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。

Analysis on the targeted admission medical graduates and their work preference in rural areas: A three-year survey conducted in four medical schools

Objectives: To describe the employment and residency training status of the first-three cohorts of targeted admission medical students, analyze their willingness to fulfil the contracts and work in primary healthcare sectors, and to provide relevant policy recommendations. Methods: Three cohorts of medical graduates were recruited from four medical schools located in the Central and Western regions of China, namely,the class of 2015, the class of 2016, and the class of 2017. Year-long follow-up surveys were conductedin the three specified promotions of 2016, 2017, and 2018. Results: The contract fulfilment rate of the class of 2015 graduates was higher than 98%, and the graduates of the 2016 class stated that they would "definitely fulfil the contract" accounted for 80.6%, and 94.7% for the class of 2017, respectively. In 2015 and 2016, 51.6% of graduates were willing to serve at grassroots level health institutions or township hospitals for more than three years. On average, after their contracts are expired, the targeted admission medical graduates were willing to continue working in their trades for 4.8 more years. For every 1 000 yuan increase in the monthly salary paid by the township hospitals, the graduates showed their high interest in continuing to work in their positions for 1.3 more years on average. Conclusions: The contract fulfilment rate of the class of 2015 graduates after completion of their standardised residency training was relatively high. The majority of graduates were willing to fulfil their contracts and complete the service period. The income was the only motivation factor for graduates'' willingness to serve in primary healthcare institutions.