Purpose:Transformational leadership among core hospital leaders boosts medical organizations' competitiveness, adaptability, and sustainability, which is jointly affected by individual, organizational and environmental factors. This study aims to unpack its configurational framework and propose strategies to strengthen core hospital leaders' transformational leadership. Patients and Methods:Data were collected from an online questionnaire among 31 core hospital leaders. The fuzzy-set qualitative comparative analysis (fsQCA) was used to explore the causal mechanism of high-level transformational leadership. We enrich this mechanism by professional background, critical thinking, initiative spirit, family-work conflict, job satisfaction, subordinates' followership, and work pressure. Results:Result shows initiative spirit is the only necessary condition (consistency=0.911) for the formation of high-level transformational leadership among core hospital leaders. Three configurations are the sufficient conditions that lead to high-level transformational leadership among core hospital leaders with two different professional backgrounds (overall solution consistency= 0.952). Conclusion:Core hospital leaders' initiative spirit is an indispensable condition for improving high-level transformational leadership, emphasizing the necessity for core leaders to be proactive in order to develop such leadership. Besides, the study also uncovered three configurations are the sufficient conditions for core hospital leaders with diverse professional backgrounds to achieve high-level transformational leadership. This finding offers significant insights into hospital management practices, suggesting that core hospital leaders' work should be managed in a personalized manner based on their professional backgrounds, thereby fostering favorable conditions conducive to the development of their high-level transformational leadership capabilities. Furthermore, the central insight of this study is that the formation of high-level transformational leadership contingent upon the collaboration of professional background, critical thinking, initiative spirit, family-work conflict, job satisfaction, subordinates' followership, and work pressure, contributing to a holistic and more rigorous view for the development of transformational leadership.

The Internet era provides new opportunities for knowledge transfer between individuals, which helps medical students efficiently learn medical knowledge and skills. This study aims to (1) assess the status of knowledge sharing among Chinese medical students; (2) examine the association between web-based learning environment, media literacy, flow, and knowledge sharing; (3) identify the moderating role of media literacy and flow in the relationship between web-based learning environment and knowledge sharing. The study was conducted online from July to September 2021 in China. A total of 987 valid responses were retained (response rates was 82.25%). Hierarchical linear regression analysis was used to explore factors related to knowledge sharing and test the moderating effect of flow and media literacy on the association of web-based learning environment and knowledge sharing. The mean score of knowledge sharing among Chinese medical students was 3.91 ± 0.58. Knowledge sharing was significantly and positively influenced by the web-based learning environment (β =.159, P < .001), flow (β =.480, P < .001) and media literacy (β = .366, P < .001). Flow (β =.732, P < .001) and media literacy (β = .900, P < .05) significantly moderated the association between web-based learning environment and knowledge sharing. The positive correlation between web-based learning environment and knowledge sharing is more pronounced among medical students with high flow or high media literacy. Our finding provides a more optimal pathway for promoting knowledge sharing in Chinese medical education settings, including strengthening network infrastructure construction, creating a harmonious web-based learning environment, and integrating media literacy into the curriculum.

Background Avoidant paruresis is a common clinical condition in urology and psychosomatic medicine. However, it has limited treatment options that are safe and effective with few side effects.Aims Our study aimed to investigate the effectiveness and safety of the Chinese herbal Yangxin Tongquan decoction combined with cognitive–behavioural therapy (CBT) for avoidant paruresis.Methods Sixty-eight patients with avoidant paruresis were divided into a treatment group (33 patients) and a control group (35 patients). The control group was assigned 10 weeks of CBT and systematic desensitisation. In addition to CBT and systematic desensitisation, the treatment group was given the Chinese herbal Yangxin Tongquan decoction during the 10-week study. The Shy Bladder Syndrome Scale (SBS) and the Self-rating Anxiety Scale (SAS) were administered before and after treatment to measure any change.Results The overall efficacy in the treatment group (n=30) was 80.0% vs 62.5% in the control group (n=33). Comparing pretreatment and post-treatment measures, both groups showed improvement in SBS scores and SAS scores (treatment group: t(SBS)=8.397, p(SBS)<0.001, t(SAS)=8.216, p(SAS)<0.001; control group: t(SBS)=6.802, p(SBS)<0.001, t(SAS)=5.171, p(SAS)<0.001). Moreover, both groups’ SBS and SAS scores changed significantly over time (SBS scores: Ftime=118.299, p<0.001; SAS scores: Ftime=92.114, p<0.001). However, the treatment group performed better than the control group (SBS scores: Ftime*group=5.709, p=0.020; SAS scores: Ftime*group=7.235, p=0.009).Conclusions The Chinese herbal Yangxin Tongquan decoction combined with cognitive–behavioural psychotherapy positively affects the treatment of avoidant paruresis without significant adverse effects.

目的 探讨医学生成就目标对学业成就的影响.方法 本研究于2019年5月至6月采用网络问卷调查法收集数据,抽样方法为分层抽样法.研究使用了人口学因素统计表、成就目标量表、学业成就量表.分析采用描述性统计分析、Pearson相关分析及多元线性阶层回归分析检验医学生成就目标对学业成就的影响.结果 医学生成绩接近目标定向的均值为(3.45±0.77)、成绩回避目标定向的均值为(3.43±0.80)、掌握目标定向的均值为(3.85±0.66).医学生成绩接近目标定向对学业成就具有显著的正向影响(β=0.336,P<0.01);医学生掌握目标定向对学业成就具有显著的正向影响(β=0.540,P<0.01).结论 掌握目标定向占主导的成就目标是最有利于医学生发展的成就目标维度.

To clarify the influence factors of faculty's involvement in shared governance of teaching remodeling, the research project collected teacher's decisions and management experience in teaching remodeling, analyzed their involvement behavior and the influence factors by grounded theory. Results showed that the real participation and symbolic participation were identified as two participation level of teacher involvement behavior in shared governance of teaching remodeling, and the symbolic participation is a major behavior. The barriers to prevent teachers' participation were low degree of involvement, lack of opportunity and weak subjective motivation. Their behaviors were affected by three factors: contextual, individual and operation process. It is necessary to strengthen the construction of contextual and optimize process factors of teachers' involvement, to adopt different incentive strategies according to different characteristics of teachers and focus on motivating those with education ideal and teaching capacity.

BackgroundBoosting the individual learning passion of medical students is a novel approach to improve their academic performance. It facilitates the medical education reform, motivating both policymakers and educators to focus on the function of positive psychology in the career development of medical students. Therefore, this study aimed (1) to assess the status of two types of learning passion; (2) to clarify the relationship between self-esteem and two types of learning passion among Chinese medical students; (3) to examine the mediating role of psychological capital (PsyCap) in the relationship between self-esteem and two types of learning passion, respectively; and (4) to identify the moderating role of professional identity in the relationship between PsyCap and two types of learning passion, respectively.MethodsA cross-sectional online survey was conducted from April to June 2016 in China. A total of 1,218 valid questionnaires (effective completion rate: 67.93%) were collected from four medical schools.ResultsSelf-esteem significantly and positively influenced medical students’ PsyCap (β = 0.637, P < 0.01) and two types of learning passion, including harmonious learning passion (β = 0.589, P < 0.01) and obsessive learning passion (β = 0.436, P < 0.01). PsyCap fully mediated the relationship (β = 0.578, P < 0.01) between self-esteem and harmonious learning passion positively, whereas it suppressed the relationship (β = 0.490, P < 0.01) between self-esteem and obsessive learning passion. Further, professional identity significantly moderated the correlation between PsyCap and harmonious learning passion (β = −0.554, P < 0.05), rather than obsessive learning passion (P > 0.05).ConclusionTwo types of learning passion of medical students are positively influenced by self-esteem and PsyCap. Medical students with high-level self-esteem should possess strong PsyCap, which augments their harmonious as well as obsessive learning passion. Moreover, the positive effect of medical students’ PsyCap on harmonious learning passion is more notable among those with a lower professional identity. Finally, this study argues that strengths-based interventions of self-esteem and PsyCap are a beneficial approach for future enhancing learning passion in the domain of medical education.

Objective:The online learning motivation scale for medical students was developed and its reliability and validity were tested.Methods:From June 6 to 14, 2021, a panel discussion method was used to determine the scale of the medical students' motivation for online learning scale. A total of 1 082 medical students enrolled in Harbin Medical University and Jiamusi University were selected by whole-group sampling and stratified sampling to conduct the general situation questionnaire and the medical students' motivation for online learning scale. The reliability and validity of the medical students' online learning motivation scale were analyzed.Results:The online learning motivation scale for medical students contains 6 dimensions of external influence, career development, freedom from routine, social service, competence pursuit, and interest in knowledge, with 27 entries. Validation factor analysis showed that the ratio of χ2 and degrees of freedom ( χ2/ DF) was 4.99, the root mean square error of approximation ( RMSEA) was 0.06, the goodness of fit index ( GFI) was 0.90, the comparative fit quality index ( CFI) was 0.95, the normative fit index ( NFI) was 0.93, value-added fit index ( IFI) was 0.95, non-standard fit index ( TLI) was 0.94, and the cronbach coefficient of the scale was 0.95. Conclusions:The online learning motivation scale for medical students has good reliability and validity and can be used as a reliable instrument to measure medical students' online learning motivation.

Reflective performance under the guidance of reflective theory plays an important role in the training of medical talents, while the integrity of reflection requires the cultivation of individual ability and the construction of reflection context. However, in the field of medical education, there is a lack of comprehensive examination of the participants and functional elements in reflective practice. In order to strengthen the construction of reflective context, this paper analyzes the internal logic for education mode development guided by reflective theory in medical colleges based on the perspective of ecological community theory. The article also expounds the external characteristics of the overall coordination, multiple openness and dynamic balance of education mode among reflective practice in medical colleges based on ecological community theory. The authors try to propose the internal and external ecological construction pathway for the development of education mode based on ecological community theory, which includes balancing the internal ecological in medical colleges' education mode among reflective practice, coordinating the external ecological in medical colleges' education mode among reflective practice and promoting the internal and external ecological cycle in medical colleges' education mode among reflective practice.

This paper applies Parsons' "AGIL" functional framework to analyze the medical education system of Russia in combination with Russia's economic system, political system, social community system and cultural model hosting system. Some thoughts and suggestions on the reform of medical education in China are formed like pooling social resources to provide stronger support ; refining system law, strengthening social solidarity; cooperating with all stakeholders an with integration of multiple culture elements, so to reform current social value concept and create a powerful engine to drive education development.

Learning motivation is a significant factor that ensures quality in medical education, and might affect the academic performance and well-being of medical students. This study aimed to explore the status of achievement goal orientations among medical students in China and to further identify the association among academic performance, academic well-being, and achievement goal orientations. Data were collected through a cross-sectional, anonymous survey conducted with 3,511 respondents (effective response rate = 81.7%), from four medical universities in China, and demographic factors, achievement goal orientations, academic performance, and academic well-being were assessed. The average score of achievement goal orientations of Chinese medical students suggested a difference in demographic factors, including sex, year of study, experience of leadership cadre, and family income. Both mastery and performance-avoidance goals were associated with academic performance, subjective academic stress, subjective learning adaptability, subjective sleep quality, and subjective well-being. Performance-approach goals were related to academic performance, subjective academic stress, and subjective learning adaptability. The achievement goal orientations of the medical students in this study were at a middle level. The findings emphasize the importance of mastery goals for promoting the academic performance and well-being of medical students. More care and attention toward achievement goal orientations can be beneficial for the improvement of the academic performance and well-being among medical students.

Shared governance is defined by co-operation in policy making by institution authority and faculty that encourage all steak-holders to work together for optimizing the operation of their colleges. Faculty involvement in medical college governance has a significance value for self-dependent innovation, improvement, cross-disciplines and coordinated management in medical education. This study explores the multiple influencing factors on medical college faculty involvement in medical college governance like awareness of medical teachers, collaboration culture and challenges from bureaucratic system. In order to promote faulty involvement in shared governance, medical colleges should focus on constructing a shared governance culture, refining the system of faculty involvement in governance, enhancing the consciousness and capacity of faculty staff.

Objective:To investigate the current status of classroom silence of medical students as well as its relationship with the perception of classroom environment, to promote students' active attitude in classroom teaching, so as to provide reference for achieving participatory training model.Methods:This study was performed by questionnaire investigation. In October 2020, an online survey was conducted among 7 202 medical students from four medical schools in Heilongjiang Province. The relationship between classroom silence and perception of classroom environment was analyzed by Pearson correlation tests and multiple linear regression.Results:The total score of classroom silence was(2.95±0.66)which was negatively correlated with perception of classroom environment's six dimensions [teacher's positive expectation(3.77±0.72), size of class (3.05±0.89), classroom atmosphere (2.71±0.80), classroom conversation (3.06±0.73), teaching method(3.14±0.86), course setting (2.23±0.66), all P<0.01]. After controlling the demographic variables, teachers' positive expectation predicted classroom silence( β=0.034, P<0.01), and the other dimensions negatively predicted classroom silence( β=-0.214~-0.043, P<0.01). Conclusions:The classroom silence was identified at a moderate level and it was influenced by the perception of classroom environment. A dynamic classroom environment should be created, so as to decrease the level of classroom silence and encourage the participation of medical students in learning process.

Objectives: The main objectives of this study were to describe the current state of character strengths (CSs) of nurses; explain how they affect stress, sleep quality, and subjective health status; and reveal the mediating role of stress for the subject matter on the association between CSs, sleep quality, and subjective health status. Methods: A cross-sectional online survey was conducted from September to October 2020 in China. A multistage stratified sampling method was used, and 1,221 valid questionnaires across 100 cities in 31 provinces were collected. Results: For the participants in this survey, the three dimensions of CSs ranging from high to low were caring (4.20 ± 0.640), self-control (3.53 ± 0.763), and inquisitiveness (3.37 ± 0.787). There was difference in CSs scores across age (F = 8.171, P < 0.01), professional categories (F = 5.545, P < 0.01), and job tenure (F = 9.470, P < 0.01). The results showed that CSs significantly affected the psychological stress (β = −0.365, P< 0.01), sleep quality (β = 0.312, P< 0.01), and subjective health (β = 0.398, P< 0.01) of nurses. Moreover, psychological stress partially mediated the association between CSs and both types of health outcomes. Conclusion: In China, the CSs of nurses are at high levels. We find that nurses with high-level CSs are likely to experience less psychological stress and exhibit healthy psycho–physiological responses, which contribute to positive health outcomes. Finally, our study argues that strength-based interventions of positive psychology in hospitals should be provided to minimize threats to the physical and psychological health of health professionals, which is a beneficial choice for future hospital reforms in the domain of occupational health management.

Objective:To understand the current situation of formative assessment in clinical medicine education, and to provide reference information and decision-making basis for better improving students' learning and adjusting teachers' teaching.Methods:From November 2019 to August 2020, 417 clinical teachers in affiliated hospitals and teaching hospitals of three medical colleges in Heilongjiang Province were investigated by self-made questionnaire of formative evaluation of clinical medical education, and the data were analyzed by descriptive statistical method.Results:The overall cognition of clinical teachers to formative assessment was good; the overall average implementation status of formative assessment was (3.73±0.28), and the mean values of each dimension from high to low were evaluation content(3.98±0.64), evaluation feedback(3.97±0.55), evaluation subject(3.49±0.86), evaluation method (3.48±0.76); the overall average effect of formative assessment was (3.74±0.04).Conclusions:The current situation of formative assessment of undergraduate clinical medical education is good, but there are some problems, such as the lack of understanding of formative assessment by clinical teachers, the diversity of evaluation subjects and evaluation methods, and so on. It is suggested that we should follow the concept of formative evaluation, develop multiple methods, and participate in multi-dimensional subjects.

Medical education policy is the criteria document guiding the development of medical education in China. The choice and application of medical education policy tools have direct impact on implementation the policy. Taking the national medical education policy documents from January 1, 2003 to September 30, 2020 as the research object, using the content analysis method and grounded theory to evaluate following categories by "building analysis framework, sample selection, text unit coding, classification and data analysis" so to make an overall investigation on China's medical education policy from the aspects of policy release time and quantity, policy instruments and policy value characteristics. The results show that there are different medical education policy issuing departments releasing documents with poor legal effect and uneven value characteristics, the use of policy instruments is mainly complementary. Therefore, suggestions are put forward as follows: to clarify the main body of policy content, improve the medical education system with innovative strategy and flexibility in application of policy instruments, so to promote a balanced development of the value characteristics of medical education policy.

Autonomous learning plays a very important role in the academic growth of medical students. This paper discusses the influencing factors of medical students' autonomous learning, so to provide a basis for improving students' autonomous learning capacity and teaching methods. The results show that the influencing factors of medical students' autonomous learning include learning motivation, learning interest, career planing, learning achievement, peer influence of dormitory, external environment and teachers. The influencing factors of medical students' autonomous learning are diverse. Medical colleges and universities can improve students' awareness and autonomous learning from three aspects: the establishment of guidance system, the construction of learning dormitory and the change of teachers' role orientation.

The problem of mobile phone addiction and academic procrastination among medical students has been widely acknowledged. This study aimed to explore the influence of demographic factors on mobile phone addiction, academic procrastination, and academic achievement among medical students. Further, it investigated the association between mobile phone addiction, academic procrastination, and academic achievement. This cross-sectional study was conducted between May and June 2019. A total of 3 511 medical students participated in an online questionnaire survey (effective response rate = 81.7%). Demographic factors, the Scale of Academic Achievement, the short scale of the Mobile Phone Problem Use (MPPUS-10), and the Academic Procrastination Scale–Short (APS-S) were used. Hierarchical multiple regression analysis revealed that the average scores for academic procrastination, mobile phone addiction, and academic achievement were 2.66 ± 0.91, 5.13 ± 1.53, and 4.51 ± 0.71, respectively. Moreover, there were significant differences in gender, grade, leadership experience, and family monthly income across mobile phone addiction, academic procrastination, and academic achievement. Mobile phone addiction was negatively associated with learning dedication, learning performance, and relationship facilitation. Academic procrastination was negatively associated with learning dedication, learning performance, relationship facilitation, and objective achievement. Mobile phone addiction and academic procrastination was revealed as prevalent among Chinese medical students, and negatively influences their academic achievement. It is critical to establish a more efficient learning environment for Chinese medical students to minimize the negative impact of mobile phone addiction and academic procrastination.

该研究围绕目前我国医学教育现状与俄罗斯等"一带一路"沿线国家医学教育特点,比较分析了中国与"一带一路"沿线国家医学教育的不同及可借鉴的经验,提出:(1)建立并完善中国与"一带一路"沿线国家医学教育交流与合作机制,提高院校医学教育质量;(2)汲取他国的好做法、好经验,完善毕业后医学教育和评估体系;(3)进一步加大医学教育的资源投入,强化医学教育融入人文教育,提高我国整体医学自主创新能力.

Formative assessment refers to the process of improving and adjusting teaching based on students' learning situation and to find out weakness in time, so as to gain timely and effective feedback of education. This paper reviews the research status of formative evaluation in undergraduate clinical medicine education including the theoretical framework, evaluation methodology, learning outcome test, evaluation system construction, and the cultivation of medical students' autonomous learning ability with data from literature review. In addition, this paper summarizes the problems existing in the research and application of formative assessment in undergraduate clinical education from the aspects of cognitive bias of the concept of formative assessment, insufficient breadth and depth of formative assessment research, lack of research on formative assessment system and lack of research on innovation of formative assessment. Finally, the research prospect of formative assessment is put forward in order to provide reference for the follow-up research.

Background: The main objectives of this study were as follows: (1) evaluate the prevalence of burnout syndrome among doctors, (2) establish associations with demographic factors in China, and (3) examine the mediating role of psychological attachment in the relationship between job burnout and career calling. Methods: This cross-sectional survey was conducted by administering an online questionnaire in May 2016. The survey was performed across Thirty provinces. In total,A total of 3,016 Chinese doctors were selected as participants, of which 2,617 completed valid questionnaires (effective response rate: 86.77%). Results : The overall prevalence of burnout symptoms among Chinese doctors was 85.79%. Little variance was reported for burnout symptoms according to age ( Wald c 2 = 6.843, P < 0.05, OR <1 ), professional title ( Wald c 2 = 13.110, P < 0.05, OR > 1), and daily working hours ( Wald c 2 = 7.226, P < 0.05, OR > 1). However, the burnout of Chinese doctors was found to be associated with psychological attachment ( B = -0.6433, P < 0.0001) and career calling ( B = 0.3653, P < 0.0001); furthermore, psychological attachment ( B = 0.2350, P < 0.001) mediated the relationship between job burnout and career calling. Conclusion : Burnout symptoms among Chinese doctors were prevalent and associated with age, professional title, and long working hours. Chinese doctors aged 20-30 experienced a much higher level of burnout symptoms. The longer hours doctors worked, the more likely they were at risk of burnout symptoms, especially among attending physicians. Doctors who endured high-level burnout tended to exhibit decreasing psychological attachment, which threatened their sense of career calling. Finally, this paper proposed related explanations for the function mechanisms based on both theoretical and practical perspectives.