Page 7 - 2022-22-中国全科医学

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【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

我国农村地区由高血压、糖尿病等慢性病导致的 费培养项目，很多中西部省份在国家项目之外也增
疾病负担不断上升 ［1］ 。慢性病的诊断、治疗和管理 加了省级甚至地市级项目。2014 年，我国开始实施
主要依靠基层医疗卫生服务。同时，新型冠状病毒 住院医师规范化培训，订单定向医学毕业生需要参
肺炎（COVID-19）疫情的有效防控也离不开基层卫 加为期 3 年的住院医师规范化培训，并在考核合格
生服务体系 ［2］ 。基层卫生人才队伍建设是落实“以 后继续履约到乡镇卫生院工作 ［7-8］ 。2010 年开始，
基层为重点”的卫生工作方针、建设“以人为本” 国家相关部委多次针对订单定向医学生免费培养出
的整合型卫生服务体系的基础和关键，而当前高质 台相关政策，不断细化和完善政策内容。截至2021年，
量卫生人才缺乏已成为农村基层卫生健康事业发展 已经招收了 12 批订单定向医学生，其中 2010—2013
的主要瓶颈。为农村地区培养、吸引和保留合格的 年招收的 4 届订单定向医学生已完成 5 年的医学本科
卫生人才，是世界各国卫生服务体系改革的重点任 学习和 3 年的全科住院医师规范化培训，进入社区或
务。WHO 将各国的经验汇总为四类干预措施：教育 乡镇卫生院工作。本文根据近年来参与订单定向医
类干预措施、强制类干预措施、经济激励类干预措施、 学生免费培养政策的研究与实践，对订单定向医学
专业支持类干预措施 ［3］ 。由于实施的政策环境差异， 生免费培养政策的设计理念和执行过程进行系统性
这些干预措施所得出的政策效果也各不相同 ［4］ 。 回顾与分析，并基于此对未来的政策走向提出建议。
2010 年，国家发展改革委、教育部、卫生部等 5 1 订单定向医学生免费培养政策的目标和设计理念
部委共同出台了“订单定向医学生免费培养”政策， 订单定向医学生免费培养政策是卫生人才培养体
旨在为农村地区培养高质量的全科医生，提高农村 制机制创新的重要举措，是体现“以基层为重点”
基层卫生服务能力 ［5］ 。订单定向医学生免费培养项 的卫生工作方针的重要行动，是加强基层卫生人才
目从农村招收医学生，免收学费，并给学生发放一 队伍建设、提升基层医疗卫生服务水平、推动建立
定的生活补贴。订单定向医学生需要与当地卫生健 分级诊疗制度的治本之策，是深化医药卫生体制改
康行政部门和医学院校签订合同，毕业后，根据合同， 革、加快建设“健康中国”的重要举措，也是落实“脱
需要到签约的乡镇卫生院服务 6 年。国家每年为中 贫攻坚”战略、推进“健康扶贫”可持续发展的重要
西部地区培养约 5 000 名订单定向医学生 ［6］ 。此外， 基础。在政策设计中，充分体现了“以人为本”的理念，
部分东部省份也开展了本地区的订单定向医学生免 综合考虑了订单定向医学生的职业发展，明确指出