Page 110 - 2023-04-中国全科医学

2023年2月 第26卷 第4期 http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn ·495·

林芸芸，黄珊珊，宋艳玲，等 . 海南省农村订单定向医学毕业生基层工作情况及职业规划调查研究［J］. 中国全
科医学，2023，26（4）：494-503.［www.chinagp.net］
LIN Y Y，HUANG S S，SONG Y L，et al. Working status in primary care and career planning in targeted admission
medical graduates：a study from Hainan Province［J］. Chinese General Practice，2023，26（4）：494-503.

Working Status in Primary Care and Career Planning in Targeted Admission Medical Graduates：a Study from
4*
3
Hainan Province LIN Yunyun 1，2 ，HUANG Shanshan ，SONG Yanling 1，2 ，ZHANG Yunbo 1，2 ，LIU Xuejun ，GU
Shenhong 1，2*
1.College of General Practice and Continuing Education，Hainan Medical University，Haikou 570102，China
2.Department of General Practice，the First Affiliated Hospital of Hainan Medical University，Haikou 570000，China
3.Department of General Practice，Wanning Dong'ao Town Health Center，Wanning 571528，China
4.Primary Health Department of Hainan Provincial Health Commission，Haikou 570000，China
*
Corresponding authors：LIU Xuejue；E-mail：liuxjxr@126.com
GU Shenhong，Professor，Chief physician；E-mail：1574063710@qq.com
LIN Yunun and Huang Shanshan are the first authors
【Abstract】 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