农村订单定向医学生的基层留任：基于四所院校的八年跟踪分析

Background  The training of rural order-oriented medical students is an important initiative to alleviate the shortage of medical human resources in rural areas. As of October 2023three batches of order-oriented medical graduates have completed their required service obligations. Howeverthere is still a lack of systematic research and definitive conclusions regarding their career development and whether they will continue to serve in rural areas after fulfilling their service commitments. Objective  Based on eight years of panel data from a cohort of rural order-directed medical studentsthis study aims to analyze their early career development characteristics and identify key factors influencing their retention in primary healthcare institutions. The findings are intended to provide policy recommendations for the training and management of order-directed medical graduates in China. Methods  Since 2010a dynamic follow-up cohort has been establishedinvolving order-directed medical graduates from Qinghai UniversityGuangxi Medical UniversityJiujiang Universityand Gannan Medical University. This study utilized data from 2 041 graduates from the 2015-2019 cohortscollected through annual online surveys conducted over eight years.The surveys tracked their career developmentincluding professional title promotionadministrative role acquisitionaverage monthly incomeand the proportion of performance-based pay. Descriptive analysis was used to summarize the characteristics of career developmentwhile Logistic regression models were employed to explore factors influencing retention in primary healthcare institutions after the contractual period. Results  Among the 2 041 order-oriented medical graduates included1 06852.3% were male and 97347.7%were female. By the eighth year after graduation92.0%69/75of graduates had obtained the title of attending physicianand 24.0%18/75held administrative positions. The average monthly income was 5 573.4 yuanwith performance-based pay accounting for 45.7% of the total. As of December 2023with 232 graduates remaining in their positions after contract completionresulting in a 37.5% retention rate in primary healthcare settings. Among the 386 graduates who left primary healthcare settings13635.2%transitioned to hospitals above the county levelrepresenting the largest proportionfollowed by 10727.7%moving to county-level hospitalsand 29.07.5%pursuing graduate studies. Multivariate Logistic regression analysis revealed that contract placement in home county/cityOR=2.7495%CI=1.57-4.78P=0.001and holding administrative positionsOR=2.0295%CI=1.14-3.59P=0.016were significant facilitators of retention in primary healthcare settings post-contract completion among order-oriented medical graduates. Converselypassing the national medical licensing exam within two years of graduationOR=0.3795%CI=0.15-0.94P=0.036emerged as a barrier to retention. Conclusion  Order-directed medical graduates show rapid career progressionwith over half choosing to remain in county-level or lower primary healthcare institutions after fulfilling their contracts. This strengthens human resource capacity and improves care quality in primary healthcare settings. Notablyorder-directed medical graduates who obtained physician qualification within two years post-graduation exhibited significantly higher occupational mobility in primary healthcare settings.