我国农村订单定向免费医学生培养成效及存在问题

Effectiveness and challenges of targeted admission medical education program in rural China

目的:评价农村订单定向免费医学生培养政策实施效果,分析影响其效果的主要因素,探索培养的规律和模式,为农村基层卫生人才建设提供政策建议。方法:通过队列研究方法、采用问卷调查、定量和定性研究相结合的方法,在江西、青海和广西三个省份选取四所承担国家订单定向医学生培养项目的院校,对2015(首届)届和2016届医学毕业生开展现场调研,建立了订单定向医学生队列和非订单定向生队列,对737名医学毕业生进行了基线调查,跟踪随访了580人,开展了63次深入访谈和专题小组讨论。结果:订单定向生中农村生源占比由2015年73. 8%降至2016年63. 5%,低于非定向生。订单定向生家庭年收入低于非定向生家庭约1万元;选择订单定向政策的主要原因是毕业后有工作、高考分数限制和免学费;各地区政策实施过程中的合同签署和工作安排方面存在很大差异;收入和工作环境是影响毕业生就业意向的主要因素;仅1. 6%的定向毕业生有意愿到乡镇卫生院,但实际上履约率达到90%以上,到乡镇卫生院报到率达到80%。结论:订单定向政策可有效解决农村基层人才缺乏问题;需要尽快完善保障订单定向政策顺利实施的相关政策;提高基层岗位收入和改善工作环境能够留住人才。

Objective:This study aims to investigate the current situation of the enrollment,training model and career planning of medical students in the targeted admission program.By analyzing the implementation process of this targeted admission policy in medical education,we raise some feasible strategies to increase the attraction and retention of health professionals in rural China.Methods:The study chose 4 medical universities in central and western China.A cohort of 308 medical graduates from this targeted admission program were recruited in June 2015.A baseline survey,including questionnaire survey,in-depth interviews and the focus group discussions,was conducted right before their graduation.The first follow-up online survey was done 6 months after their graduation.Results:72.9%of the investigated students in the program used to live in rural areas before 15 years old.The average annual household income was 28 200 Yuan.The top three reasons of choosing this program were:guaranteed job after graduation,low performance in the college entrance examination,and wavier of tuition fee.There were significant differences of implementation of this policy between different provinces,especially the contract-signing and job deployment.Income and working environment were the main influencing factors of the medical graduates'job-seeking intention.Conclusions:The targeted admission program is rather successful in attracting medical graduates for rural health services.However,extra efforts are needed to improve the implementation of the policy and to retain the medical graduates in rural area.