预防医学学生临床实习现状调查分析及对策探讨

目的了解某高校预防医学学生临床实习情况,分析问题的原因,探讨解决方法。方法对某高校2010年5-8月参加临床实习的200名预防医学专业的学生通过问卷调查的方式进行普查,以内对照的方式研究实习生精力投入情况对参与诊疗程度的影响。通过随机抽样的方法在参与临床实习带教的2所三甲医院分别抽取25名带教医生进行问卷调查,结合实习生的调查数据,研究带教医生对实习生参与诊疗程度的影响。结果学生对临床实习的精力投入与实习参与度有强相关性,RR值为3.84（χ2=85.81,P〈0.005）,与实习效果也有一定的相关性,RR值1.12（χ2=85.81,P〈0.005）;带教医生不给机会、法律制约（法律没赋予实习生诊疗权限）和医患关系紧张成为影响学生实习效果的最主要因素（χ2=17.33,P〈0.005,r=0.775）;法律制约、学生积极性不高、医患关系紧张、临床工作繁重以及带教无价值体现是影响带教医生鼓励学生临床实践的最主要因素（χ2=16.81,P〈0.05,r=0.922）。结论预防医学专业的学生虽然大多能较好地完成临床实习,但由于实习时间短,且相当部分学生将主要时间和精力放在了准备考研、出国、找工作及各类考证上,影响了学生投入临床实习的时间;就业形势严峻、医患关系紧张及法律保障缺失是影响学生临床实习质量好坏的深层次原因。制定配套就业政策,缓解医学生就业压力;提早临床实习及制定保障性法规是解决上述问题的根本办法。

Investigation and analysis of current situation of the clinical practice of the preventive medicine students

Objective To investigate the current situation of the clinical practice of the preventive medicine students of a university,and analyze the problems,and suggest the countermeasures.Methods Questionnaire was used to survey the situation of the clinical practice of the preventive medicine students of a university from May to August 2010.The survey was included the effort they pay for the clinical practice and the involvement in the clinical treatment,and analyzed the effect of the energy they input on the degree of involvement in the clinical practice.25 teaching doctors were randomly selected from 2 3A hospitals for the survey of their degree of encouragement for the participation of the intern students in clinical treatment,the factors affecting their energetic teaching.Taking together with the survey on the students,we also analyzed the influence of the teaching doctors on the participation of the students in clinical practice.Results The more the attention that students pay to clinical practice,the more they can take part in the practice（X2=85.81,P0.005,RR=3.84）.The more the attention that students pay to clinical practice,the more they can learn from this practice（X2=85.81,P0.005,RR=1.12）.The teaching doctors＇ attitude,the legal constraints and the tension relationship between patients and doctors,are the main factors affecting the students＇ passion（X2=17.33,P0.005,r=0.775）.The legal constraints,the students＇ lack of passion,the tension relationship between patients and doctors,the tension of clinical work and the worthless of clinical teaching are the main factors affecting the teaching doctors＇ passion（X2=16.81,P0.05,r=0.922）.Conclusion Facing with the high tension of employment,it is hard for the student to pay much attention to clinical practice.A lot of preventive medical students are busy with going aboard,seeking jobs,taking part in the entrance exams for graduate schools.The tension relationship between patients and doctors is another key point.So setup the employment policy,ease the employment pressure and make proper clinical practice schedule are the fundamental ways to solve these problems.