Background The program of targeted medical education program has been carried out since 2010 in China, aiming to train general medical talents working in primary care. Further research is needed to explore the working status and career planning in targeted admission medical graduates (TAMG) , as well as the overall assessment for them by the employing unit.
Objective To comprehensively understand the working status (competencies, satisfaction, intention to improve professional capabilities) , career planning, retention intention and associated factors after fulfilling the preadmission commitments in TAMG working in Hainan's primary care after completing the "5+3" standardized general residency program, providing a basis for the optimization of incentive policies for training and retaining general practitioners (GPs) , and for medical colleges to determine the orientation and development direction of a general practice school (department) .
Methods From April 25 to May 6, 2021, by use of cluster sampling, 615 GPs (including 309 TAMG trained with the "5+3" standardized general residency program who work as a GP in primary care after graduation, 56 assistant GPs trained with the "3+2" program, and 250 GPs trained with general medicine before shifting to the post) were selected from 19 cities (counties) in Hainan Province to attend a self-administered questionnaire survey for collecting information about their capabilities, satisfaction and intention to improve professional capabilities. At the same time, 1 574 leaders and colleagues of the TAMG were invited to evaluate the capabilities of the TAMG. The factors influencing the retention intention of the TAMG after fulfilling their preadmission commitments in primary care were analyzed by binary Logistic regression. For further understanding the working status, life and thoughts on the job of the TAMG, the offline research team of this study conducted field investigation in three primary hospitals (one in Haikou, one in Qiongzhong, and one in Sanya) , and held a group discussion with directors of health committees of Haikou, Qiongzhong and Sanya, and directors of the three primary hospitals, as well as 38 randomly selected TAMG from May 7 to 8, 2021.
Results TAMG had lower mean score of self-rated capabilities than assistant GPs trained with the "3+2" program〔 (19.31±2.59) vs (20.46±2.72) 〕, and GPs trained with general medicine before shifting to the post〔 (19.31±2.59) vs (20.77±2.73) 〕 (P<0.05) . TAMG had lower mean score of self-rated job satisfaction than assistant GPs trained with the "3+2" program〔 (39.77±4.66) vs (41.59±4.56) 〕, and GPs trained with general medicine before shifting to the post〔 (39.77±4.66) vs (41.10±5.19) 〕 (P<0.05) . TAMG had lower mean score of self-rated intention to improve professional capabilities than GPs trained with general medicine before shifting to the post〔 (7.80±2.25) vs (9.10±3.17) 〕 (P<0.05) . However, the mean score of capabilities of TAMG rated by TAMG' leaders and colleagues was higher than that rated by themselves〔 (20.29±3.43) vs (19.31±2.59) 〕 (t'=5.735, P<0.001) . One hundred and fourteen of TAMG (36.89%) intended to stay on after the expiration of the contract. The main factors affecting their retention intention were professional title, current income, and wanting to be a GP (P<0.05) . According to the group discussion, TAMG had high level of enthusiasm at their work and a great sense of team spirit. Moreover, more than half of them had a clear career plan. The challenges faced by TAMG in primary care were the following: overall low level of remuneration, unsatisfactory working environment, insufficient understanding and insufficient understanding and undervaluing of GPs and general practice in relevant administrative departments, inadequate implementation of relevant policies, and limited conditions in primary care hindering the acquisition of the latest advances in general medicine and continuing education.
Conclusion The TAMG had high levels of capabilities and job statistician, but low level of intention to improve professional capabilities and to stay on after the expiration of the contract. Their capabilities were recognized by their leaders and colleagues. The implementation of incentive policies was un-ideal in Hainan, which may be due to satisfactory implementation of the incentive system for health talents in primary care. In view of this, it is suggested that relevant departments in Hainan take multiple measures collaboratively to effectively implement the incentive regimen of training and retaining GPs.
