Abstract:

Compulsory rural service directed medical student free training program is a medical education policy oriented to the cultivation of high-quality general medical talents for primary care system in rural areas, and is an important initiative to deepen the reform of the pharmaceutical and health system and accelerate the construction of a "healthy China", which is an important foundation for implementing the "poverty removal" and promotion of sustainable development of "poverty alleviation by health". Policy of compulsory rural service directed medical students free training program was designed scientifically and rationally, effectively combining motivating mechanisms with compulsory mechanisms, and is continuously refined in the practice process. In the course of policy implementation, various regions of our country have developed their characteristic implementation strategies accordingly in the links of enrollment, training, employment, and contract performance. The program based on the policy educated a large number of qualified GPs for rural primary care system. The compulsory rural service directed medical students fulfilled the contract well, and the career development trend was positive, which contributed to strengthening the construction of the primary health workforce, enhancing the level of primary health service, and promoting the establishment of a hierarchical diagnosis and treatment system. However, during the implementation of the policy, many challenges have been encountered, such as some students' low learning enthusiasm during the training period, limited capacity of local authorities to implement the policy, the need for improvement of pay incentives for primary GPs and the short service cycle. In this paper, we conducted a systematic analysis of the design concept and execution process of the policy of free training for compulsory rural service directed medical students, and suggested that further expansion of scale of the compulsory rural service directed free training program should be conducted to improve the quality of cultivation, enhance the effective collaboration among multiple parties and the contract fulfillment, which will collectively promote the effective implementation of the policy, thereby providing talent support for the hierarchical diagnosis and treatment system and the "Health China" strategy.

Key words: General practitioners, Target admission medical graduates, Education, medical, Health policy, Health workforce, Primary health care

摘要：

订单定向医学生免费培养政策是面向农村基层培养高质量全科医学人才的医学教育政策，是深化医药卫生体制改革、加快建设"健康中国"的重要举措，是落实"脱贫攻坚"战略、推进"健康扶贫"可持续发展的重要基础。订单定向医学生免费培养政策的设计科学且合理，将激励机制与约束机制有效结合，并在实践过程中不断完善。在政策实施过程中，我国各地区在招生、培养、就业和履行合同等环节因地制宜地发展出了各具特色的执行策略。该政策为农村基层培养了大量合格的全科医生，订单定向医学生履行合同情况良好，职业发展趋势积极正向，为加强基层卫生人才队伍建设、提升基层医疗卫生服务水平、推动建立分级诊疗制度做出了贡献。但在政策执行过程中也遇到了培养期间部分学生学习积极性较低、部分地区无法有效落实编制和履行合同、基层全科医生薪酬激励机制有待完善和服务周期短等诸多挑战。本文对订单定向医学生免费培养政策的设计理念和执行过程进行了系统分析，建议进一步扩大订单定向医学生免费培养规模，提高培养质量，多方有效协作，践行契约精神，共同推动该政策的有效落实，从而为分级诊疗制度和"健康中国"战略提供人才支撑。

关键词: 全科医生, 订单定向医学生, 教育，医学, 卫生政策, 卫生人力, 初级卫生保健