订单定向医学生的工作意愿：基于四所医学院校的三年跟踪分析

目的：跟踪分析三届订单定向医学生与普通临床毕业生在毕业三年后的就业与规培情况，探讨首届定向生的实际履约情况、基层服务意愿与职业发展路径特点，并提出政策建议。方法：选取中西部四所医学院校，分别对2015—2017届订单定向生和普通五年制医学生在毕业当年建立队列，随后连续三年开展随访调查。结果：首届（2015届）订单定向毕业生到乡镇卫生院服务的履约率高于98%，2016届定向生表示“一定会履行合约”的学生占80.6%。2015、2016两届学生中有51.6%愿意在基层服务满3年以上，在完成服务期后，定向生平均愿意在基层继续服务4.8年。乡镇卫生院发放的月工资每提高1 000元，学生平均愿意在基层多服务1.3年。结论：已毕业定向生在规培结束后回乡镇卫生院履约的比例很高，多数已毕业定向生愿意履约完成服务期，收入是唯一可以提高其基层服务意愿的激励因素。     

首届订单定向医学毕业生就业现状研究

目的:描述分析首届订单定向医学毕业生的就业现状,评价订单定向医学生培养项目实施效果,发现存在的问题并提供相关的政策建议。方法:对中西部4所医学院校的2015届305名订单定向医学毕业生和315名临床五年制医学毕业生进行随访调查。分析其履行合约、参加工作及住院医师规范化培训情况。结果:订单定向毕业生合约履行率99.3%。订单定向毕业生和临床五年制毕业生到乡镇卫生院工作的比例分别为90.7%、2.8%,月平均收入分别为2 011元、2 774元,参加住院医师规范化培训的比例分别是77.8%、43.3%。结论:4所医学院校首届订单定向医学毕业生履行合约及参加住院医师规范化培训情况良好,但工作编制和待遇落实较为滞后,订单定向和住院医师规范化培训之间的关系尚未明确。建议在订单定向医学生毕业前,医学院校尽早与地方卫生行政部门和人力资源与社会保障部门协调联系,及早落实医学生的就业工作。同时,在充分协商的基础上,尽快明确订单定向医学生参加住院医师规范化培训的程序和要求。     

我国农村订单定向免费医学生培养成效及存在问题

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。     

宿迁市农村订单定向医学本科生履约现状分析

目的:分析宿迁市农村订单定向医学本科生毕业后履约情况和参加住院医师规范化培训情况,评价宿迁市农村订单定向医学本科生培养工作并提出相关政策建议。方法:采用自制问卷,对宿迁市2011年、2012年培养的85名农村订单定向临床医学专业本科生进行普查,采用描述性统计分析方法对数据进行分析。结果:86.08%农村订单定向医学本科生毕业后履约,就业后第一年参加住培的比例为92.65%,住培期间月平均总收入为3606.9元,82.54%的农村订单定向医学本科生认为住培基地成立独立的全科医学科“非常必要”,对住培满意度为95.24%,住培结束后愿意继续履约的比例为55.56%,合约期满后愿意继续留在基层工作的比例为10.29%。结论:宿迁市农村订单定向医学本科生履约情况及参加住培情况良好,对住培满意度高,但住培结束后与合约期满后愿意留在基层工作的比例低,相关部门应采取措施提高基层吸引力。     

订单定向医学生的职业发展：基于四所医学院校的七年跟踪分析

目的：应用订单定向医学生队列的7年面板数据,探究其职业发展情况,为我国中西部农村地区留住基层卫生人才提供参考。方法：自2015年起,选取我国中西部四所医学院校的订单定向与普通临床毕业生建立队列并跟踪其职业发展情况。结果：在规培进程和执业医师考试通过率方面,订单定向毕业生与普通临床毕业生相似;在职称和职务晋升方面更快,毕业7年后,82.5%成为主治医师,16.2%获得职务。然而,其月收入显著低于普通临床毕业生,且差值绝对值逐年增大。截至2022年12月,完成合同的493名订单定向毕业生中,38.5%留在基层;离开基层的毕业生中,60%前往县级及以上公立医院工作,7.9%攻读研究生,27.7%待业。结论：订单定向毕业生培养质量好,职业晋升快,但较低的收入显著影响其留在基层的意愿。服务期满后,有1/3左右的订单定向毕业生选择留在基层。     

定向培养 还需完善安置机制

正2010年,国家发改委、原卫生部等部门启动实施了农村订单定向医学生免费培养工作,记者日前在贵州省调研时了解到,2015年贵州省首批290名订单定向生已全部到定向乡镇卫生院履约服务。目前,定向生前期培养的端口比较畅通,但后期安置的长效机制还有待完善。人员不足、质量不高是制约基层医疗卫生事业发展的瓶颈问题,     

农村订单定向医学生基层就业的SWOT分析

2018年7月起,农村订单定向医学生(以下简称“定向医学生”)将陆续结束规培到基层工作。为了解这些学生的思想动态,减少在校定向医学生的情绪波动,文章在对新乡医学院2015-2018届的281名定向医学生调研的基础上,就定向医学生基层就业情况进行SWOT分析,建议从加大基层基础设施建设、制定严格配套政策、建立健全人才培养机制等方面入手,解决临床医学定向生的发展空间,使国家相关政策落到实处。     

农村订单定向医学生免费培养政策实施现状调查

调查订单定向医学生的招生情况、培养模式和职业生涯规划,分析农村订单定向医学生免费培养政策的实施过程,为农村基层卫生人才建设提供可行性策略和路径。方法:采用问卷调查和定性研究方法,在江西、青海和广西三个省份抽取四所承担国家订单定向医学生培养项目的院校,对2015年应届医学毕业生308人进行问卷调查、深入访谈和专题小组讨论。结果:调查对象中,1~15岁主要生活地在农村的有223人(72.9%),家庭年收入平均为2.82万元;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。结论:订单定向政策能够有效解决农村基层卫生人才缺乏问题;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。     

我国农村订单定向医学生履约期满后续约意愿分析

目的 系统评价我国农村订单定向医学生履约期满后续约意愿。方法 系统检索有关订单定向医学生履约期满后基层服务意愿的研究,由2名研究人员独立筛选文献、提取所需信息,并对纳入研究进行偏倚风险质量评价,采用Stata 17.0软件进行Meta分析。结果 共纳入29篇文献,包括12 928名研究对象,其中2 732名订单定向医学生有续约意向。结果显示,我国订单定向医学生履约期满后意愿续约率为17.5%(95%CI:12.6%～22.3%)。结论 我国订单定向医学生履约期满后意愿续约率较低,有必要采取有针对性的措施,促进订单定向医学生续约意愿的提高。     

中国疾控中心近五年研究生就业情况分析

目的 基于近5年（2016—2020届）中国疾控中心培养的研究生毕业、就业情况进行分析和研究,为我国公共卫生人才培养提供数据支持。方法 利用北京高校毕业生就业平台及资源管理系统毕业生数据,分析研究生毕业、就业情况和特点。结果 2016—2020年累计毕业生共计687人,其中定向生119人,占17.3%,非定向生568人,占82.7%;非定向毕业生总体就业率为93.2%,其中2016—2018年的就业率比较稳定,均为100%;考研或继续从事博士后工作人数比较平稳,共55人,占9.7%;出国仅占0.4%。非定向毕业生就业去向疾控中心、卫生监督中心和妇幼保健院等专业公共卫生机构的最多,占53.5%;其次医院等医疗卫生机构（占18.1%）、企业（占9.3%）。就业去向选择专业公共卫生机构的近几年来保持平稳,选择医院等医疗卫生机构有略微增长趋势。结论 可通过提升公共卫生机构吸引力、加大教育培训等措施为我国公共卫生机构输送高质量公共卫生人才,推动我国卫生健康工作的发展。     

广西三地首届服务期满农村订单定向医学生工作及影响因素研究

目的：分析广西首届服务期满农村订单定向医学生工作情况、工作满意度、续约情况及影响因素,并提出政策建议。方法：选取广西河池、南宁、北海三市,对47名订单定向医学生及乡镇卫生院院长、卫生行政部门管理人员进行问卷调查和深度访谈。结果：广西三地首届服务期满农村订单定向医学生续约率为42.6%;年收入差距8万元,周工作时长54小时,年培训机会1～4次;非续约者服务期满再就业后对工作条件、职业发展评价高于服务期满前和续约者;工作满意度也高于续约者;影响续约因素中,收入水平位居第1。结论：广西首届服务期满农村订单定向医学生乡镇卫生院续约率不高;收入差距大、工作时间长、培训机会少、工作条件差、职业发展受限,并且续约者工作满意度低、离职倾向高,短期内流失率可能进一步增加;收入水平是影响订单定向医学生续约的首要因素,居民认可尊重产生的工作成就感归属感有助于提高续约率。     

Rural Health Leaders Pipeline, 1990–2005: Case Study of a Second-Generation Rural Medical Education Program

ABSTRACT

A pipeline model has been suggested to increase the rural physician supply. This study is an institutional case report used to describe the context, development, and in-house evaluation of the University of Alabama Rural Health Leaders Pipeline, 1990–2005. This program was developed at a University of Alabama School of Medicine branch campus to target rural students at multiple levels, elementary schools through residency, and includes a minority focus. Requirements to enter the medical program include living 8 years in rural Alabama, meeting admission requirements, and affinity for rural lifestyles. Twenty-six percent of 316 high school participants, all 40 students in the minority-focused college program, and 3% of 90 medical program students were African American. The program includes (1) puppet shows in elementary schools depicting different health professions, (2) Rural Health Scholars Program for 11th-grade students, (3) Minority Rural Health Pipeline Program for college students, (4) Rural Medical Scholars Program, a 5-year track of study in rural community health and medicine, and (5) assured admission to family medicine residency. Outcomes studied in this case report included medical school performance, graduation rate, selection of family medicine specialty, and rural practice location. Medical scholars were anticipated to experience academic difficulty, select family medicine specialty, and locate in rural practice more often than peers. Compared to peers, medical scholars showed lower scores on preclinical courses and USMLE steps 1 and 2, reflective of their lower MCAT and GPA scores, but had (1) similar graduation rates (95% vs peers 84%), (2) higher family medicine selection rate (47% vs Huntsville 27% vs Tuscaloosa 12% vs Birmingham 4% [OR compared to Birmingham 22.7, 95% CI 10.5–49.4]), and (3) higher rural practice rate (67% vs peers 14% vs national group 9%) in the first RMSP classes. Based on these important outcomes being better than or equal to the traditional student cohorts, the institution concluded that the Rural Health Leaders Pipeline demonstrates successful use of the rural pipeline model.     

Admission factors predicting family medicine specialty choice: a literature review and exploratory study among students in the Rural Medical Scholars Program

Purpose: The Rural Medical Scholars Program (RMSP) was created to increase production of rural family physicians in Alabama. Literature review reveals reasons medical students choose careers in family medicine, and these reasons can be categorized into domains that medical schools can address through admission, curriculum, and structural interventions. We examine whether admission factors can predict family medicine specialty choice among students recruited from rural Alabama. Methods: We developed a questionnaire to study the ability of admission factors to predict family medicine specialty choice among Rural Medical Scholars (RMS). Eighty RMS graduates were surveyed by mail and 64 (80%) responded. Findings: Student characteristics of humanitarian outlook with commitment to rural or underserved populations, family medicine decision or intention made before or at medical school admission, and community influence were positive associations with RMS choosing family medicine residencies; shadowing in an urban hospital was a negative association. Conclusions: Statements of interest, intentions, plans, and decisions regarding family medicine should be elicited at the time of RMSP admission interview. Strong attachment to home community and commitment to serving and living in a rural area are also important. Students whose introduction to medicine was informed through shadowing or observing in urban hospitals should be considered less likely to become family physicians. Larger sample size studies are needed to assess the role of gender, race, marital status, size of rural town, and MCAT score of candidates in affecting residency choices of students selected for this rural medical education track.     

Influences on choice of surgery as a career: a study of consecutive cohorts in a medical school

AIM: To examine the differential impact of person-based and programme-related features on graduates' dichotomous choice between surgical or non-surgical field specialties for first-year residency. METHODS: A 10-year cohort study was conducted, following 578 students (55.4% male) who graduated from a university medical school during 1994-2003. Data were collected as follows: at the beginning of medical studies, on career preference and learning frame; during medical studies, on academic achievement, cross-year peer tutoring and selective clinical traineeship, and at graduation, on the first-year residency selected. Contingency and logistic regression analyses were performed, with graduates grouped by the dichotomous choice of surgery or not. RESULTS: Overall, 23% of graduates selected a first-year residency in surgery. Seven time-steady features related to this choice: male sex, high self-confidence, option of surgery at admission, active learning style, preference for surgery after Year 1, peer tutoring on clinical surgery, and selective training in clinical surgery. Logistic regression analysis, including all features, predicted 87.1% of the graduates' choices. Male sex, updated preference, peer tutoring and selective training were the most significant predictors in the pathway to choice. DISCUSSION: The relative roles of person-based and programme-related factors in the choice process are discussed. The findings suggest that for most students the choice of surgery derives from a temporal summation of influences that encompass entry and post-entry factors blended in variable patterns. It is likely that sex-unbiased peer tutoring and selective training supported the students' search process for personal compatibility with specialty-related domains of content and process.