You You, Xie Ana, Cleland Jennifer
Institute of Medical Education/National Center for Health Professions Education Development, Peking University, Beijing, China.
Institute of Economics of Education, Peking University, Beijing, China.
Med Educ. 2022 Dec;56(12):1203-1213. doi: 10.1111/medu.14918. Epub 2022 Aug 25.
Many countries are driving forward policies and practices to train medical students for later rural practice. Previous research has investigated individual (e.g., rural upbringing) and structural factors (e.g., curricular exposure) associated with rural practice intention. However, the relationship between academic performance in medical school and rural practice intention has been neglected, although optimisation theory suggests there may be a relationship. To address this gap, our aim was to identify the relationship between academic performance and rural practice intention.
Data were collected via a cross-sectional (self-report) survey in 2021. Participants were students from 60 of the 96 rural order directed (RODs) medical programmes across China. We asked students their rural practice intention. We conducted univariate analyses to test for associations between rural practice intention and independent variables, including socio-demographics, ROD location, grade year and academic performance measures. We used multilevel logistic regression models to test whether students' academic performance in medical school could be used to predict rural practice intention, holding the other factors constant.
There were 13 123 respondents, representing roughly 77.6% of the student population from the 60 schools. There was a statistically significant relationship between student (self)-reported academic performance in medical school and rural practice intention. Higher performers had a lower likelihood (ORs: 0.65-0.78) of rural practice intention. This held across all performance measures (GPA rank, academic awards and student leadership) and for the sub-group with rural upbringing (ORs: 0.68-0.78).
This is the first study to identify a relationship between medical school performance and rural practice intention. The findings suggest that students maximise their utility when choosing career options, with higher performers having lower rural practice intention. These data provide insight into the complexity of medical career decision making and can be used by medical school and workforce planners to inform rural training, recruitment and retention strategies.
许多国家正在推进相关政策和实践，以培养医学生日后从事农村医疗工作。以往的研究调查了与农村医疗实践意愿相关的个体因素（如农村成长经历）和结构因素（如课程接触）进行了调查。然而，医学院校学业成绩与农村医疗实践意愿之间的关系一直被忽视，尽管优化理论表明两者可能存在关联。为填补这一空白，我们的目的是确定学业成绩与农村医疗实践意愿之间的关系。
2021年通过横断面（自我报告）调查收集数据。参与者是来自中国96个农村定向医学项目中60个项目的学生。我们询问了学生他们的农村医疗实践意愿。我们进行了单变量分析，以检验农村医疗实践意愿与包括社会人口统计学、农村定向项目地点、年级和学业成绩指标在内的自变量之间的关联。我们使用多层逻辑回归模型来检验医学院校学生的学业成绩是否可用于预测农村医疗实践意愿，同时保持其他因素不变。
共有13123名受访者，约占60所学校学生总数的77.6%。医学院校学生自我报告的学业成绩与农村医疗实践意愿之间存在统计学上的显著关系。成绩较好的学生从事农村医疗实践的可能性较低（比值比：0.65 - 0.78）。这在所有成绩指标（平均绩点排名、学术奖项和学生领导力）以及有农村成长经历的亚组中均成立（比值比：0.68 - 0.78）。
这是第一项确定医学院校成绩与农村医疗实践意愿之间关系的研究。研究结果表明，学生在选择职业选项时会最大化自身效用，成绩较好的学生农村医疗实践意愿较低。这些数据为医学职业决策的复杂性提供了见解，医学院校和劳动力规划者可利用这些数据为农村培训、招聘和留用策略提供参考。
