Using relationship styles based on attachment theory to improve understanding of specialty choice in medicine.
Using relationship styles based on attachment theory to improve understanding of specialty choice in medicine.
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DOI：
10.1186/1472-6920-6-3
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发表时间：
2006-01-11
影响因子：
3.6
通讯作者：
Katon, Wayne J
中科院分区：
文献类型：
--
作者：
Ciechanowski, Paul S;Worley, Linda L M;Katon, Wayne J
背景：与非初级保健专科相比，初级保健的患者-提供者关系具有更大的连续性和深度。基于依恋理论，我们假设医学生的关系类型与专业选择因素相关，并且这些因素将中介关系类型与初级保健专业最终匹配之间的关联。方法：对106名四年级医学生的关系方式、人口学特征和住院医师专业匹配进行测定。我们评估了1)关系方式与专业选择因素之间的关联；2)专业选择因素与专业匹配；3)风格与专业匹配的关系。我们还进行了中介分析，以确定在专业选择问卷中检查的因素是否介导关系类型与初级保健专业最终匹配之间的关联。结果：依恋类型的流行程度与一般人群和其他医学院环境相似，59%的学生认为自己拥有安全的关系类型。以病人为中心是直接相关的，而职业奖励与初级保健专业的匹配呈负相关。与具有安全关系风格的学生相比，具有自力更生关系风格的学生更有可能匹配非初级保健专业（OR = 5.3, 95% CI 1.8, 15.6）。以患者为中心的专科选择因素在关系方式与专科匹配之间具有充分的中介作用。结论：基于依恋理论的关系类型评估可能是提高医学生对专业选择的理解和建议的潜在有用方法。
BACKGROUND: Patient-provider relationships in primary care are characterized by greater continuity and depth than in non-primary care specialties. We hypothesized that relationship styles of medical students based on attachment theory are associated with specialty choice factors and that such factors will mediate the association between relationship style and ultimately matching in a primary care specialty.METHODS: We determined the relationship styles, demographic characteristics and resident specialty match of 106 fourth-year medical students. We assessed the associations between 1) relationship style and specialty choice factors; 2) specialty choice factors and specialty match, and 3) relationship style and specialty match. We also conducted mediation analyses to determine if factors examined in a specialty choice questionnaire mediate the association between relationship style and ultimately matching in a primary care specialty.RESULTS: Prevalence of attachment styles was similar to that found in the general population and other medical school settings with 59% of students rating themselves as having a secure relationship style. Patient centeredness was directly associated, and career rewards inversely associated with matching in a primary care specialty. Students with a self-reliant relationship style were significantly more likely to match in a non-primary care specialty as compared to students with secure relationship style (OR = 5.3, 95% CI 1.8, 15.6). There was full mediation of the association between relationship style and specialty match by the specialty choice factor characterized by patient centeredness.CONCLUSION: Assessing relationship styles based on attachment theory may be a potentially useful way to improve understanding and counsel medical students about specialty choice.