China Center for Health Development Studies, Peking University, Beijing, China.
Qinghai Center for Health Development Studies, Medical College of Qinghai University, Xining, Qinghai, China.
Front Public Health. 2023 Feb 2;11:1042898. doi: 10.3389/fpubh.2023.1042898. eCollection 2023.
Since 2010, China has implemented a national programme to train general practitioners for rural areas. The programme enrolled medical students with a rural background who signed a contract for 6 years' compulsory rural service after graduation. China is transitioning its national COVID-19 strategies in view of the features of coronavirus Omicron variant, the vaccination coverage, and the need for socioeconomic development. Strengthening primary health care, especially the health workforce in rural areas, should be an important consideration during the policy transition. This study aims to evaluate the implementation process of enrolling medical students in the programme, their willingness to work in the rural settings and their actual job choice after graduation.
The study chose four medical universities in central and western China. A total of 2,041 medical graduates who have signed a contract for compulsory rural service and 1,576 medical graduates enrolled "as usual" (no compulsory rural service) were recruited in five campaigns-every June from 2015 to 2019. A survey was conducted 1 week before their graduation ceremony.
The top three reasons for choosing this programme were: a recommendation of a family member or teacher, a guaranteed job after graduation and the waiver of the tuition fee. 23.0-29.7% of the study participants were not familiar with the policy details. 39.1% of the medical students signed a contract with a county other than that of their hometown. Medical graduates on the compulsory rural service programme had very low willingness (1.9%) to work in rural areas but 86.1% of them actually worked at township health centers. In contrast, the willingness to work at township health centers was 0.2% for the comparison group (medical graduates without the contract), and their actual job choice at township health centers was 0%.
Although the well-trained medical graduates on the compulsory rural service programme have low willingness to work in the township health centers, 86.1% of them choose to do so following their contract. This programme will strengthen the primary health workforce to deal with the increasing disease burden as China is transitioning its national COVID-19 strategies.
自 2010 年以来，中国实施了一项针对农村地区的全科医生培训国家计划。该计划招收具有农村背景的医学生，他们毕业后签订了为期 6 年的农村服务强制合同。鉴于冠状病毒奥密克戎变种的特征、疫苗接种覆盖率以及社会经济发展的需要，中国正在调整其国家 COVID-19 战略。加强基层卫生保健，特别是农村地区的卫生人力，应是政策过渡期间的一个重要考虑因素。本研究旨在评估该计划招收医学生的实施过程、他们在农村地区工作的意愿以及毕业后的实际工作选择。
本研究选择了中国中部和西部的四所医科大学。在五个阶段（每年 6 月）共招募了 2041 名已签订农村服务强制合同的医科毕业生和 1576 名“正常入学”（无强制农村服务）的医科毕业生。在他们毕业典礼前一周进行了一项调查。
选择该计划的前三个原因是：家人或老师的推荐、毕业后有保障的工作和免学费。23.0-29.7%的研究参与者对政策细节不熟悉。39.1%的医学生与家乡以外的县签订了合同。参加强制农村服务计划的医学生在农村工作的意愿非常低（1.9%），但实际上有 86.1%的人在乡镇卫生院工作。相比之下，对照组（无合同的医学生）的乡镇卫生院工作意愿为 0.2%，而他们的实际工作选择为 0%。
尽管参加强制农村服务计划的经过良好培训的医学生在乡镇卫生院工作的意愿较低，但其中 86.1%的人按照合同选择了这样做。随着中国调整其国家 COVID-19 战略，该计划将加强基层卫生人力，以应对不断增加的疾病负担。
