目的 从社会组织网络嵌入性的角度,探讨公立医院医务人员工作内外匹配（包括组织匹配和区域匹配）在人际信任与隐性医学知识共享行为之间的中介效应,完善公立医院医务人员隐性医学知识共享机制的研究。方法 采用问卷调查方式对公立医院医务人员进行调查,运用SPSS 17.0软件进行数据分析,采用AMOS 22.0建立公立医院医务人员工作内外匹配在人际信任与隐性医学知识共享行为之间的中介效应回归方程。结果 公立医院医务人员人际信任与隐性医学知识共享行为之间有显著的正相关关系,标准化回归系数为0.446（P <0.001）。加入工作内外匹配变量后,公立医务人员人际信任对隐性医学知识共享行为的标准化回归系数由0.446（P <0.001）降到0.189（P<0.01）。结论 公立医务人员人际信任正向预测隐性医学知识共享行为;组织匹配、区域匹配在公立医务人员人际信任与隐性医学知识共享行为之间具有部分中介效应。

Objective To explore a new path of interpersonal trust impact on knowledge sharing behavior-being from the perspective of job embeddedness．Methods Questionnaire survey was used to investigate the medical staff in public hospitals．SPSS 17.0 software was used to analyze the data．AMOS 22.0 was used to establish the regression equation of intermediary effect between interpersonal trust and tacit medical knowledge sharing behavior of medical staff in public hospitals．Results There was a significant positive correlation between interpersonal trust and tacit medical knowledge sharing behavior．The standardized regression coefficient was 0.446（P <0.001）．When added the fitting to organization and community,the standardized regression coefficient decreased from 0.446（P <0.001）to 0.189（P <0.01）．Conclusions The interpersonal trust of public medical staffs positively predicts the tacit medical knowledge sharing behavior．Organizational matching and regional matching have partial mediating effect between interpersonal trust and tacit medical knowledge sharing behavior of public medical staff.

目的 了解高职医学生职业决策困难现状及其主要影响因素,提出改善对策。方法 采用分层整群抽样方法,选取广州市某职业院校740名全日制医学生进行问卷调查。结果 被调查高职医学生职业决策困难总平均分值为(3.55±0.647),其中职业规划探索维度均分最低为(3.42±0.797),其它维度均分从低到高分别是职业目标探索(3.49±0.766)、职业信息探索(3.58±0.678)和职业自我探索(3.69±0.659);单因素方差分析结果显示,不同专业、所在专业是否为第一志愿、不同家庭所在地的高职医学生职业决策困难分值均存在差异(P<0.05);多元逐步回归分析结果显示,家庭所在地、学校职业规划指导课程、兼职或见习的经历、学校活动(就业指导讲座、职业规划大赛等)、对所学专业的就业前景很乐观、学校提供了充足的就业信息、曾参加过创新创业大赛,是医学生职业决策困难的预测因素(P<0.05)。结论 高职医学生职业决策困难程度处于中等水平,学校可通过开展有针对性的职业指导,建立系统的职业决策困难测评与干预体系,搭建实践、就业服务平台等方法改善高职医学生职业决策困难状况,为学生提供强有力的支持与保障;政府可加大政策导向,引导高职医学生面向基层就业。

Objective To understand the current situation and main influencing factors of career decision-making difficulties of higher vocational medical students, and put forward improvement countermeasures. Methods The method of stratified cluster sampling was adopted, with 740 full-time medical students from a vocational college in Guangzhou being investigated. Results The average score of career decision-making difficulty of medical students surveyed in higher vocational colleges was (3.55±0.647), in which the average score of the career planning exploration was the lowest (3.42±0.797), and the average scores of other dimensions from low to high were career goal exploration (3.49±0.766), career information exploration (3.58±0.678) and career self-exploration (3.69±0.659). The results of one-way analysis of variance (ANOVA) showed that there were significant differences in the scores of career decision-making difficulties of medical students in higher vocational colleges among different majors, the major being the first choice or not, and different living places (P<0.05). The results of multiple stepwise regression analysis showed that family location, school guidance courses for career planning, part-time or trainee experience, school activities (employment guidance lectures, career planning competitions, etc.), being optimistic about the employment prospects of their majors, schools providing sufficient employment information, and having participated in innovation and entrepreneurship competitions were predictors of difficulties in career decision-making for medical students (P<0.05). Conclusions The difficulty of career decision-making of medical students in higher vocational colleges was in the middle level. Schools can establish a systematic evaluation and intervention system aiming at career decision-making difficulties by carrying out targeted career guidance, and build practice and employment service platform to improve the career decision-making difficulties of medical students in higher vocational colleges, and to provide strong support and security for students. The government can enhance policy guidance for medical students in higher vocational colleges to apply for primary hospital.