China will fully implement the standardised training system for residents in 2020

Measuring job stress of dental workers in China during the COVID-19 pandemic: reliability and validity of the hospital consultants' job stress questionnaire

BACKGROUND

The Hospital Consultants' Job Stress Questionnaire (HCJSQ) has been widely used to assess sources and levels of job stress. However, its reliability and validity among Chinese dental workers have not been extensively studied. The objective of this study was to assess the reliability and validity of the HCJSQ specifically in Chinese dental workers.

METHODS

The HCJSQ was used to explore the sources and the global ratings of job stress among Chinese dental workers. To assess the reliability and validity of the HCJSQ, various statistical measures were employed, including Cronbach's alpha coefficient, Spearman-Brown coefficient, Spearman correlation coefficient, exploratory factor analysis, confirmatory factor analysis, convergent validity, and discriminant validity.

RESULTS

Of the participants, 526 (17.4%) reported high levels of stress, while 1,246 (41.3%) and 1,248 (41.3%) reported moderate and low levels of stress, respectively. The Cronbach's alpha coefficient for the modified HCJSQ was 0.903, and the Spearman-Brown coefficient was 0.904. Spearman correlation coefficient between individuals' items and the total score ranged from 0.438 to 0.785 (p < 0.05). Exploratory factor analysis revealed that three factors accounted for 60.243% of the total variance. Confirmatory factor analysis demonstrated factor loadings between 0.624 and 0.834 on the specified items. The fit indices of the confirmatory factor analysis indicated good model fit, with a Root Mean Square Error of Approximation of 0.064, Normative Fit Index of 0.937, Comparative Fit Index of 0.952, Incremental Fit Index of 0.952, Tucker-Lewis index of 0.941, and Goodness of Fit Index of 0.944. Additionally, the convergent validity and discriminant validity showed a good fit for the three-factor model.

CONCLUSION

The results of this study confirm that Chinese dental workers experience high levels of stress, and the three-factor model of the HCJSQ proves to be a suitable instrument for evaluating the sources and levels of job stress among Chinese dental workers. Therefore, it is imperative that relevant entities such as hospitals, medical associations, and government take appropriate measures to address the existing situation.

Work Patterns and Intensity of Chinese Surgical Residents- A Multicenter Time-and-Motion Study

OBJECTIVE

This study aimed to record and analyze surgical resident trainee time allocation among junior doctors in China in order to understand the training environment and optimize realistic training and patient care objectives.

DESIGN

Multicenter observational time and motion study.

SETTING

Multicenter, carried out in 5 tier 3 public hospitals in 5 provinces across China.

PARTICIPANTS

Surgical resident trainees at various stages of training were eligible to enter the study, total n = 44. Registered nurses were eligible to be observers, n = 4 from each hospital.  An expert team comprising 4 chief surgeons and 10 surgical residents participated in establishing the clinical activity list.

RESULTS

Participants were observed during working hours (08.00-17.00) for 10 consecutive working days and time spent on different activities were recorded. Work patterns between hospitals were often dissimilar. Most time was spent on direct patient care (34.1%; 95% CI, 28.0%-40.1%) followed by indirect patient care (24.4%; 95% CI, 15.5%-33.2%), scholarly activity (21.1%; 95% CI, 13.7%-28.5%) and other (20.4%; 95% CI, 14.1%-26.8%). Subcategory analysis showed that the amount of time spent each day performing certain tasks was 137 minutes for operating theatre tasks, 103 minutes for medical record-keeping, 25 minutes for direct patient contact, 20 minutes being taught, 12 minutes teaching others, 12 minutes hand-over time, and 0 minutes of outpatient clinic attendance. Inter-observer reliability of 96.5% was obtained prior to recordings.

CONCLUSIONS

Chinese surgical resident work patterns fall within the range found in other international studies albeit with some exceptions. The training environment appears broadly suitable for competence-based surgical training in China. Inadequate outpatient activity has led to changes in trainee work rosters and trainer requirements. Both strengths and deficiencies were confirmed and addressed. Further audit is required.

Factors associated with graduation examination results from standardised residency training in Zhejiang Province, China: a cross-sectional analysis of medical examination results data from 2020

OBJECTIVE

Standardised residency training is an important part of postgraduation medical education in China. The graduation examination tests the effect of residency training and is an important measure to guarantee the quality of residency training. This study aimed to analyse the results and associated factors of the graduation examination of standardised residency training in Zhejiang Province in 2020.

DESIGN

Cross-sectional analysis of examination results data.

SETTING

Medical and health institutions and universities in Zhejiang Province.

PARTICIPANTS

A total of 5555 examinees took the graduation examination of standardised residency training in Zhejiang Province in 2020.

PRIMARY OUTCOMES

Pass rates of the practical skill examination and written examination.

RESULTS

The pass rates for the practical skill examination and written examination were 91.8% and 96.5%, respectively. Examinees aged 30 and above (adjusted OR (AOR)=0.48, 95% CI 0.26 to 0.89), those with 3 years (AOR=0.19, 95% CI 0.09 to 0.43) and 2 years (AOR=0.61, 95% CI 0.40 to 0.96) of training, those who retook the examination (AOR=0.28, 95% CI 0.20 to 0.391) and those from primary healthcare institutions (AOR=0.56, 95% CI 0.40 to 0.77) were less likely to pass the practical skill examination. Examinees with a postgraduate degree and those from colleges and universities had higher pass rates in the written examination (AOR=6.37, 95% CI 1.95 to 23.34; AOR=2.87, 95% CI 1.40 to 6.65, respectively). Examinees aged 30 and above (AOR=0.08, 95% CI 0.01 to 0.30), those aged between 25 and 30 (AOR=0.22, 95% CI 0.03 to 0.80), those who retook the examination (AOR=0.04, 95% CI 0.03 to 0.07), those from second-level hospitals (AOR=0.58, 95% CI 0.39 to 0.87) and those who failed the practical skill examination (AOR=0.17, 95% CI 0.12 to 0.25) were less likely to pass the written examination.

CONCLUSIONS

The pass rate of the graduation examination of standardised residency training was associated with the individual characteristics of the examinees. The results of practical skill examination were related to the results of the written examination.

High prevalence and risk factors of dropout intention among Chinese medical postgraduates

BACKGROUND

A high attrition rate in medical students has exacerbated the physician shortage in China. However, few studies have explored the risk factors of dropout intention in medical postgraduates. This study compared the prevalence of dropout intention and mental distress between medical and non-medical postgraduates in China and investigated risk factors for dropout intention. This study also explored the impact of medical postgraduates' perception of the Chinese healthcare environment on their mental status and dropout intention.

METHODS

This cross-sectional study was conducted using online questionnaires from October 2020 to April 2021. Convenience sampling was used to recruit postgraduates in different majors. Outcomes included dropout intention and potential risk factors, including mental distress, quality of life, and fatigue. Medical postgraduates were additionally assessed for healthcare environment satisfaction, burnout, career choice regret, and experiences of workplace violence. A logistic regression model was constructed to evaluate the association between dissatisfaction, mental distress, and turnover intention.

RESULTS

A total of 740 medical and 670 non-medical postgraduates participated in the survey. The rates of depression symptoms (33.8% vs. 39.0%, p < 0.001), anxiety symptoms (22.2% vs. 32.4%, p < 0.001), and somatic symptoms (34.7% vs. 42.4%, p = 0.004) were lower in medical postgraduates, while more medical postgraduates (58.4% vs. 48.4%, p < 0.001) reported dropout intention. Dissatisfaction with the healthcare environment (odds ratio [OR]: 1.65; 95% confidence interval [CI]: 1.17-2.34, p = 0.005), career choice regret (OR: 6.23; 95% CI: 4.42-8.78, p < 0.001), and high perceived stress (OR: 2.74; 95%CI: 1.90-3.94, p < 0.001) remained independently associated with turnover intention.

CONCLUSIONS

Mental distress is common among postgraduates, calling for timely interventions. Medical postgraduates reported higher turnover intention. Healthcare environment perception also affected the mental health and dropout intentions of medical students. A decent future income, reduced workload, shorter duration medical training, and better doctor-patient relationships are urgently needed.

Cultivation of compound ability of postgraduates with medical professional degree: the importance of double tutor system

As we all know, medical postgraduate education is very important for training high-quality clinicians, and can have a long-term impact on the promotion of the global health service system. In recent years, following the example of developed countries in Europe and America, the Chinese government has reformed the training mode of medical postgraduates and implemented the double tutor system. Although this system will bring many positive effects in theory, the difficulties encountered in implementing this system are real and need the joint efforts of schools, tutors and students to solve them. This article closely follows the background of the current era, compares the differences between Chinese and foreign graduate training modes, and emphatically discusses the significance and problems of the double tutor system in the postgraduate education reform in China.

Workplace violence against doctors in China: A case analysis of the Civil Aviation General Hospital incident

Background

Violence against health professionals is a global public health problem. In 2019, a doctor was killed in Civil Aviation General Hospital (CAGH), which triggered national discussion about hospital violence. Sina Weibo, the Chinese version of Twitter, played an important role in this public discussion. The CAGH incident provides us with an opportunity to explore how social media was used in the discussion on violence against doctors.

Methods

Using the built-in search engine of Sina Weibo, a data set containing 542 Chinese micro-blogs was established. Three keywords: Civil Aviation General Hospital, doctor, and knife were used to search for related posts between December 24th, 2019 and January 19th, 2020. We made a content analysis of the posts to investigate: Weibo users' demographics, views about the incident of CAGH, and measures to prevent hospital violence.

Results

Overall, 89.3% of the posts were sent by individual Weibo users, and 10.7% by organizations. Among the individual users, doctors accounted for 27.4%, but only 1.0% came from the legal profession. In addition, 86.7% of the micro-blogs expressed sympathy for the attacked doctor, and 23.1% of the micro-blogs thought that the imperfect medical system was the main cause of the accident. Nearly half of the posts described their disappointment with the government and the society, and 58.6% of medical staff users expressed regret for engaging in medical work. Only 14.2% of micro-blogs put forward some constructive strategies to prevent hospital violence.

Conclusion

Weibo users played an important role in spreading and discussing the CAGH incident. However, constructive measures to protect doctors were rarely mentioned, and legal opinions were not reflected in time. Hospital violence has caused public dissatisfaction with the government and weakened the professional confidence of medical staff. Occupational health and public health stakeholders must take effective measures to solve workplace violence against doctors.