School of Integrated Traditional Chinese and Western Medicine, Jining Medical University, Jining, China.
School of Public Health, Jining Medical University, Jining, China.
Front Public Health. 2023 Jul 17;11:1089625. doi: 10.3389/fpubh.2023.1089625. eCollection 2023.
The fulfillment of contractual obligations by rural-oriented tuition-waived medical students (RTMSs) to work in rural medical institutions after graduation directly impacts the improvement of rural health quality. This study aimed to not only quantitatively measure the direct impact of honesty-credit, specialty identity, and career identity on willingness to fulfill the contract of RTMSs but also to quantify the intermediary role of specialty identity and career identity between honesty-credit and willingness to fulfill the contract. The research results provided recommendations for the rural-oriented tuition-waived medical education (RTME) program to achieve its goal of training rural primary healthcare personnel.
From March to May 2022, 1162 RTMSs were selected as the research objects. The honesty-credit, specialty identity, career identity, and willingness to fulfill the contract were quantitated using a self-completed questionnaire. Pearson's correlation analysis and structural equation modeling were used for statistical analysis and mediating effect evaluation.
A total of 455 (42.3%) RTMSs had high willingness to fulfill the contract, and honesty-credit had a significant direct positive effect on willingness (β = 0.198, < 0.001), specialty identity (β = 0.653, < 0.001), and career identity (β = 0.180, < 0.001). In the intermediary path between honesty-credit and willingness, career identity [95% confidence interval (CI): 0.007-0.051] had significant mediating effects. Career identity (95% CI: 0.030-0.149) also had significant mediating effects between specialty identity and willingness, and specialty identity (95% CI: 0.465-0.760) had significant mediating effects between honesty-credit and career identity. These results strongly confirmed that honesty-credit, specialty identity, and career identity are early and powerful predictors of the willingness to fulfill the contract of RTMSs.
The honesty-credit of RTMSs can predict their willingness to fulfill the contract early, significantly and positively. For the students who fail to pass the credit assessment for many times and have a strong tendency to default, their training qualifications should be canceled in time, so that students who are truly willing to serve rural areas can enter the project, and finally achieve the policy goal of "strengthening the rural primary medical and health system".
农村订单定向医学生（RTMS）毕业后到农村医疗机构履约工作，直接影响农村卫生服务质量的提升。本研究旨在定量测量诚信、专业认同和职业认同对 RTMS 履约意愿的直接影响，同时量化诚信与履约意愿之间专业认同和职业认同的中介作用。研究结果为农村订单定向免费医学教育（RTME）项目实现培养农村基层医疗卫生人才的目标提供了建议。
2022 年 3 月至 5 月，选取 1162 名 RTMS 作为研究对象。采用自填式问卷对诚信、专业认同、职业认同和履约意愿进行定量测量。采用 Pearson 相关分析和结构方程模型进行统计分析和中介效应评价。
共有 455 名（42.3%）RTMS 具有较高的履约意愿，诚信对履约意愿有显著的直接正向影响（β=0.198，<0.001），专业认同（β=0.653，<0.001）和职业认同（β=0.180，<0.001）。在诚信与履约意愿的中介路径中，职业认同[95%置信区间（CI）：0.007-0.051]具有显著的中介效应。专业认同（95%CI：0.030-0.149）在专业认同和履约意愿之间也具有显著的中介效应，而诚信与职业认同之间的中介效应显著（95%CI：0.465-0.760）。这些结果有力地证实了诚信、专业认同和职业认同是 RTMS 履约意愿的早期、有力预测因素。
RTMS 的诚信可以早期、显著和积极地预测其履约意愿。对于多次信用评估不及格且有强烈违约倾向的学生，应及时取消其培训资格，使真正愿意服务农村地区的学生能够进入该项目，最终实现“加强农村基层医疗卫生体系”的政策目标。
