Page 29 - 2022-22-中国全科医学

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Employment and Contract Performance of Medical Graduates from Compulsory Rural Service Directed Free Training
Program：a Five-year Follow-up Analysis Based on the Graduates from Four Medical Schools CHENG Xiaoran 1，2 ，
2
2
2*
3
ZHANG Xiaotian ，WANG Jingya ，ZHANG Zhong ，DOU Lidi ，LIU Xiaoyun 2
1.School of Public Health，Peking University，Beijing 100191，China
2.China Center for Health Development Studies，Peking University，Beijing 100191，China
3.Center for Rural Medical Education Research，Gannan Medical University，Ganzhou 341000，China
*
Corresponding author：ZHANG Xiaotian，Post doctor；E-mail：xiaotian_zhang@hsc.pku.edu.cn
【Abstract】 Background Compulsory rural service directed medical student free training program is an important initiative
to ameliorate the shortage of health human resources in rural areas of China，and the first graduates of the policy have now completed the
contract performance. Analysis of the performance situation and influencing factors of these students is needed to improve the policy of
compulsory rural service directed medical student free training program in time and improve and stabilize the performance rate of the rural
service directed medical students. Objective To analyze the employment and performance status of compulsory rural service directed
medical graduates of 2015—2019 in four Midwestern medical schools，and to analyze the influencing factors on the performance of the
rural service directed medical students，so as to make recommendations to further improve the training policy of the rural service directed
medical students. Methods A cohort of rural service oriented medical students was established from four medical schools including
Qinghai University，Guangxi Medical University，Jiujiang college，and Gannan Medical College，and other five-year graduates
of clinical medicine from the same session were selected as controls. A baseline questionnaire was administered to graduates before
graduation，which included the basic information，family information，job expectations，and so on. An online follow-up survey was
conducted annually thereafter and included graduates' employment，performance status，and so on. This study was conducted in July
2021 using data from a baseline survey of graduates of 2015—2019 from four institutions and a follow-up survey from September 2020. A
total of 2 041 rural service directed medical graduates and 1 579 other 5-year clinical students were enrolled. Compare the difference in
employment between rural service oriented medical graduates and other five-year clinical students. Multivariate Logistic regression was
used to analyze the influencing factors on the performance of rural service directed medical graduates. Results In the baseline survey，
2.26%（46/2 038） of the rural service directed medical graduates were willing to work in township health institutes. In the 2020 follow-
up survey，86.04%（228/265） of the rural service directed medical graduates chose to work in township health institutes. In a 2018
follow-up survey of 2015 and 2016 rural service directed medical graduates，43.67%（290/664） of graduates expressed reluctance to
remain in township health institutes after the expiry of the contract. 97.48%（1 546/1 586） of rural service directed medical graduates
were allocated as personnel in public institution，a higher proportion than other clinical 5-year graduates （P<0.05）. The overall
performance rate of 5-year rural service directed medical graduates was 97.84%（1 589/1 624），and the results of multivariate logistic
regression analysis showed that male gender，desired job location as rural areas in the baseline survey，job having public institution
quota，and contract location as home district（county） were the promoting factors for the performance of rural service directed medical
graduates（P<0.05）. Conclusion Rural service directed medical students are more smoothly employed with high performance rates，
and the recruitment of this type of medical students should focus on students who have willingness to work in rural areas and try to contract
with the counties where the students are from.
【Key words】 General practitioners；Target admissionmedical graduates；Employment；Contract fulfillment；
Education，medical；Primary health care

中国农村地区长期面临全科医生数量严重不足的 镇卫生院）工作 6 年，其中有 3 年住院医师规范化
问题。为增加农村地区的全科医学人才供给，提高 培训（简称规培）计入履约时间。如果订单定向医
中国农村地区医疗服务质量，自 2010 年起，中西部 学生违反合同规定需接受处罚，处罚方式包括罚金、
省份依据发展改革委等 5 部门联合印发的《开展农 5 年内不准考取省内公立医院岗位、违约行为计入个
村订单定向医学生免费培养工作的实施意见》（发 人诚信档案等。至 2015 年，第一届订单定向医学生
改社会〔2010〕1198 号）开始培养订单定向医学 毕业，其签署的合同也于 2021 年到期。订单定向医
生 ［1］ 。订单定向医学生在入学前须与培养学校和当 学生的就业状况如何？有多少订单定向医学生履行
地县级卫生行政部门签署定向就业协议，在校学习期 了就业协议？哪些因素会影响订单定向医学生选择
间免除学费和住宿费，并享受一定额度的生活补助， 到农村地区从事医疗卫生服务？这些都是亟待调查
毕业后需按合同规定到指定的医疗机构（一般是乡 和深入分析的问题。既往研究缺乏对订单定向医学