Fostering student motivation towards community healthcare: a qualitative study.
Fostering student motivation towards community healthcare: a qualitative study.
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DOI：
10.1136/bmjopen-2020-039344
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发表时间：
2021-01-07
期刊：
影响因子：
2.9
通讯作者：
Okayama M
中科院分区：
文献类型：
--
作者：
Yahata S;Takeshima T;Kenzaka T;Okayama M
本研究探讨了什么样的经验影响区域配额（chikiwaku）医学生的动机，实践社区医疗保健（CH），这种影响的机制，通过集中在他们的经验，以社区为基础的医学教育（CBME）计划。基于访谈的定性主题分析。研究对象为日本科比大学的千喜若学生，采用立意抽样。14名学生参加。参与者的中位数（IQR）年龄为23岁（23-24岁）;一半是六年级学生，一半是五年级学生。2018年9月至12月，访谈进行了录音和逐字转录。根据“编码和理论化步骤”方法分析数据。我们的理论框架包括三个内部动机（即，需要，认知和情绪）和他们的下属动机理论自我决定理论，期望价值理论，积极和消极的情绪。出现了三种机制和相应的经验。第一个机制是社区卫生服务的设想和准备，包括相应的体验--对社区的同理心、对社区卫生服务需求的把握、对社区卫生服务实践的理解、对社区卫生服务行为的寻找、对个人生活与职业冲突的消解。第二个机制属于支持性社区，包括大力建设学生社区卫生服务社区，并与社区居民和谐相处。心理效应包括情感启发和框架效应。学生的经验带来的变化和影响所描述的机制，并有积极和消极的影响，他们对CH的动机。这些结果可以解释通过多方面的镜头动机理论。作者发现，医学生对CH的动机机制来自与社区居民，医疗保健专业人员和其他学生的积极互动，以及接触有吸引力的社区环境和文化。这些经验应纳入CBME方案，以进一步鼓励对儿童健康的积极态度。
This study investigated what kinds of experiences influence regional quota (chiikiwaku) medical students’ motivation to practice community healthcare (CH), and the mechanism of this influence, by focusing on their experiences in a community-based medical education (CBME) programme. A qualitative thematic analysis based on interviews. Participants were recruited from the chiikiwaku students of Kobe University, Japan, using purposive sampling. Fourteen students participated. The median (IQR) age of participants was 23 (23–24); half were sixth-year and half fifth-year students. From September to December 2018, the interviews were audiorecorded and transcribed verbatim. Data were analysed according to the ‘Steps for Coding and Theorisation’ method. Our theoretical framework comprised three internal motives (ie, needs, cognitions and emotions) and their subordinate motivation theories self-determination theory, expectancy-value theories, and positive and negative emotions, respectively. Three mechanisms and corresponding experiences emerged. The first mechanism, envisioning and preparing for practising CH, included corresponding experiences—empathy for the community, grasping the demands for CH, understanding the practices of CH, finding a role model and diminishing the conflicts between personal life and career. The second mechanism, belonging to a supportive community, included the robust construction of students’ CH community and harmonisation with community residents. The third mechanism, psychological effects included the affect heuristic and framing effect. Student experiences brought about the changes and influences described in the presented mechanisms, and had both positive and negative impacts on their motivation towards CH. These results can be interpreted through the multifaceted lenses of motivation theories. The authors revealed that motivation mechanisms of medical students towards CH derived from positive interaction with community residents, healthcare professionals and other students, and from exposure to attractive community environments and cultures. These experiences should be incorporated into CBME programmes to further encourage positive attitudes towards CH.
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