Abstract: Background　So far，the rural-oriented tuition-free medical education（RTME） program initiated in 2010 by the National Development and Reform Commission and other four departments have trained nearly 57 000 targeted admission medical graduates to become healthcare workers in township health centers in central and western of China，achieving the objective of "full coverage" in terms of the number of general practitioners，namely，training one general practitioner with a five-year undergraduate medical degree for each township health center in central and western of China. The status of work and life of the targeted admission medical graduates，and the assessment for them by the primary hospitals deserve attention. Objective　To investigate the work and life situation of the first（2010 admitted） targeted admission medical graduates in primary care in Chongqing，offering suggestions for the culture and employment of these graduates. Methods　From August to December 2019，a survey was conducted among the first targeted admission medical graduates（n=160） who were admitted in 2010，and started to fulfill the obliged health services in primary care in Chongqing in 2018 after completing a five-year undergraduate medical degree program and a three-year national standardized residency training program using a questionnaire developed by our research group for collecting information regarding their contracted hospital，salary，career planning after fulfilling the contractual obligations，living conditions and difficulties，as well as job satisfaction. Besides，for collecting the assessment for them by their contracted side，factors associated with their retention in primary care as well as recommendations on fostering targeted admission medical graduates，focus group discussions were carried out with managers from the local health commissions of Yongchuan District，Nanan District，Liangping District，and Qianjiang District，administrators and middle-level managers from the contracted township health centers. Results　The survey achieved a response rate of 75.6%（121/160）. In terms of work status，the contracted township health centers of 35.5%（43/121） of the respondents had set up a general practice department/general practice clinic；13.2%（16/121） of the respondents worked as a general practitioner in their contracted hospital；81.0%（98/121） had a monthly income lower than 6 000 yuan；80.2%（97/121） had passed the intermediate professional title examination，but 92.8%（90/97） of them had not been employed as an attending physician；66.9%（81/121） had not participated in a continuing medical education training/academic conference in the last year. For career planning after the expiration of the contractual obligation services，54.6%（66/121） said they were unclear，but 4.1%（5/121） planned to continue to work in primary care. In terms of life condition，17.4%（21/121） of the respondents said that they were provided with a free room for temporary residence by the contracted hospital；76.9%（93/121） said that their contracted hospital could not help them to address some of the practical difficulties relating to living. In terms of satisfaction with job：71.1%（86/121） of the respondents were dissatisfied with their income；47.1%（57/121） were dissatisfied with their jobs and tasks；19.9%（24/121） were dissatisfied with their work performance；and 18.2%（22/121） were dissatisfied with being undervalued by leaders of their contracted hospital. Focus group discussions revealed that targeted admission medical graduates were evaluated with strong learning ability，and high overall personal qualities，but may be relatively underpaid. Moreover，due to many factors，their levels of intention to work in primary care for a long period of time were not high. And the fostering suggestions were as follows：Universities and organizations（implementing the national standardized residency training program） should strengthen the ideological guidance of working in primary care in targeted admission medical graduates；the contracted hospitals should strengthen communications with targeted admission medical graduates. Conclusion　The first targeted admission medical graduates working in primary care in Chongqing showed low level of job satisfaction，and may be undervalued by the contracted hospitals，indicating that the training mode for these graduates and requirements of the contracted hospitals may be not well matched. In view of this，it is suggested that universities and organizations implementing the national standardized residency training program should improve the training mode for targeted admission medical graduates，and relevant government departments should improve the treatment for these graduates，such as salary and professional title promotion，so that these graduates are willing to work and retain in primary care，and have chances to put into practice the things they learn.

Key words: General practitioners；Target admission medical graduates；Education, medicine；Job status；Job satisfaction

摘要： 背景　国家发展改革委等5部门于2010年启动实施农村订单定向医学生免费培养工作，截至目前已为中西部乡镇卫生院培养了近5.7万名订单定向生，从规模上实现了为中西部每家乡镇卫生院培养1名从事全科医疗本科医学生的“全覆盖”。订单定向医学生在基层的工作和生活现况，以及基层医疗卫生单位对订单定向生的评价，是值得进一步关注的问题。目的　了解重庆市2010级首届订单定向生在基层的工作和生活情况，进而为订单定向生的培养与使用提供建议。方法　于2019年8—12月，以重庆市2010级完成5年本科医学教育、3年住院医师规范化培训并履约到基层工作的首批订单定向生为调查对象（n=160），采用研究组自行设计的调查表，调查其工作单位情况、薪酬待遇、服务期满后的工作计划、生活状况及面临的困难、对基层工作满意度等。另分别对重庆市永川区、南岸区、梁平区、黔江区订单定向生所在区（县）卫生健康委相关管理人员、签约乡镇卫生院的院负责人和中层管理人员共38人开展焦点小组访谈，主要访谈其对首届农村订单定向医学生的评价、影响订单定向生“扎根基层”的因素及培养建议等。结果　最终回收有效调查表121份（75.6%）。工作方面：43例（35.5%）订单定向生所在工作单位已设立全科医学科/全科诊室；16例（13.2%）在工作单位从事全科岗位；98例（81.0%）月收入<6 000元；97例（80.2%）已通过中级职称考试，但其中的90例（92.8%）尚未被聘为主治医师；81例（66.9%）近一年未参加过继续医学教育培训/学术会议；对于服务期满后的工作计划，66例（54.6%）表示不清楚，5例（4.1%）计划继续留在基层工作。生活方面：21例（17.4%）订单定向生表示单位提供免费周转房，93例（76.9%）认为单位不能为其解决部分实际困难。对基层工作的满意度方面：86例（71.1%）订单定向生对个人收入不满意，57例（47.1%）对工作岗位和承担任务不满意，24例（19.9%）对个人工作业绩不满意，22例（18.2%）对单位领导重视程度不满意。访谈结果显示：订单定向生在基层工作单位展现出较强的学习能力，综合素质较高，但收入欠佳；受多种因素影响，订单定向生长期服务基层的意愿不强；建议高校和住院医师规范化培训单位加强对订单定向生思想方面的引领，同时加强订单定向生与签约单位的沟通。结论　首届订单定向生在乡镇卫生院的工作满意度不高，基层单位对订单定向生重视程度不足，订单定向生培养模式和签约单位的需求“脱节”。教育培训单位应该进一步完善订单定向生培养模式，相关政府部门须全面落实薪酬及职称晋升等相关待遇，使订单定向生能够“下得去、用得上、留得住”。

关键词: 全科医生；农村订单定向医学生；教育, 医学；工作现状；职业满意