• 【瑞士居民赞成和反对医学职业的论点。】 复制标题 收藏 收藏
    DOI:10.1186/1472-6963-6-98 复制DOI
    作者列表:Buddeberg-Fischer B,Dietz C,Klaghofer R,Buddeberg C
    BACKGROUND & AIMS: BACKGROUND:In some Western countries, the medical profession is continuously losing prestige, doctors are claiming of high demands, low rewards, and difficult structural working conditions. This study aimed to investigate the arguments given by Swiss residents for and against a career in medicine. METHODS:As part of a prospective cohort study of Swiss medical school graduates on career development, 567 fourth-year residents were asked to answer the free-response item of what arguments there still were in favour of or against a career in medicine. They also indicated whether they would choose the medical profession all over again (yes/no). The statements were transcribed, content categories inductively formulated, and their descriptions written down in a code manual. Arguments were encoded according to the code manual and assigned to eight content categories (Mayring's content analysis). Frequency distributions were given for categories and tested with Chi2-tests for differences in gender, speciality fields, and whether or not the respondent would again choose a career in medicine. RESULTS:The 567 participants made 1,640 statements in favour of and 1,703 statements against a career in medicine. The content analysis of the residents' answers yielded eight categories with arguments both for and against a career in medicine. Of all "statements for" responses, 70% fell into the two top-ranking categories of Personal experiences in day-to-day working life (41.2%) and Interpersonal experiences in professional relationships (28.8%). The top-ranking category of the "statements against" arguments was General work-related structural conditions (32%), followed by Social prestige and health-policy aspects (21%). Main arguments in favour of a career in medicine were interdisciplinary challenge, combination of basic sciences and interpersonal concerns, helping suffering people, guarantee of a secure job; arguments against comprised high workload, time pressure, emotional stress, poorly structured continuing education, increasing bureaucracy, work-life imbalance, low income, and decreasing social prestige. The statements revealed few differences depending on gender, medical field, and attitude towards choosing the medical profession again; one out of five young doctors would not do so. CONCLUSION:Residents' chief complaint is deteriorating structural working conditions, including unfavourable work-life balance. Making medicine an attractive profession again will require sustainable changes in health-policy framework and social reward.
    背景与目标: 背景:在某些西方国家,医学界一直在失去声望,医生声称要求高,报酬低并且结构性工作条件艰苦。这项研究旨在调查瑞士居民支持和反对医学职业的观点。
    方法:作为对瑞士医学院毕业生职业发展的一项前瞻性队列研究的一部分,要求567名四年级居民回答自由回答的问题,即哪些观点仍然支持或反对医学职业。他们还指出是否会再次选择医学专业(是/否)。语句被转录,内容分类归纳,并在代码手册中记录了它们的描述。根据代码手册对参数进行编码,并将其分配给八个内容类别(Mayring的内容分析)。给出了频率分布的类别,并通过Chi2-test进行了测试,以检查性别,专业领域的差异以及受访者是否会再次选择从事医学职业。
    结果:567名参与者发表了1,640项赞成的陈述,而1,703项反对医学职业的陈述。居民回答的内容分析产生了八类,分别支持和反对医学职业。在所有“回应声明”中,有70%属于日常工作生活中的个人经历(41.2%)和人际关系中的职业经历(28.8%)这两个最重要的类别。 “反对声明”论证中排名最高的类别是与一般工作有关的结构性条件(32%),其次是社会声望和卫生政策方面(21%)。支持医学职业的主要论据是跨学科的挑战,基础科学与人际关系的结合,帮助受苦的人们,确保一份稳定的工作;反对意见包括工作量大,时间压力大,情绪紧张,继续教育结构不良,官僚主义加剧,工作生活失衡,低收入和社会声望下降。声明显示,根据性别,医学领域和对再次选择医学专业的态度,差异不大。五分之一的年轻医生不会这样做。
    结论:居民的主要抱怨是结构性工作条件的恶化,包括不利于工作与生活的平衡。要使医学再次成为有吸引力的行业,将需要健康政策框架和社会奖励的可持续变化。
  • 【男性和女性医师:家庭和职业比较。】 复制标题 收藏 收藏
    DOI:10.1016/0277-9536(90)90192-u 复制DOI
    作者列表:Uhlenberg P,Cooney TM
    BACKGROUND & AIMS: :This article compares career and family characteristics for male and female physicians aged 30-49 in the United States. Despite women's increased presence in the profession, male physicians still out-earn and work more hours than their female counterparts. Males are also more often involved in families than are females. Compared with the U.S. population, male physicians are more likely to marry and parent, while the opposite is true for female physicians. The work-family interface also provides dramatic gender differences. Marriage and parenting, which might be expected to impinge on physicians' careers, actually seem to spur men's work commitment and earnings, but have the reverse effect for women. A review of research findings from other industrialized countries reveals similar gender differences in physicians' work and family patterns. The consequence of women's increased presence in the medical profession are discussed in light of these marked gender contrast in work and family life.
    背景与目标: :本文比较了美国30-49岁年龄段的男性和女性医师的职业和家庭特征。尽管女性在该行业的存在有所增加,但男性医师的收入和工作时间仍比女性医师多。男性也比女性更常参与家庭生活。与美国人口相比,男性医师更容易结婚和成亲,而女性医师则相反。工作与家庭的界面也提供了巨大的性别差异。婚姻和养育子女可能会影响医生的职业,实际上似乎促进了男性的工作投入和收入,但对女性却产生了相反的影响。对其他工业化国家的研究结果进行的审查显示,医生的工作和家庭模式也存在类似的性别差异。鉴于女性在工作和家庭生活中存在明显的性别差异,讨论了女性在医疗行业中所占比例增加的后果。
  • 【最终临床实践要素与早期职业护士的过渡经验之间的关联:一项横断面研究。】 复制标题 收藏 收藏
    DOI:10.1016/j.nepr.2019.102680 复制DOI
    作者列表:Kaihlanen AM,Elovainio M,Haavisto E,Salminen L,Sinervo T
    BACKGROUND & AIMS: :The final clinical practicum before graduation prepares nursing students for the transition from a student to a nurse, but the essential elements of the final clinical practicum that enhance successful transition are not known. We examined the associations of five elements of the final clinical practicum with four indicators of the transition experience in new nurses. We also tested whether psychosocial work characteristics modified these associations. The study sample comprised 712 Finnish nurses who had graduated within the previous two years before the data collection (response rate: 18%). The data were collected using a questionnaire survey in 2018. The elements of the final clinical practicum included (1) the systematicness of the practicum, (2) teacher involvement, (3) the quality of supervision, (4) preparing for the demands of a nurse's work and (5) being part of a professional team. Our results, based on linear regression analysis, showed that all the elements except the quality of supervision were associated with indicators of the transition experience (beta range: from 0.08 to 0.35). Job demands modified several of these associations. The findings of this study highlight the potential for well-implemented final clinical practicums to promote a smoother transition for new nurses.
    背景与目标: :毕业前的最终临床实习课程为护理专业学生为从学生过渡到护士的过渡做好准备,但是提高最终成功过渡的最终临床实习课程的基本要素尚不清楚。我们研究了最终临床实践的五个要素与新护士过渡经验的四个指标之间的关系。我们还测试了社会心理工作特征是否改变了这些关联。该研究样本包括712名芬兰护士,他们在数据收集之前的两年内毕业(答复率:18%)。数据是通过2018年的问卷调查收集的。最终临床实践的要素包括(1)实践的系统性,(2)教师的参与,(3)监督的质量,(4)为满足需求而做的准备护士的工作;(5)是专业团队的一部分。我们基于线性回归分析的结果表明,除监督质量外,所有要素均与过渡经验指标相关(β范围:0.08至0.35)。工作要求修改了其中的一些关联。这项研究的结果突显了实施良好的最终临床实践以促进新护士顺利过渡的潜力。
  • 【我们从这里去哪里? -审判管理人员职业发展的机遇和障碍:对英国审判管理专业人员的调查。】 复制标题 收藏 收藏
    DOI:10.1186/s13063-020-04316-z 复制DOI
    作者列表:Mitchell E,Goodman K,Hartley S,Hickey H,McDonald AM,Meadows HM,Rhodes S,Taylor J,Wakefield N,Farrell B,UK Trial Managers’ Network Executive Group.
    BACKGROUND & AIMS: BACKGROUND:Clinical trials commonly have a dedicated trial manager and effective trial management is essential to the successful delivery of high-quality trials. Trial managers have diverse experience and currently there is no standardised structured career pathway. The UK Trial Managers' Network (UKTMN) surveyed its members to understand what is important to them with respect to career development since this would be important in the development of any initiative intended to develop a skilled workforce. METHODS:We conducted an online survey of UKTMN members, who are trial management professionals, working on academic-led trials in the UK. Members were asked what they perceive as opportunities and barriers to career development. Two reminders were sent to facilitate completion of the survey, and responders were offered the opportunity to enter a prize draw for waived fees at the UKTMN annual meeting. Data were analysed descriptively by using Stata (version 15.1), and free-text responses were reviewed for themes. RESULTS:The survey was sent to 819 UKTMN members; 433 responses were received, although 13 were from non-UKTMN members; thus 420 respondents' data were included in analyses. Respondents were representative of UKTMN membership; however, more responses were received by trial managers based in registered clinical trials units (CTUs). The top three opportunities for career development were (i) training, (ii) helping design trials and (iii) undertaking relevant qualifications. The top three barriers were (i) funding, (ii) few opportunities to get involved in development activities aside from managing a trial and (iii) unclear organisational career pathway. Almost all respondents (401/420, 95.4%) considered career development either very or quite important. Although all respondents had a day-to-day role in managing trials, there was huge disparity between job titles. CONCLUSION:Career development is important to trial managers yet there is a lack of a structured pathway. The enablers and disablers to career development for trial managers should be clearly considered by the clinical trial community and, in particular, employers, sponsors and funders in order to develop a highly skilled workforce of trial managers, who are key to the delivery of trials.
    背景与目标: 背景:临床试验通常有专门的试验管理者,有效的试验管理对于成功交付高质量的试验至关重要。审判管理人员经验丰富,目前还没有标准化的结构化职业道路。英国审判管理者网络(UKTMN)对其成员进行了调查,以了解对于他们的职业发展而言,什么对他们而言很重要,因为这对于制定任何旨在培养熟练劳动力的计划至关重要。
    方法:我们对UKTMN成员进行了在线调查,这些成员是试验管理专业人员,他们在英国从事学术主导的试验。询问成员如何将其视为职业发展的机遇和障碍。发送了两个提醒以方便完成调查,并且在UKTMN年度会议上为响应者提供了参加抽奖的机会,以免除费用。使用Stata(版本15.1)对数据进行描述性分析,并针对主题对自由文本响应进行了审查。
    结果:该调查已发送给819个UKTMN成员;收到了433份答复,尽管有13份来自非UKTMN成员;因此,分析中包括了420位受访者的数据。受访者代表UKTMN成员;但是,基于注册临床试验单位(CTU)的试验管理人员收到了更多答复。职业发展的前三大机会是(i)培训,(ii)帮助设计试验和(iii)获得相关资格。前三大障碍是:(i)资金;(ii)除了管理试验外,很少有机会参与发展活动;(iii)不清楚的组织职业道路。几乎所有受访者(401 / 420,95.4%)都认为职业发展非常重要。尽管所有受访者在日常管理试验中都扮演着日常角色,但职位之间仍然存在巨大差异。
    结论:职业发展对审判管理者很重要,但缺乏结构化的途径。临床试验界,尤其是雇主,赞助商和出资者,应明确考虑试验管理者职业发展的推动力和障碍,以培养一支高技能的试验管理人员队伍,这对提供试验至关重要。
  • 【对仿真专家在该领域的职业发展路径的思考。】 复制标题 收藏 收藏
    DOI:10.1097/SIH.0000000000000450 复制DOI
    作者列表:Sanko JS,Calhoun AW,Issenberg SB,Kelly M,Battista A
    BACKGROUND & AIMS: STATEMENT:This article presents reflections of career pathways of simulation researchers as well as a discussion of the themes found in the stories presented. It is the intent of the authors to present and foster a discussion around the ways in which we as a simulation community wish to promote recognition of scholarship among simulation researchers and help support newcomers find success as simulation researchers in academia. We also present recommendations for those considering entering the field based on tactics that were successful and not successful among the scholars who shared their stories.
    背景与目标: 陈述:本文介绍了模拟研究人员的职业发展路径,并讨论了所呈现故事中的主题。作者的意图是围绕作为一个模拟社区的我们希望在模拟研究人员中增进学术认可并帮助支持新移民在学术界作为模拟研究人员获得成功的方式介绍和促进讨论。我们还为那些根据分享故事的学者中成功和不成功的策略而考虑进入该领域的人们提供了建议。
  • 【护理学生的职业偏好:挪威的一项研究。】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-2648.2007.04276.x 复制DOI
    作者列表:Kloster T,Høie M,Skår R
    BACKGROUND & AIMS: AIM:This paper is a report of a study to identify Norwegian undergraduate nursing students' career preferences at the beginning and end of their nursing education programme, together with their reasons for these preferences. BACKGROUND:International studies have shown that recruitment and retention of nurses in areas such as aged care and psychiatric nursing is difficult. It is important to know why some working areas are popular whilst others are not, so that nursing schools produce graduates who meet the needs of the community. METHODS:All students starting their nursing education programme in 2001/2002 in five Norwegian university colleges were invited to complete questionnaires at the beginning and end of their nursing education programme. In phase 1, 620 of 782 commencing students completed questionnaires (response rate 79.2%). In their third year, phase 2, 473 questionnaires were distributed (response rate 82.6%, n = 386). The questionnaire included closed questions about career preferences and open-ended questions seeking the reasons for the preferences. RESULTS:The study revealed changes in preferences between the beginning and the end of the nursing education programme. In phase 1, midwifery and paediatric nursing were ranked highest and in phase 2 working in medical/surgical ward, midwifery and psychiatric nursing were preferred. Working in aged care institutions remained unpopular throughout. Clinical experiences and professional challenges were often given as reasons for preferences. CONCLUSION:Nursing educators, clinical nurses and policymakers must reconsider their priorities and improve working conditions for nurses in aged care in order to meet society's need for nurses.
    背景与目标: 目的:本文是一项研究报告,旨在确定挪威本科护理学生在其护理教育计划的开始和结束时的职业偏好,以及他们偏爱这些职业的原因。
    背景:国际研究表明,在老年护理和精神病护理等领域很难招募和留用护士。重要的是要知道为什么有些工作区域很受欢迎,而另一些工作场所却不受欢迎,这样护士学校才能培养出满足社区需求的毕业生。
    方法:在挪威的五所大学中,所有于2001/2002年开始护理教育计划的学生都应在其护理教育计划的开始和结束时填写问卷。在第1阶段中,有782名新生中的620名完成了问卷(答复率为79.2%)。在第三年的第二阶段中,分发了473份问卷(答复率为82.6%,n = 386)。问卷包括有关职业偏好的封闭式问题和寻求偏好的开放式问题。
    结果:该研究揭示了护理教育计划开始和结束之间偏好的变化。在第1阶段,助产士和儿科护理的排名最高,在第2阶段在医学/外科病房工作,则优先选择助产士和精神病护理。在老年护理机构的工作始终不受欢迎。通常将临床经验和专业挑战作为偏爱的原因。
    结论:护理教育者,临床护士和决策者必须重新考虑其优先事项并改善老年护理护士的工作条件,以满足社会对护士的需求。
  • 【进一步提高女性医学系教师的学历:国家职业发展计划的影响。】 复制标题 收藏 收藏
    DOI:10.1089/jwh.2019.8044 复制DOI
    作者列表:Chang S,Guindani M,Morahan P,Magrane D,Newbill S,Helitzer D
    BACKGROUND & AIMS: : Background: Three national career development programs (CDPs)-Early and Mid-Career Programs sponsored by the Association of American Medical Colleges and the Hedwig van Ameringen Executive Leadership in Academic Medicine sponsored by Drexel University-seek to expand gender diversity in faculty and institutional leadership of academic medical centers. Over 20 years of success and continued need are evident in the sustained interest and investment of individuals and institutions. However, their impact on promotion in academic rank remains unknown. The purpose of the study is to compare promotion rates of women CDP participants and other faculty of similar institutional environment and initial career stage. Methods: The study examined retrospective cohorts of 2,719 CDP participants, 12,865 nonparticipant women, and 26,810 men, from the same institutions, with the same degrees, and first years of appointment in rank. Rates of promotion to Associate and Full Professor ranks in respective cohorts of Assistant and of Associate Professors were compared using Kaplan-Meier survival curves and log-rank tests, and logistic regression adjusting for other predictors of academic success. Results: In adjusted analyses, participants were more likely than men and non-participant women to be promoted to Associate Professor and as likely as men and more likely than non-participant women to be promoted to Full Professor within 10 years. Within 5 years, CDP participants were more likely than nonparticipant women to be promoted to Associate Professor and as likely as to be promoted to Full Professor; in the same interval, participants were promoted to both higher ranks at the same rates as men. For both intervals, nonparticipant women were significantly less likely than men to be promoted to either rank. Conclusions: The higher rates of promotion for women participating in national CDPs support the effectiveness of these programs in building capacity for academic medicine.
    背景与目标:
    背景:
    由美国医学院协会赞助的三个国家职业发展计划(CDP)-早期和中级职业计划,以及由Drexel大学赞助的Hedwig van Ameringen学术医学行政领导力-寻求扩大教职员工和学术机构的性别多样性医疗中心。个人和机构的持续兴趣和投资体现了超过20年的成功和持续的需求。但是,它们对晋升学术排名的影响仍然未知。这项研究的目的是比较女性CDP参与者和其他具有类似制度环境和初始职业阶段的教师的晋升率。
    方法:
    该研究回顾了来自同一机构,相同学位,任职第一年的2,719名CDP参与者,12,865名非参与者女性和26,810名男性的回顾性队列。使用Kaplan-Meier生存曲线和对数秩检验,并通过逻辑回归对其他学术成就预测因子进行调整,比较了助理和副教授各自的队列中副教授和正式教授的晋升率。
    结果:
    在调整后的分析中,与男性和非参与女性相比,参与者在10年内被提升为副教授的可能性更大,与男性和非参与女性相比,被提升为正教授的可能性更大。在5年内,CDP参与者比非参与者女性更有可能被提升为副教授,并有可能被提升为正教授。在相同的时间间隔内,参与者以与男性相同的比率晋升到两个较高的级别。在这两个时间间隔中,未参与调查的女性晋升到任一级别的可能性均明显低于男性。
    结论:
    妇女参加国家CDP的晋升率更高,支持了这些方案在提高学术医学能力方面的有效性。
  • 【在成年后变得肥胖:职业-家庭途径在男女成年过渡中的作用。】 复制标题 收藏 收藏
    DOI:10.1186/s12889-019-7797-7 复制DOI
    作者列表:Mooyaart JE,Liefbroer AC,Billari FC
    BACKGROUND & AIMS: BACKGROUND:During the transition to adulthood many young adults become obese for the first time in their lives, yet relatively little research has examined why people in this life phase become obese. This study examines what career and family life-course pathways during the transition to adulthood are related to developing obesity in young adulthood. METHODS:We use data from the NLSY97, a U.S. nationally representative panel survey conducted by the Bureau of Labor Statistics between 1997 to 2013 (N = 4688), and apply multichannel sequence analysis in order to identify clusters of typical career-family pathways during the transition to adulthood (age 17 to 27), and subsequently investigate whether these pathways are associated with becoming obese at the end of young adulthood (age 28), using logistic regression. We control for obesity at age 17 and family background factors (race, parental education, parental income, and family structure). To take into account the fact that the transition to adulthood has a different meaning for men and for women, we also interact career-family clusters with gender. RESULTS:For women, pathways characterized by college education, early home leaving, and postponement of family formation decrease the probability of becoming obese. For men, pathways characterized by early marriage increase the probability of becoming obese. CONCLUSIONS:The results highlight the importance of gender differences in how career and family pathways are related to becoming obese in young adulthood.
    背景与目标: 背景:在成年过渡期间,许多年轻人是一生中首次肥胖,但相对较少的研究调查了为何这一生阶段的人肥胖。这项研究探讨了成年过渡期间的职业和家庭生活历程与年轻成年肥胖有关。
    方法:我们使用NLSY97的数据,该数据是美国劳工统计局在1997年至2013年间进行的美国全国代表性面板调查(N = 4688),并进行了多通道序列分析,以识别在此期间典型的职业-家庭途径的聚类。过渡到成年(17至27岁),然后使用逻辑回归研究这些途径是否与年轻成年末(28岁)肥胖有关。我们控制17岁时的肥胖和家庭背景因素(种族,父母的教育程度,父母的收入和家庭结构)。考虑到向成年过渡对男人和女人具有不同含义的事实,我们还将职业家庭集群与性别互动。
    结果:对于女性而言,以大学学历,提早离开家乡和推迟家庭组建为特征的途径降低了肥胖的可能性。对于男性而言,以早婚为特征的途径增加了肥胖的可能性。
    结论:结果突出了性别差异在职业和家庭途径与年轻成年肥胖相关的重要性。
  • 【一般实践中,有18周纵向综合业务的医学院的毕业生的职业目的地:对毕业后6至8年的校友的调查。】 复制标题 收藏 收藏
    DOI:10.1007/s11845-020-02260-0 复制DOI
    作者列表:Glynn LG,Regan AO,Casey M,Hayes P,O'Callaghan M,O'Dwyer P,Culhane A,Cuddihy J,Connell BO,Stack G,O'Flynn G,O'Donnell P,O'Connor R,McKeague H,Grath DM
    BACKGROUND & AIMS: BACKGROUND:There is a worldwide recruitment and retention crisis in general practice. Workforce planning has identified the need to train more general practitioners as an urgent priority. Exposure of medical students to general practice as part of the formal and hidden curriculum, the use of longitudinal integrated clerkships, and positive experiences and role models in general practice are all thought to be contributing factors to doctors choosing careers in general practice. AIM:The aim of this study was to identify career destinations of medical school graduates in a medical school with an 18-week longitudinal integrated clerkship in general practice. DESIGN AND SETTING:This study was conducted in a single graduate entry medical school at the University of Limerick, Ireland. PARTICIPANTS:Medical school alumni 6-8 years after graduation. METHOD:A survey of graduating cohorts of the medical school from 2011 to 2013 was conducted through email and telephone. RESULTS:There were a total of 175 alumni for the period 2011 to 2013. Data was collected on 92% (161/175) through an online survey, follow-up email and telephone interview, and was triangulated with searches of professional registration databases and information from key informants. Between 6 and 8 years after graduation, a total of 43% of alumni were engaged in general practice as a career. CONCLUSION:The reform of the delivery of general practice within medical school curricula should be considered by medical schools, curriculum designers and policy-makers as part of an overall strategy to address the recruitment and retention of general practitioners as part of the global healthcare workforce.
    背景与目标: 背景:在全球范围内,普遍存在招募和挽留危机。劳动力规划已确定有必要培训更多的全科医生作为当务之急。作为正规和隐藏课程的一部分,医科学生应接受全科医学治疗,使用纵向综合业务,在全科医学中获得积极的经验和榜样,都被认为是医生选择全科医学职业的因素。
    目的:本研究的目的是确定在一般实践中具有18周纵向综合业务的医学院的医学院毕业生的职业目的地。
    设计与地点:这项研究是在爱尔兰利默里克大学的一所研究生入学医学院中进行的。
    参加者:毕业后6至8年的医学院校友。
    方法:通过电子邮件和电话对医学院2011年至2013年即将毕业的人群进行了调查。
    结果:2011年至2013年期间,共有175名校友。通过在线调查,后续电子邮件和电话采访收集了92%(161/175)的数据,并与专业注册数据库和来自关键线人的信息。毕业后的6至8年间,共有43%的校友从事普通职业。
    结论:医学院,课程设计者和政策制定者应考虑对医学院课程中的全科医学实践进行改革,作为整体战略的一部分,以解决作为全球卫生保健劳动力一部分的全科医生的招聘和留任问题。
  • 【考虑烧伤手术的职业:2016年烧伤医师调查的数据。】 复制标题 收藏 收藏
    DOI:10.1093/jbcr/iry047 复制DOI
    作者列表:Johnson LS,Jordan MH,Shupp JW
    BACKGROUND & AIMS: :There is a paucity of information in the peer-reviewed literature characterizing the current burn surgeon workforce and compensation potential, and, in a parallel topic, training opportunities and recruitment methods. What does exist documents minimal exposure to the field and surgeon shortages. A comprehensive survey was created to address 1) the demographics of current burn surgeons in practice, and 2) the structure of burn centers training models. Finally, three questions were asked regarding job satisfaction. With a response rate of 23%, demographics reflect representative involvement across the age spectrum. The majority of respondents (73.9%) had training in general surgery, with subsequent postgraduate training primarily in surgical critical care or burn fellowships. Two-thirds of respondents have active practices, cover multiple specialties, and take multispecialty call throughout the month. A variety of models are used to calculate compensation. The vast majority of burn centers train residents: general surgery residents (89%), plastic surgery residents (63%), and emergency medicine residents (32%), most of whom are in their first 3 years of training. The majority of respondents would become a burn surgeon again if they had to do it over and would recommend it to young surgeons as a career. A representative sample of burn surgeons from across North America sustains practices in similar ways. Access to the next generation of surgeons is at an early period in training (PGY1-3) which may prove valuable as surgical education evolves. Overall, burn surgeons express good job satisfaction, a significant point of interest as attention turns towards succession planning.
    背景与目标: :在经过同行评审的文献中,缺乏信息,这些信息描述了当前烧伤外科医生的劳动力和补偿潜力,以及与此并行的主题是培训机会和招聘方法。确实存在的文件证明了对现场的最小接触和外科医生的短缺。创建了一个全面的调查,以解决以下问题:1)实践中当前烧伤外科医生的人口统计资料,以及2)烧伤中心培训模型的结构。最后,提出了三个关于工作满意度的问题。人口统计信息的反映率为23%,反映了各个年龄段的代表参与程度。大多数受访者(73.9%)接受了普外科培训,其后的研究生培训主要是外科重症监护或烧伤研究金。三分之二的受访者拥有积极的执业经历,涵盖多个专业并且在整个月内都接受多专业咨询。各种模型用于计算补偿。绝大多数的烧伤中心培训居民:普通外科手术居民(占89%),整形外科手术居民(占63%)和急诊医学居民(占32%),其中大多数人处于培训的前三年。如果大多数受访者不得不这样做,他们将再次成为烧伤外科医生,并将其推荐给年轻的外科医生作为职业。来自北美各地的烧伤外科医师的代表性样本以类似的方式维持实践。下一代外科医师的培训尚处于初期阶段(PGY1-3),随着外科手术教育的发展,这可能被证明是有价值的。总体而言,烧伤医生表现出良好的工作满意度,这是关注的重点,因为注意力转向了继任计划。
  • 【妇产科的职业选择:1974-2002年英国医学院毕业生的国家调查。】 复制标题 收藏 收藏
    影响因子 :
    发表时间:2006-03-01
    来源期刊:BJOG
    DOI:10.1111/j.1471-0528.2006.00848.x 复制DOI
    作者列表:Turner G,Lambert TW,Goldacre MJ,Barlow D
    BACKGROUND & AIMS: OBJECTIVE:To report the trends in career choices for obstetrics and gynaecology among UK medical graduates. DESIGN:Postal questionnaire surveys of qualifiers from all UK medical schools in nine qualification years since 1974. SETTING:United Kingdom. POPULATION:All graduates from UK medical schools in 1974, 1977, 1980, 1983, 1993, 1996, 1999, 2000 and 2002. METHODS:Postal questionnaire surveys. MAIN OUTCOME MEASURES:Career choices for obstetrics and gynaecology and factors influencing career choices for obstetrics and gynaecology. RESULTS:Seventy-four percent (24,623/33,417) and 73% (20,709/28,468) of doctors responded at 1 and 3 years after qualification. Choices for obstetrics and gynaecology fell sharply during the 1990s from 4.2% of 1996 qualifiers to 2.2% of 1999 qualifiers, and rose slightly to 2.8% of 2002 qualifiers. Only 0.8% of male graduates of 2002 chose obstetrics and gynaecology compared with 4.1% of women. Forty-six percent of those who chose obstetrics and gynaecology 1 year after qualification were working in it 10 years after qualifying. Experience of the subject as a student, and the influence of a particular teacher or department, affected long-term career choices more for obstetrics and gynaecology than for other careers. CONCLUSIONS:The unwillingness of young doctors to enter obstetrics and gynaecology may be attributable to concerns about workforce planning and career progression problems, rather than any lack of enthusiasm for the specialty. The number of men choosing obstetrics and gynaecology is now very small; the reasons and the future role of men in the specialty need to be debated.
    背景与目标: 目的:报告英国医学毕业生在妇产科职业选择的趋势。
    设计:自1974年以来的九个资格年内,对来自英国所有医学院校的合格者进行邮政问卷调查。
    地点:英国。
    人口:1974年,1977年,1980年,1983年,1993年,1996年,1999年,2000年和2002年来自英国医学院的所有毕业生。
    方法:邮政问卷调查。
    主要观察指标:妇产科职业选择和影响妇产科职业选择的因素。
    结果:在合格后1年和3年,有74%(24,623 / 33,417)和73%(20,709 / 28,468)的医生有反应。妇产科的选择在1990年代急剧下降,从1996年合格者的4.2%降至1999年合格者的2.2%,略升至2002年合格者的2.8%。 2002年,只有0.8%的男性毕业生选择了妇产科,而女性的这一比例为4.1%。合格后1年选择产科和妇科的人中有46%在合格后10年从事该领域的工作。该学科作为学生的经历以及特定老师或系的影响,对妇产科的长期职业选择的影响比对其他职业的影响更大。
    结论:年轻医生不愿进入妇产科可能是由于对劳动力规划和职业发展问题的担忧,而不是由于对该专业没有热情。现在选择产科和妇科的男人人数很少。男性在专业领域的原因和未来角色有待商debate。
  • 【白内障手术结局与外科医生职业生涯后期的关联:一项基于人群的队列研究。】 复制标题 收藏 收藏
    DOI:10.1001/jamaophthalmol.2018.4886 复制DOI
    作者列表:Campbell RJ,El-Defrawy SR,Gill SS,Whitehead M,Campbell ELP,Hooper PL,Bell CM,Ten Hove MW
    BACKGROUND & AIMS: Importance:Evidence suggests that the quality of some aspects of care provided by physicians may decrease during their late career stage. However, to our knowledge, data regarding the association of advancing surgeon career phase with cataract surgical outcomes have been lacking. Objective:To investigate whether an increase in cataract surgical adverse events occurs during later surgeon career stages. Design, Setting, and Participants:This population-based study of 499 650 cataract operations performed in Ontario, Canada, between January 1, 2009, and December 31, 2013, investigated the association between late surgeon career stage and the risk of surgical adverse events. Linked health care databases were used to study cataract surgical complications while controlling for patient-, surgeon-, and institution-level covariates. All ophthalmologists who performed cataract surgery in Ontario within the study period were included in the analysis. Exposures:Isolated cataract surgery performed by surgeons at early, mid, and late career stages. Main Outcomes and Measures:Four serious adverse events were evaluated: dropped lens fragments, posterior capsule rupture, suspected endophthalmitis, and retinal detachment. Results:Of 416 502 participants, 244 670 (58.7%) were women, 90 429 (21.7%) were age 66 to 70 years, 111 530 (26.8%) were age 71 to 75 years, 90 809 (21.8%) were age 76 to 80 years, and 123 734 (29.7%) were 81 years or older. Late-career surgeons performed 143 108 of 499 650 cataract operations (28.6%) during the study period. Late surgeon career stage was not associated with an increased overall risk of surgical adverse events (odds ratio [OR] vs midcareer, 1.06; 95% CI, 0.85-1.32). In a sensitivity analysis with surgeon volume removed from the model, late career stage was still not associated with overall adverse surgical events (OR, 1.10; 95% CI, 0.88-1.38). Among individual complications, late surgeon career stage was associated with an increased risk of dropped lens fragment (OR, 2.30; 95% CI, 1.50-3.54) and suspected endophthalmitis (OR, 1.41; 95% CI, 1.01-1.98). These corresponded with small absolute risk differences of 0.11% (95% CI, 0.085%-0.130%) and 0.045% (95% CI, 0.028%-0.063%) for dropped lens fragment and suspected endophthalmitis, respectively. Conclusions and Relevance:These findings suggest that later-career surgeons are performing a substantial proportion of cataract operations with overall low surgical adverse event rates. Future studies might extend evaluations to the frequency of secondary surgical interventions as additional measures of surgical care quality.
    背景与目标: 重要性:证据表明,医生在职业生涯后期某些方面的护理质量可能会下降。然而,据我们所知,缺乏有关推进外科医生职业阶段与白内障手术结局的关联的数据。
    目的:研究在外科医生职业生涯后期是否发生白内障手术不良事件的增加。
    设计,地点和参与者:这项基于人群的研究于2009年1月1日至2013年12月31日在加拿大安大略省进行,涉及499650例白内障手术,研究了外科医生职业生涯后期与手术不良事件风险之间的关系。 。链接的医疗保健数据库用于研究白内障手术并发症,同时控制患者,外科医生和机构级别的协变量。分析期间包括了在研究期间在安大略省进行过白内障手术的所有眼科医生。
    暴露:在职业早期,中期和晚期,由外科医生进行的孤立白内障手术。
    主要结果和措施:评估了四个严重不良事件:晶状体脱落,后囊破裂,可疑眼内炎和视网膜脱离。
    结果:416502名参与者中,244670名(58.7%)为女性,90429(21.7%)为66至70岁,111530(26.8%)为71至75岁,90809(21.8%)为年龄76至80岁,而123734(29.7%)为81岁或以上。职业后期医生在研究期间进行了499650次白内障手术中的143108次(占28.6%)。外科医生职业生涯后期与手术不良事件的整体风险增加无关(优势比[OR] vs职业中期,1.06; 95%CI,0.85-1.32)。在从模型中删除手术量的敏感性分析中,职业后期仍未与总体不良手术事件相关(OR,1.10; 95%CI,0.88-1.38)。在个体并发症中,外科医生职业生涯后期与增加的晶状体碎片脱落风险(OR,2.30; 95%CI,1.50-3.54)和可疑眼内炎(OR,1.41; 95%CI,1.01-1.98)相关。这些分别对应于掉落的晶状体碎片和疑似眼内炎的绝对风险差异很小,分别为0.11%(95%CI,0.085%-0.130%)和0.045%(95%CI,0.028%-0.063%)。
    结论与相关性:这些发现表明,以后职业的白内障手术的比例很高,总体手术不良事件发生率较低。未来的研究可能会将评估扩展到二次手术干预的频率,作为手术护理质量的附加指标。
  • 【您在骨科创伤学方面的职业资源:OTA可以为您做什么?】 复制标题 收藏 收藏
    DOI:10.1097/BOT.0b013e3182644ca1 复制DOI
    作者列表:Mehta S,Smith JM
    BACKGROUND & AIMS: :For those choosing a career in orthopaedic traumatology, several resources have been established by the Orthopaedic Trauma Association to facilitate progression from the years in training to the early years in practice. Young practitioners have access to educational programming, such as preparation for Part II of the Board Examination, web-based resources, such as on-line job postings, advocacy in health policy for the issues that will affect their ability to practice, and public relations efforts to increase their presence in the community. Ultimately, the resources set aside for the young practitioner by the Orthopaedic Trauma Association are intended to facilitate a sense of excellence, service, and community.
    背景与目标: :对于那些选择从事骨科创伤学工作的人,骨伤科协会已经建立了一些资源,以促进从培训年限到实践的早期发展。年轻的从业人员可以使用教育计划,例如准备董事会第二部分考试,基于网络的资源(例如在线职位发布),倡导健康政策以解决可能影响其执业能力的问题以及公共关系。努力增加他们在社区中的影响力。最终,骨伤科协会为年轻从业者留出的资源旨在促进卓越,服务和社区感。
  • 【程序培训对美国女性医学研究生的妊娠结局和职业满意度的影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.jamcollsurg.2017.05.018 复制DOI
    作者列表:Davids JS,Scully RE,Melnitchouk N
    BACKGROUND & AIMS: BACKGROUND:Compared with nonprocedural fields, procedural specialization requires longer training, less flexible schedules, and greater physical demands. The impact of these factors on pregnancy, maternity outcomes, and career satisfaction has not been well described. STUDY DESIGN:Data were gathered from 738 US postgraduate medical trainee mothers via an anonymous, IRB-approved online survey. Univariate analysis was performed using chi-square tests. A logistic regression model was used to investigate the impact of procedural training on odds of assisted reproduction use and pregnancy complications, adjusting for age at first pregnancy. RESULTS:Of the 738 respondents, 221 (30.0%) were in procedural fields. A greater percentage of procedural trainees were more than 30 years old at the time of first pregnancy (52.9% vs 43.1%; p = 0.01). Controlling for maternal age, procedural trainees were significantly more likely to require assisted reproduction (odds ratio [OR] 1.28; 95% CI 1.01 to 1.61; p = 0.04), and trended toward increased odds of prolonged time to conceive (OR 1.62; 95% CI 0.99 to 2.65; p = 0.06). After delivery, procedural trainees also had higher adjusted odds of shorter maternity leave (OR 1.52; 95% CI 1.06 to 2.18; p = 0.03) and were significantly more likely to report a desire to have chosen a less demanding specialty or job (OR 1.95; 95% CI 1.40 to 2.72; p < 0.001). CONCLUSIONS:Procedural trainees have higher rates of assisted reproduction, shorter maternity leave, and are ultimately more likely to express career dissatisfaction. These findings illustrate the need for adequate support for trainee mothers, particularly in procedural specialties.
    背景与目标: 背景:与非程序领域相比,程序专业化需要更长的培训时间,更不灵活的时间表以及更大的身体需求。这些因素对怀孕,产妇结局和职业满意度的影响尚未得到很好的描述。
    研究设计:数据是通过IRB批准的匿名在线调查从738名美国研究生医学生母亲那里收集的。使用卡方检验进行单变量分析。使用逻辑回归模型调查程序培训对辅助生殖使用和妊娠并发症机率的影响,并根据首次妊娠的年龄进行调整。
    结果:在738名受访者中,有221名(30.0%)在程序领域内。第一次怀孕时,更大比例的程序培训学员年龄超过30岁(52.9%对43.1%; p = 0.01)。控制产妇年龄,程序培训生更有可能需要辅助生殖(优势比[OR] 1.28; 95%CI 1.01至1.61; p = 0.04),并且倾向于延长受孕时间的机率(OR 1.62; 95) %CI 0.99至2.65; p = 0.06)。分娩后,程序实习生的产假较短的调整后几率也更高(OR 1.52; 95%CI 1.06至2.18; p = 0.03),并且更有可能报告他们希望选择要求不高的专业或工作的意愿(OR 1.95) ; 95%CI 1.40至2.72; p <0.001)。
    结论:程序性受训者的辅助生殖率更高,产假时间更短,最终更有可能表达职业上的不满。这些发现表明,需要为受训母亲提供足够的支持,特别是在程序方面。
  • 【安全和卫生保健质量对中国护理职业决策的影响。】 复制标题 收藏 收藏
    DOI:10.1111/jonm.12140 复制DOI
    作者列表:Zhu J,Rodgers S,Melia KM
    BACKGROUND & AIMS: AIM:The aim of the study was to understand why nurses leave nursing practice in China by exploring the process from recruitment to final exit. This report examines the impact of safety and quality of health care on nursing career decision-making from the leavers' perspective. BACKGROUND:The nursing shortage in China is more serious than in most developed countries, but the loss of nurses through voluntarily leaving nursing practice has not attracted much attention. METHOD:This qualitative study draws on a grounded theory approach. In-depth interviews with 19 nurses who have left nursing practice and were theoretically sampled from one provincial capital city in Mainland China. FINDING:'Loss of confidence in the safety and quality of health care' became one of the main categories from all leavers' accounts of their decision to leave nursing practice. It emerged from three themes 'Perceiving risk in clinical practice', 'Recognising organisational barriers to safety' and 'Failing to meet expectations of patients'. DISCUSSION:The findings indicate that the essential work value of nursing to the leavers is the safety and quality of care for their patients. When nurses perceived that they could not fulfil this essential work value in their nursing practice, some of them could not accept the compromise to their value of nursing and left voluntarily to get away from the physical and mental stress. However, some nurses had to stay and accept the limitations on the safety and quality of health care. CONCLUSION:The study suggests that well-qualified nurses voluntarily leaving nursing practice is a danger signal for patients and hospitals, and has caused deterioration in nursing morale for both current and potential nursing workforces. It suggests that safety and quality of health care could be improved when individual nurses are empowered to exercise nursing autonomy with organisational and managerial support. IMPLICATIONS FOR NURSING MANAGEMENT:The priority retention strategies need to remove organisational barriers to the safety and quality of health care. Under the current nursing shortage, Chinese hospital managers might consider recruiting nurses and care assistants of different educational levels, which would effectively improve nursing team work and support nurses' to stay and actively achieve their work values for the safety and quality of health care.
    背景与目标: 目的:该研究的目的是通过探索从招聘到最终离职的过程,了解为什么护士离开中国的护理实践。本报告从毕业生的角度考察了安全性和医疗质量对护理职业决策的影响。
    背景:中国的护理短缺情况比大多数发达国家更为严重,但是由于自愿离开护理实践而造成的护士流失并没有引起人们的广泛关注。
    方法:本定性研究借鉴了扎根的理论方法。对19位已经离开护理实践的护士进行的深入访谈,理论上是从中国大陆一个省会城市抽取的。
    结果:从所有离开者关于离开护理实践的决定的叙述中,“对医疗安全性和质量的信心丧失”已成为主要类别之一。它来自三个主题:“在临床实践中意识到风险”,“认识到组织对安全性的障碍”和“未能满足患者的期望”。
    讨论:研究结果表明,为离职者提供护理的基本工作价值是为其患者提供护理的安全性和质量。当护士认为自己无法在护理实践中实现这一基本工作价值时,其中一些人便无法接受对其护理价值的妥协,因此自愿离开以摆脱身心压力。但是,一些护士不得不留下来并接受医疗保健安全性和质量的限制。
    结论:该研究表明,合格的护士自愿离开护理实践对患者和医院来说是一个危险信号,并已导致当前和潜在护理人员的护理士气下降。它表明,如果个人护士在组织和管理支持下被赋予行使护理自主权的权利,则可以提高医疗保健的安全性和质量。
    护理管理的含义:优先级保留策略需要消除对医疗保健安全和质量的组织障碍。在当前护理短缺的情况下,中国医院管理人员可能会考虑招募不同文化程度的护士和护理助手,这将有效地改善护理团队的工作,并支持护士留下来并积极实现其工作价值,以确保医疗的安全性和质量。

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