• Guangwei Deng, Di Zhao, Jonathan Lio, Xiaopeng Ma, Liang Liang, and Chenpeng Feng.
• School of Management, Hefei University of Technology, Hefei, China.
• J Eval Clin Pract. 2020 Feb 1; 26 (1): 92-100.

BackgroundHospital culture is a crucial aspect of residents' training. However, the mechanisms related to stakeholder culture (SC) and teacher-resident interaction remain unclear. The study investigated the relationship between hospital culture and training performance of residents. Also, it explored the mediating effect of teacher-resident exchange and the moderating effect of the teacher's transactional leadership style within a Chinese context.MethodsBased on stakeholder and leadership member exchange theories, we constructed a composite model. Data were collected from 296 residents from five tertiary hospitals in China. Hierarchical moderated regression analyses were used to test the hypotheses.Results(a) Both the employee-orientation culture (EOC) (β = .14, P ≤ .05) and patient-orientation culture (POC) (β = .47, P ≤ .001) in the hospital were significantly related to residents' training performance. (b) Teacher-resident exchange fully mediated the relationship between EOC and training performance and partially mediated the relationship between POC and training performance. (c) The moderating role of transactional leadership style (TLS) in the relationship between EOC and leader-member exchange (LMX) (β = -.17, P ≤ .05) was negative; it was not significant in the interaction between POC and TLS (β = .06, P > .1).ConclusionThe results suggest that trainers should consider the value of multiple cultures and ensure balance among stakeholders rather than focusing on a single one. Furthermore, a positive interaction improves teacher-student relationship and training performance. Most importantly, educational departments should pay attention to establishing assessment tools, using rewards and incentives in residents' training.© 2019 John Wiley & Sons, Ltd.

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