Page 112 - 中国全科医学2022-16期

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【Abstract】 Background The mental health of trainees receiving the three-year standardized general practice
residency program（SGPRP）has been valued recently，and psychological problems are considered to be one major type of
causes of their failure to complete the full training. So understanding the mental health status and associated factors of psychological
problems in these GP trainees are of important significance for the development of residency training policies and programs.
Objective To explore the mental health status and causes of psychological problems in GP trainees of SGPRP，improving
the attention of SGPRP managers and the society given to the mental health of GP trainees. Methods This was a mixed-
method sequential explanatory study. In January 2021，by use of convenience sampling，all in-service GP trainees of SGPRP
were recruited from Peking University Shenzhen Hospital to attend a self-administered survey to complete the Demographic
Questionnaire compiled by our research team and the Symptom Checklist 90（SCL-90）. The total score and domain scores of
the SCL-90 were analyzed overall，then were compared among the trainees by grade. For understanding the main life events
triggering emotional or psychological problems and their associations with residency training program or specialty，and GP
trainees' preferred assistance as well as suggestions for the development of SGPRP，from February to June 2021，purposive and
heterogeneous sampling were used to recruit GP trainees with mental health assessment to attend an in-depth，semi-structured
interview using phenomenological research procedure. The interview results were recorded，and transcribed，then coded using
NVivo 12，and analyzed using Colaizzi's seven-step analysis and thematic analysis. Results All GPs（n=84）responded to
the survey，with a 100% response rate. The mean total SCL-90 score and the mean total symptom index for 84 GP trainees were
（149.61±50.55），and（1.66±0.56），respectively. Of them，29（34.5%）had a total score ≥ 160. The prevalence of
obsessive-compulsive，depression，interpersonal sensitivity，anxiety，paranoid ideation，anger-hostility，psychoticism，
somatization and phobic-anxiety（prevalence of symptoms in each domain was defined as domain score ≥ 2） was 53.6%（45/84），
39.3%（33/84），34.5%（29/84），26.2%（22/84），22.6%（19/84），21.4%（18/84），19.0%（16/84），14.3%（12/84），
and 14.3%（12/84），respectively. The depression domain score varied significantly across GP trainees by grade（P<0.05）.
The prevalence of depression was 48.4%（15/31） in grade 2 GP trainees. In total，21 GP trainees attended the interview，14 （66.7%）
of whom had a total SCL-90 score ≥ 160. Four themes emerged from the analysis：impact of personal problems on psychological
status；harm and benefits caused by interpersonal interactions at work；psychological stress related to the residency base；lack of
confidence related to specialty choice. Conclusion The high prevalence of psychological problems in GP trainees may be closely
related to personal factors and problems encountered during residency training. In view of this，psychological guidance and crisis
intervention should be listed as an important part of residency training management，and efforts should be made to enhance the
trainees' sense of existence and belonging as well as self-confidence，thereby helping them to successfully complete the training.
【Key words】 General practice；Standardized residency training program；Psychological health；Root cause
analysis；Mixed method study

在我国，临床医学本科毕业生经过为期三年的全科 全科住培学员对于经验的描述，从受访者视角对其心理
住院医师规范化培训（简称住培）并通过考核，可取得 问题产生的原因进行深入挖掘，进而回答量性研究难以
全科医生执业资格 ［1-3］ 。在住培期间，学员可能会由于 完全“回答”的问题，以期为针对性干预措施的制定和
包括个人感情问题、学业压力、经济压力及社会认可度 实施提供依据。
低等在内的多种原因出现心理问题 ［4-5］ ，这是导致其 1 对象与方法
无法完成规定时长培训的主要原因之一 ［6］ 。近年来， 本研究采用基于解释性序列设计的混合研究方法；
关于全科住培学员出现心理问题的报道并不少见。陈楠 首先进行量化的调查与分析，再根据量性研究结果对质
等 ［7］ 的研究结果显示，全科住培学员心理健康筛查阳 性研究方案进行设计。量性研究为质性研究提供了样本
性率高达 26.3%；周晨等 ［8］ 的研究结果显示，全科住 选择、半结构化访谈提纲设计的依据，质性研究结果可
培学员症状自评量表（SCL-90）总均分及其各因子得 对量性研究的结果做出解释和补充说明 ［9］ 。本研究已
分均高于全国常模。但上述研究多仅通过量表调查法对 通过北京大学深圳医院伦理委员会审批，审批号为“北
全科住培学员的心理健康状况进行评估，原因或影响因 大深医伦申（研）〔2021〕第（012）号”。
素的分析多依靠量化赋值及分组对比来实现，较少关注 1.1 定量研究
全科住培学员的真实感受与情感体验，这也导致既往研 1.1.1 研究对象 采用方便抽样法，于 2021 年 1 月，
究对全科住培学员心理问题产生的原因剖析不够深入。 选取北京大学深圳医院全体在岗全科住培学员为研究对
本研究在采用经典量表调查法的基础上，将质性研究方 象。纳入标准为本院正在接受全科住培的学员；排除标
法运用于全科住培学员心理问题分析中，通过深入分析 准：因病、事假等原因不在岗及拒绝参与调查者。