從工作特性模式探討醫師的終身學習態度

Abstract

隨著科技的進步、病人安全的重視、醫學資訊的多樣性及複雜性，醫師必需終身學習以促進醫療品質。終身學習已成為醫療人員專業素養的基本要素。醫學教育的目標在於確保醫療專業人員終身持續不斷的學習，然而過去的研究鮮少探討個人因素及環境因素對於終身學習的影響。本研究旨在於探討工作特性與終身學習的關係，希望能找出影響醫師終身學習的預測因素。本研究為橫斷式問卷調查，於北、中、南區三家醫學中心進行收案。研究工具包含基本資料表、中文版工作特性量表(Chinese Version of the Job Content Questionnaire，簡稱C-JCQ)、終身學習量表(the revised version of the Jefferson Scale of Physician Lifelong Learning，簡稱JeffSPLL)。問卷資料以描述統計說明研究對象的背景資料，以及在主要變項上的得分情形。以推論統計包括獨立樣本t檢定、變異數分析(analysis of variance，簡稱ANOVA)、Pearson積差相關分析不同背景變項在醫師終身學習的差異，以及各主要變項的相關情形。以ANOVA分析四種工作特性類型在醫師終身學習之差異。並以階層迴歸分析檢定工作要求、工作控制以及社會支持對於醫師終身學習的主效果，以及工作要求分別與工作控制、社會支持的交互作用，以了解工作控制及社會支持的調節作用。本研究共收集有效問卷351份，研究對象的平均年齡為36.8(SD = 10.14)，平均工作年資為9.86年(SD = 9.75)，而男女人數分別為233人(66.4%)和118人(33.6%)。研究結果發現醫師之終身學習態度平均得分為3.40(SD = 0.41)，經Pearson積差相關分析顯示工作要求(r = 0.199, p < 0.01)、工作控制(r = 0.402, p < 0.01)、主管支持(r = 0.297, p < 0.01)和同事支持(r = 0.290, p < 0.01)與醫師終身學習有顯著相關。ANOVA分析顯示工作特性類型與醫師終身學習態度有顯著差異，低壓型工作(低工作要求/高工作控制)的醫師其終身學習態度高於被動型工作(低工作要求/低工作控制)的醫師，主動型工作(高工作要求/高工作控制)的醫師其終身學習態度高於被動型工作(低工作要求/低工作控制)的醫師及高壓型工作(高工作要求/低工作控制)的醫師。階層回歸分析結果顯示工作要求(β = 0.103, p < 0.05)及工作控制(β = 0.223, p < 0.001)正向影響醫師終身學習，主管支持(β = 0.123, p = 0.058)和同事支持(β = 0.121, p = 0.053)對於醫師終身學習沒有顯著影響。工作要求與工作控制的交互作用達顯著水準，而社會支持與工作控制的交互作用未達顯著水準，交互作用圖顯示低工作要求者比高工作要求者更能顯現工作控制對終身學習的正向影響。較高的工作要求及工作控制皆與醫師終身學習正向相關，相較於提高工作要求，提升工作控制是一項更重要因素。本研究結果，可運用在工作設計上的改善，作為未來推動醫師終身學習之參考。

As the rapid development of medical science and growing knowledge of medical information, physicians must engage in lifelong learning to provide good quality and holistic healthcare. Lifelong learning has been identified as an important element of medical professionalism. A key point of medical education is to ensure continuity of learning throughout life. Little is known, however, about factors contributing to physicians’ lifelong learning. The aims of the research were to explore the relationship between job characteristics and physicians’ lifelong learning and find out the predictors for physicians’ attitude toward lifelong learning. The study was a cross-sectional survey. Participating physicians were recruited from three medical centers in north, middle and south Taiwan. The study questionnaire included the demographic data, Chinese Version of the Job Content Questionnaire (C-JCQ), and the revised version of the Jefferson Scale of Physician Lifelong Learning (JeffSPLL). The descriptive statistics, independent t-test, analysis of variance (ANOVA), Pearson correlation, and hierarchical regression analysis were used to analyze data. A total of 351 valid participants were collected. The average age and the average working experience of the participants were 36.8 years (SD = 10.14) and 9.86 years (SD = 9.75). There were 233 males (66.4%) and 118 females (33.6%). The results showed that the participants’ average score on physicians’ attitude toward lifelong learning (JeffSPLL) was 3.40 (SD = 0.41). Person correlation coefficient analysis showed that physicians’ lifelong learning scores was significantly correlated with job demand (r = 0.199, p < 0.01), job control (r = 0.402, p < 0.01), support from supervisors (r = 0.297, p < 0.01) and support from colleagues (r = 0.290, p < 0.01). The results of ANOVA test revealed the job types (active, passive, high strain, low strain) resulted in different levels of learning. Low strain (low demand/high control) physicians’ attitude toward lifelong learning was better than those of passive (low demand/low control) physicians. In addition, active (high demand/high control) physicians’ attitude toward lifelong learning was higher than those of passive (low demand/low control) physicians and high strain (high demand/low control) physicians. The results of the hierarchical regression analysis revealed that job demand (β = 0.103, p < 0.05) and job control (β = 0.223, p < 0.001) were positively associated with physicians’ lifelong learning. However, the relationship of supervisor support (β = 0.123, p = 0.058) and colleague support (β = 0.121, p = 0.053) to lifelong learning were not significant. Moreover, a significant job demand x job control interaction was found, but the job demands × social support interaction had no significant relationships with physician’s lifelong learning. Regarding the interaction effect, the effect of increasing job control on increasing physicians’ lifelong learning is greater for those with low job demand than for those with a high job demand. Job demand and job control were both positively associated with physician’s lifelong learning. The effect of increasing job control on the attitude toward lifelong learning is more important than the effect of increasing job demand. The results of this study can be applied to improve job redesign and serve as reference to advance physicians’ lifelong learning in the future.