中国全科医学 ›› 2024, Vol. 27 ›› Issue (22): 2766-2772.DOI: 10.12114/j.issn.1007-9572.2023.0783

• 论著·全科医学教育研究 • 上一篇    下一篇

农村订单定向医学毕业生工作场所患者源暴力、职业倦怠与离职意向的关系研究

申丽君1,2, 李晗歌1, 王培成1, 朱纪明1,3,*()   

  1. 1.100084 北京市,清华大学万科公共卫生与健康学院
    2.100084 北京市,清华大学医学院
    3.100084 北京市,清华大学健康中国研究院
  • 收稿日期:2023-12-20 修回日期:2024-05-02 出版日期:2024-08-05 发布日期:2024-05-28
  • 通讯作者: 朱纪明

  • 作者贡献:

    申丽君进行文章构思、数据分析,撰写论文初稿;申丽君、李晗歌、王培成、朱纪明负责研究设计,进行问卷开发与数据采集;朱纪明负责项目统筹、文章修订、质量控制,对文章整体负责。

  • 基金资助:
    国家社会科学基金教育学一般课题(BLA220240)

Association between Burnout, Workplace Violence, and Turnover Intention among Medical Graduates from a National Compulsory Service Programme

SHEN Lijun1,2, LI Hange1, WANG Peicheng1, ZHU Jiming1,3,*()   

  1. 1. Vanke School of Public Health, Tsinghua University, Beijing 100084, China
    2. School of Medicine, Tsinghua University, Beijing 100084, China
    3. Institute for Healthy China, Tsinghua University, Beijing 100084, China
  • Received:2023-12-20 Revised:2024-05-02 Published:2024-08-05 Online:2024-05-28
  • Contact: ZHU Jiming

摘要: 背景 农村订单定向医学生免费培养项目是缓解农村地区基层医生匮乏、提升基层医疗卫生队伍整体素质和技术水平的重要举措。目前,完成"5+3"培养模式的农村订单定向医学毕业生(以下简称定向毕业生)逐步履约进入基层工作,其基层工作现状及服务期满后留任意愿受到高度关注。 目的 探讨职业倦怠和工作场所患者源暴力对离职意向的影响,为稳定全科医生队伍提供政策建议。 方法 于2021年12月—2022年2月,采用分层整群抽样方法抽取9个省份,在各省卫生健康委科教处的协助下向定向毕业生开展电子问卷调查。定向毕业生的职业倦怠采用职业倦怠量表-服务行业版(MBI-HSS)评估,工作场所患者源暴力涉及语言暴力和躯体暴力,离职意向的测量问题为"服务期满后,您是否愿意继续服务基层?"。采用多因素Logistic回归分析定向毕业生的职业倦怠和工作场所患者源暴力对离职意向的影响。 结果 3 615份定向毕业生的问卷被有效回收。87.77%(3 173/3 615)的定向毕业生服务期满后不愿意/不确定是否留任。17.46%(631/3 615)的定向毕业生遭受过躯体暴力,60.33%(2 181/3 615)的毕业生遭受过语言暴力。定向毕业生的职业倦怠检出率为55.82%(2 018/3 615),其中,60.80%(2 198/3 615)的定向毕业生处于中度/重度情感耗竭,去个性化和个人低成就感的占比分别为67.55%(2 442/3 615)和83.76%(3 028/3 615)。多因素Logistic回归分析结果显示,在控制了性别、职称、个人月收入等社会经济学因素后,处于职业倦怠的定向毕业生有4.92倍[95%CI(3.87~6.25)]的风险离职,1.92倍[95%CI(1.50~2.46)]的风险不确定是否留任(P<0.05);遭受语言暴力和躯体暴力的定向毕业生分别有1.46倍[95%CI(1.12~1.91)]和0.38倍[95%CI(0.27~0.52)]的风险会在服务期满后离职(P<0.05)。 结论 目前,定向毕业生的离职意向较高,预计服务期满后基层全科人才流失较多。职业倦怠是离职意向的核心影响因素,我国定向毕业生职业倦怠状况不容乐观,应从多个层面加强对工作的调节,缓解员工负面情绪,从而稳定全科医生队伍。

关键词: 职业倦怠, 工作场所暴力, 离职意向, 农村订单定向医学生, 全科医生, 影响因素分析

Abstract:

Background

China's National Compulsory Service Programme (CSP) is an important measure to alleviate its shortage of primary health care (PHC) workforce and improve quality of care in rural areas. Currently, the work status and turnover intention of the CSP medical graduates (the fully-fledged general practitioners in China) have received considerable attention.

Objective

This article will investigate the medical graduates' workplace violence, burnout, and turnover intention, in order to provide policy recommendations to stabilize the general practitioners.

Methods

From December 2021 to February 2022, an online structural questionnaire survey was conducted in nine out of 22 provinces adopting a stratified random sampling method. The electronic questionnaires were distributed to medical graduates with the assistance of the Science and Education Department of the Provincial Health Commission. The burnout of medical graduates was assessed using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) . Workplace violence involved the verbal and physical violence. Turnover intention was measured by "Are you willing to continue serving at the PHC institutions upon the completion of the contract (the compulsory service) ?" Multivariate Logistic regression analysis was used to explore the impact of burnout and workplace violence on turnover intention.

Results

A total of 3 615 questionnaires were effectively collected. 87.77% (3 173/3 615) of medical graduates were unwilling or unsure to continue their employment after finishing the contract. 17.46% (631/3 615) of medical graduates had experienced physical violence, and 60.33% (2 181/3 615) had experienced verbal violence. In addition, the detection rate of burnout was 55.82% (2 018/3615) , of which 60.80% (2 198/3 615) were in moderate or severe emotional exhaustion, while the proportions of depersonalization and personal accomplishment were 67.55% (2 442/3 615) and 83.76% (3 028/3 615) , respectively. Logistic regression analysis showed that after controlling for socio-economic factors such as gender, professional title, and personal monthly income, medical graduates who were experiencing burnout had a 4.92 times[95%CI (3.87-6.25) ] higher risk of leaving, a 1.92[95%CI (1.50-2.46) ]times higher risk of uncertain retention (P<0.05) . Medical graduates who experienced verbal and physical violence were 1.46 times[95%CI (1.12-1.91) ] and 0.38 times[95%CI (0.27-0.52) ] more likely to leave after the contract expires (P<0.05) .

Conclusion

Medical graduates have a high intention to leave, and it is expected that there will be a significant loss of general practitioners after the contract expires. Burnout is a significant and prevalent problem affecting turnover intention. Efforts should be made from multiple perspectives to alleviate medical graduates' negative emotions, and thus stabilize the general practitioners.

Key words: Burnout, Workplace violence, Turnover intention, Medical graduates from a national compulsory service programme, General practitioners, Root cause analysis