评价乳腺外科住院医师规范化培训学员的自我导向学习能力。

本回顾性调查纳入了陆军军医大学第一附属医院乳腺甲状腺外科2016级至2020级共55名住院医师规范化培训学员，采用改良的中文版《自我导向学习等级评定量表》(SRSSDL)评估其自我导向学习能力。将所有乳腺外科规范化培训学员按性别、人员类别、是否在职及出科成绩进行分组，比较其各维度评分及总分之间的差异。量表评分均为偏态分布数据，采用M (P₂₅，P₇₅)进行描述，2组比较采用Mann-Whitney U检验，多组比较采用Kruskal-Wallis H检验，组间两两比较采用Dunn Bonferroni校正法检验。

参与调查的学员中，自我导向学习能力测评最低得分174分，最高得分290分，中位得分234分。男学员的SRSSDL总分高于女学员[248.00(222.50, 284.00)分比221.00(186.75，254.50)分，Z＝－2.109，P＝0.035)，并且男学员在学习策略、学习评价维度评分高于女学员[57.00(50.50，85.00)分比48.00(45.00，59.50)分，Z＝－2.268，P＝0.023；48.50(40.00, 63.25)分比43.50(36.00, 49.25)分，Z＝－2.622，P＝0.009]。在职学员在学习意识、学习行为维度得分高于非在职学员[53.00(48.00，60.00)分比47.50(43.25, 55.75)分，Z＝－2.152, P＝0.031; 43.00(37.00, 50.00)分比38.00(31.75，45.75)分，Z＝－1.975，P＝0.048]。专业型硕士与普通学员的学习意识、学习策略、学习行为、学习评级、人际关系能力各维度评分及总分比较，差异均无统计学意义(Z＝0.000、－0.697、－0.230、－0.137、－0.009、－0.246，P＝1.000、0.486、0.818、0.891、0.993、0.806)。不同出科成绩组的学员间在学习意识、学习策略、学习行为、学习评级、人际关系能力及测评总分比较，差异均有统计学意义(χ²＝14.881、9.688、9.645、6.597、7.423、10.541，P＝0.001、0.008、0.008、0.037、0.024、0.005)。

乳腺外科住院医师规范化培训学员具备一定的自我导向学习能力，但不同性别、在职与否及人员类别间存在一定差异。因此，在培训过程中，需要带教医师根据学员的特征更具针对性地培养学员自我导向学习能力，进一步提高临床教学水平。

To evaluate the self-directed learning ability of standardized medical training residents of breast surgery.

This retrospective survey included 55 standardized medical training residents(grade 2016-2020) in the Department of Breast Surgery, the First Affiliated Hospital of Army Medical University. The modified "Self-Rating Scale of Self-Directed Learning (SRSSDL)(Chinese version) was used to evaluate their self-directed learning ability. All the trainees were divided into groups by gender, personnel category, on-the-job or not, and final subject achievement. The scores of each dimension and total score were compared between groups. The scores were expressed ad M (P₂₅, P₇₅) because of skewed distribution. The Mann-Whitney U test was used for comparison between two groups, Kruskal-Wallis H test was used for multi-group comparison, and Dunn Bonferroni correction method was used for pairwise comparison.

Among 55 medical residents, the lowest score was 174, the highest score was 290, and the median score was 234. The total SRSSDL score of male students were significantly higher than that of female students [248.00(222.50, 284.00) vs 221.00(186.75, 254.50), Z=-2.109, P=0.035]; the male students had significantly higher scores in learning strategy and evaluation compared with female students [57.00(50.50, 85.00) vs 48.00(45.00, 59.50), Z=-2.268, P=0.023; 48.50(40.00, 63.25) vs 43.50(36.00, 49.25), Z=-2.622, P=0.009]. The on-the-job students had significantly higher scores in awareness and learning activities compared with other students [53.00(48.00, 60.00) vs 47.50(43.25, 55.75), Z=-2.152, P=0.031; 43.00(37.00, 50.00) vs 38.00(31.75, 45.75), Z=-1.975, P=0.048]. There was no significant difference in the scores of learning awareness, learning strategies, learning behavior, learning rating, interpersonal skills and total scores between professional masters and ordinary trainees (Z=0.000, -0.697, -0.230, -0.137, -0.009, -0.246, P=1.000, 0.486, 0.818, 0.891, 0.993, 0.806). There was no significant differences in the scores of learning awareness, learning strategies, learning behaviors, learning ratings, interpersonal skills and total scores between students with different subject achievement (χ²=14.881, 9.688, 9.645, 6.597, 7.423, 10.541, P=0.001, 0.008, 0.008, 0.037, 0.024, 0.005).

The standardized training residents of breast surgery have certain self-directed learning ability, varying among trainees with different genders, personnel categories and vocational status. Therefore, in the training, it is necessary for teachers to cultivate the self-directed learning ability of trainees in a more targeted manner according to their characteristics, so as to further improve the clinical teaching quality.