University-Affiliated Hospitals: Clinical Practice, Education, or Research—Which Takes Precedence?

Description

Question: How do physicians in Chinese university-affiliated hospitals perceive the balance among clinical, teaching, and research responsibilities, and how does the current performance evaluation system impact their professional development? Design, Setting, and Participants: This cross-sectional survey study was conducted from May to December 2024 across 16 university-affiliated tertiary hospitals in 7 Chinese provinces. A nationally representative sample of 1,423 physicians completed validated questionnaires assessing their perceptions of clinical, teaching, and research tasks, as well as evaluations of the professional system. Main outcomes: Primary outcomes included physicians’ role prioritization, pressures associated with clinical workload, marginalization of teaching, and alienation of research due to quantitative evaluation metrics. The shared data include the original questionnaire and the raw data collected from it.

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Participant Sample: Eligible participants were licensed clinical physicians working in university-affiliated tertiary hospitals. Exclusion criteria included incomplete survey responses, cognitive impairments, or logical inconsistencies in responses. A stratified cluster random sampling method was employed: 1.Stage 1: Random selection of 3–5 cities from each economic region. 2.Stage 2: Random selection of 1–3 tertiary hospitals per city, totaling 16 hospitals. 3.Stage 3: Cluster sampling by department (internal medicine, surgery, obstetrics/gynecology, pediatrics, otolaryngology, and others) to ensure balanced specialty representation. Study Measures and Variables: Data were collected via a self-administered questionnaire comprising: Sociodemographic and Occupational Characteristics: 14 single-choice and 9 multiple-choice items (e.g., age, gender, department, years of practice). 2.Multidimensional Occupational Perception Questionnaire: Developed through literature review and expert consultation, this 30-item tool assessed five domains using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree): 1.Clinical Medical Tasks (CMT): 7 items (e.g., “Clinical experience is critical for professional success”). 2.Research Tasks (RT): 6 items (e.g., “Research capability should be prioritized for career advancement”). 3.Academic Teaching Tasks (ATT): 6 items (e.g., “Hospitals should allocate more resources to teaching”). 4.Occupational Evaluation System Perception (OESP): 5 items (e.g., “The current evaluation system requires reform”). 5.Occupational Role Weighting Perception (ORWP): 6 items (e.g., “Physicians should balance clinical, teaching, and research roles”). Statistical Analysis: Statistical analyses were conducted using SPSS 26.0 and Amos 24.0. The reliability and validity of the self-developed Multidimensional Occupational Perception and Evaluation Questionnaire for Physicians were first assessed. After confirming adequate psychometric properties of the survey tool, descriptive statistics were performed on the general characteristics questionnaire to compare the frequency of single-choice responses and assess differences in prevalence rates for multiple-choice items. Pearson correlation analysis was applied to examine associations among the five dimensions of the questionnaire (CMT, ATT, RT, OESP, ORWP). Effect sizes were estimated using Pearson’s correlation coefficient (r), interpreted as follows: 0.5 = large effect, 0.3 = medium effect, and 0.1 = small effect. A two-sided asymptotic P value < 0.05 was considered statistically significant. Path analysis was conducted with CMT, ATT, and RT as independent variables and OESP and ORWP as dependent variables, following confirmation of significant correlations between these variables via Pearson analysis. Path coefficients were compared under conditions of satisfactory model fit.

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