻度、中度和重度倦怠检出率分别为20.2%(864/4 276)、7.9%(337/4 276)和0.7%(29/4 276),东、中、西部地区导师的职业倦怠均以轻度倦怠为主,检出率分别为17.7%(271/4 276)、20.3%(298/4 276)、23.0%(295/4 276)。排除了个人特征因素的影响后,在情感耗竭维度,不同地区导师均受其对临床工作评价的影响(东部地区: b=-0.21, P<0.001;中部地区: b=-0.35, P<0.001;西部地区: b=-0.37, P<0.001),且东部地区导师还受到其对教学工作评价的影响( b=-0.15, P=0.014);在人格解体维度,东部地区导师的倦怠受其对教学工作评价影响( b=-0.28, P<0.001),中部地区导师的倦怠受其对临床工作评价影响( b=-0.28, P<0.001),西部地区导师对临床( b=-0.17, P=0.010)、教学( b=-0.33, P<0.001)和科研工作评价( b=-0.21, P=0.005)均会影响其职业倦怠;在个体成就感降低维度,不同地区导师的职业倦怠均受其对临床工作评价(东部地区: b=-0.20, P=0.001;中部地区: b=-0.23, P<0.001;西部地区: b=-0.17, P=0.009)和教学工作评价(东部地区: b=-0.21, P<0.001;中部地区: b=-0.26, P<0.001;西部地区: b=-0.23, P<0.001)的影响。 结论:临床医学专业研究生导师存在一定程度的职业倦怠,受不同工作评价的影响,应当采取针对性措施对导师的职业倦怠进行预防和干预,以降低临床、教学工作中的不利因素对东、中部地区导师的影响,降低临床、教学、科研工作中的不利因素对西部地区导师的影响。

Objective To understand the current situation of burnout among postgraduate supervisors in clinical medicine across different regions,to analyze and compare the differential influencing factors,and to inform measures for alleviation.Methods From November to December 2021,a voluntary sample of 4276 postgraduate supervisors in clinical medicine from 36 institutions in east,central and west China participated in the survey,and Kruskal-Wallis rank sum test and chi-square test were used to explore the differences in their burnout across different regions;multiple linear stepwise regression was used to analyze the influencing factors.Results The burnout detection rate of 4276 supervisors participating in the survey was 28.8%(1230/4276),and the detection rates of mild,moderate and severe burnout were 20.2%(864/4276),7.9%(337/4276)and 0.7%(29/4276),respectively,and the burnout of instructors in the eastern,central and western regions were mainly mild burnout,and the detection rates were 17.7%(271/4276),20.3%(298/4276),and 23.0%(295/4276).After excluding the influence of personal characteristics factors,in the emotional exhaustion dimension,supervisors in different regions were affected by clinical work evaluation(eastern region:b=-0.21,P<0.001;central region:b=-0.35,P<0.001;western region:b=-0.37,P<0.001),and supervisors in the eastern region were also affected by teaching work evaluation(b=-0.15,P=0.014);in the dimension of depersonalization,supervisors'burnout in the eastern region was affected by teaching work evaluation(b=-0.28,P<0.001),supervisors'burnout in the central region was affected by clinical work evaluation(b=-0.28,P<0.001),and supervisors'clinical(b=-0.17,P=0.010),teaching(b=-0.33,P<0.001)and research work evaluation(b=-0.21,P=0.005)in the western region all affected their burnout;In the dimension of reduced individual achievement,the burnout of supervisors across different regions is affected by both clinical work evaluation(eastern region:b=-0.20,P=0.001;central region:b=-0.23,P<0.001;western region:b=-0.17,P=0.009)and teaching work evaluation(eastern region:b=-0.21,P<0.001;central region:β=-0.26,P<0.001;western region:b=-0.23,P<0.001).Conclusions There exists a certain degree of burnout among instructors of graduate students in clinical medicine,which is affected by different job evaluations.Targeted measures should be taken to prevent and intervene in the burnout of instructors,so as to reduce the influence of unfavorable factors in clinical and teaching work on instructors in the east and central regions,and reduce the influence of unfavorable factors in clinical,teaching and research work on instructors in the west.