Analysis of the current situation of performance willingness and performance arrival of order-directed medical students in Shanxi Province
-
摘要:
目的 调查订单定向医学生履约意愿与实际履约到岗现状，分析可能影响其履约意愿的因素，以提高订单定向医学生的履约意愿与履约到岗率，最终提升基层全科医生的培养质量和使用成效。 方法 采取整群抽样方法，于2021年7—9月对山西省1 024名在校订单定向医学生与45家卫生健康管理部门采用问卷星进行线上问卷调查，所得数据使用SPSS 26.0统计学软件进行统计分析。 结果 1 024名在校订单定向医学生中，930人(90.8%)愿意前往签约地履约，94人(9.2%)不愿意前往签约地履约。不同性别、生源地、户籍与履约地是否同一地市、履约地级别在校订单定向医学生的履约意愿差异均无统计学意义(P>0.05)，不同年级、对政策了解程度、对全科医学的信心以及对未来工作了解程度学生的履约意愿差异均有统计学意义(P<0.05)。45家卫生健康管理部门中，35家(77.8%)履约率>75%，8家(17.8%)履约率在50%~75%，2家(4.4%)履约率在25%~49%，无履约率<25%的部门。 结论 在校订单定向医学生整体履约意愿与实际履约率仍有待提高，积极进行政策宣教、加强学校全科教育有利于提高订单定向医学生履约意愿；可适当延长订单定向医学生基层服务年限、选派原籍生源以改善履约现状。 Abstract:Objective This study aims to investigate the willingness to perform and the actual performance of the order-oriented medical students, analyze the influencing factors that may affect their willingness to perform, so as to improve the willingness to perform and the performance rate of the order-oriented medical students, and ultimately improve the quality of training and the effectiveness of the use of primary general practitioners. Methods Adopting the whole cluster sampling method, an online questionnaire survey was conducted from July to September 2021 on 1 024 current order-oriented medical students in Shanxi Province with 45 health and health management departments using Questionnaire Star, and the obtained data were statistically analyzed using SPSS 26.0 statistical software. Results Among the 1 024 school order-oriented medical students, 930 (90.8%) were willing to travel to the contracted place for fulfillment, and 94 (9.2%) were not willing to travel to the contracted place for fulfillment. There was no statistical significance in the willingness of school-based order-oriented medical students to fulfill the contract in terms of gender, place of origin, whether the household registration and the place of fulfillment were in the same city or state, and the level of the place of fulfillment (P>0.05). The differences were statistically significant (P<0.05) in terms of grade level, knowledge of policies, confidence in general medicine, and knowledge of future work. Of the 45 health and health management departments, 35 (77.8%) had a compliance rate greater than 75%, 8 (17.8%) had a compliance rate between 50%-75%, 2 (4.4%) had a compliance rate between 25%-49%, and none had a compliance rate below 25%. Conclusion The overall willingness of order-oriented medical students to fulfill the contract and the actual fulfillment rate still needs to be improved. Active policy propaganda and strengthening school general education are conducive to increasing the willingness of order-oriented medical students to comply; appropriately extending the years of grass-roots service for order-oriented medical students and selecting and sending students from their home countries will improve the current situation of compliance. -
Key words:
- Order-oriented /
- Medical students /
- Retention intention /
- General Practice /
- Medical education /
- Influencing factors
-
表 1 不同类别订单定向医学生履约意愿比较[例(%)]
Table 1. Comparison of willingness to fulfill the obligationsog order-oriented medical students of different categories
项目 愿意(n=930) 不愿意(n=94) 统计量 P值 性别 1.765a 0.184 男性 277(29.0) 35(37.2) 女性 653(71.0) 59(62.8) 年级 41.050a < 0.001 2017级 124(13.3) 27(28.7) 2018级 130(14.0) 26(27.7) 2019级 188(20.2) 16(17.0) 2020级 282(30.3) 22(23.4) 2021级 206(22.2) 3(3.2) 生源地 1.182a 0.234 农村 922(99.1) 92(97.8) 城镇 8(0.9) 2(2.2) 户籍与履约地 0.818a 0.366 同一地市 603(64.8) 65(69.1) 不同地市 327(35.2) 29(30.9) 履约地级别 0.194a 0.660 乡镇卫生院 896(96.3) 91(96.7) 村卫生院 16(1.7) 1(1.1) 其他 18(2.0) 2(2.2) 政策了解程度 9.452b < 0.001 完全了解 37(4.0) 0 基本了解 512(55.1) 16(17.0) 不太了解 321(34.5) 41(43.6) 基本不了解 42(4.5) 26(27.7) 完全不了解 18(1.9) 11(11.7) 对全科医学是否有信心 133.178a < 0.001 是 849(91.3) 32(34.0) 否 81(8.7) 62(66.0) 是否了解未来工作 107.104a < 0.001 是 866(93.1) 56(59.6) 否 64(6.9) 38(40.4) 注：a为χ2值，b为Z值。 
下载: 导出CSV
表 2 各地市及县区卫生健康管理部门履约现状调查
Table 2. Survey on the current status of HHM compliance in cities and districts
项目 部门数量(%) 履约率 ＞75% 35(77.8) 50%~75% 8(17.8) 25%~49% 2(4.4) ＜25% 0 实际履约年限认知 了解实际需履约年限为3年 33(73.3) 不了解实际需履约年限为3年 12(26.7) 违约时间 医学院校毕业后违约 21(87.7) 住院医师规范化培训后违约 1(4.1) 真正履约工作后3年内违约 2(8.2)
下载: 导出CSV
表 3 变量赋值方法
Table 3. Variable assignment methods
变量 赋值方法 年级 2017级=(0, 0, 0, 0)，2018级=(1, 0, 0, 0)，2019级=(0, 1, 0, 0)，2020级=(0, 0, 1, 0)，2021级=(0, 0, 0, 1) 政策了解程度 完全了解=1，基本了解=2，不太了解=3，不了解=4，完全不了解=5 对全科医学是否有信心 否=0，是=1 对未来工作的了解程度 否=0，是=1 是否愿意履约 不愿意履约=1，愿意履约=1
下载: 导出CSV
表 4 在校订单定向医学生履约意愿影响因素的logistic回归分析
Table 4. Logistic regression analysis on the influencing factors of order oriented medical students' fulfillment intention
变量 B SE Waldχ2 P值 OR值 95% CI 年级 -0.495 0.084 15.464 < 0.001 0.609 0.517~0.718 政策了解程度 1.199 0.129 87.081 < 0.001 3.318 2.579~4.269 对全科医学的信心 3.011 0.247 148.864 < 0.001 20.308 12.520~32.940 对未来工作的了解程度 2.217 0.247 80.655 < 0.001 9.182 5.660~14.896
下载: 导出CSV
-
[1] 宁吉喆. 第七次全国人口普查主要数据情况[J]. 中国统计, 2021(5): 4-5.NING J Z. Major data situation of the seventh national population census[J]. China Statistics, 2021(5): 4-5. [2] 林建. 乡村振兴战略下我国农村医疗卫生服务供需矛盾分析[J]. 中国卫生经济, 2020, 39(12): 9-12.LIN J. Analysis of the contradiction between supply and demand of rural medical and health services in China under the strategy of rural revitalization[J]. China Health Economy, 2020, 39(12): 9-12. [3] 吴爽, 席彪. 我国全科医生继续医学教育政策执行的制约因素及优化路径研究[J]. 中华全科医学, 2023, 21(12): 1995-1999. doi: 10.16766/j.cnki.issn.1674-4152.003275WU S, XI B. Research on the constraints and optimization path of the implementation of the policy of continuing medical education for general practitioners in China[J]. Chinese Family Medicine, 2023, 21(12): 1995-1999. doi: 10.16766/j.cnki.issn.1674-4152.003275 [4] 国家发展改革委, 卫生部, 教育部, 等. 关于印发开展农村订单定向医学生免费培养工作实施意见的通知[EB/OL]. (2010-06-02)[2023-11-17]. https://www.gov.cn/zwgk/2010-06/08/content_1623025.htm .National Development and Reform Commission, Ministry of Health, Ministry of Education, et al. Notice on the issuance of the implementation opinions on carrying out free training for rural order-oriented medical students[EB/OL]. (2010-06-02)[2023-11-17].https://www.gov.cn/zwgk/2010-06/08/content_1623025.htm .[5] 国家卫生计生委, 中央编办, 国家发展改革委, 等. 国家卫生计生委, 中央编办, 国家发展改革委, 教育部, 财政部, 人力资源社会保障部, 国家中医药管理局关于建立住院医师规范化培训制度的指导意见[J]. 中华人民共和国教育部公报, 2016(Z2): 10-12.Guiding Opinions of the National Health and Family Planning Commission, the Central Editorial Office, the National Development and Reform Commission, the Ministry of Education, the Ministry of Finance, the Ministry of Human Resources and Social Security, and the State Administration of Traditional Chinese Medicine on the establishment of a standardized training system for residents[J]. Bulletin of the Ministry of Education of the People ' s Republic of China, 2016(Z2): 10-12. [6] 魏艳君, 袁璟, 王丽君, 等. 订单定向医学生基层就业意向研究[J]. 中国农村卫生事业管理, 2021, 41(10): 704-708.WEI Y J, YUAN J, WANG L J, et al. A study on grassroots employment intention of order-oriented medical students[J]. China Rural Health Care Management, 2021, 41(10): 704-708. [7] 杨雨薇. 安徽省农村订单定向医学生专业认同与心理健康状况调查研究[D]. 合肥: 安徽医科大学, 2019.YANG Y W. Survey research on professional identity and mental health status of rural order-directed medical students in Anhui Province[D]. Hefei: Anhui Medical University, 2019. [8] 高京, 王颖, 孙强. 山东省农村订单定向医学生对免费医学教育的认知研究[J]. 卫生软科学, 2021, 35(6): 77-80.GAO J, WANG Y, SUN Q. A study of rural order-oriented medical students ' perception of free medical education in Shandong Province[J]. Health Soft Science, 2021, 35(6): 77-80. [9] 谯利平. 农村订单定向医学生就业思想动态研究-基于四川省的调查[J]. 四川文理学院学报, 2020, 30(1): 116-119.QIAO L P. Research on the employment ideological dynamics of rural order-oriented medical students: a survey based on Sichuan Province[J]. Journal of Sichuan College of Arts and Sciences, 2020, 30(1): 116-119. [10] 谈在祥, 吴松婷, 黄霍明, 等. 农村定向医学人才配置成效与路径优化研究: 以苏北地区为例[J]. 卫生经济研究, 2020, 37(2): 38-42.TAN Z X, WU S T, HUANG H M, et al. Research on the effectiveness and path optimization of rural order-oriented medical talent allocation: taking Northern Jiangsu as an example[J]. Health Economics Research, 2020, 37(2): 38-42. [11] 朱焱, 董芳燕, 代彪. 人文教育融入农村订单定向医学生教学实践效果分析[J]. 中国初级卫生保健, 2022, 36(1): 26-29.ZHU Y, DONG F Y, DAI B. Analysis of the effect of humanistic education into the teaching practice of rural order-oriented medical students[J]. China Primary Health Care, 2022, 36(1): 26-29. [12] 郑华, 何静, 覃晓龙, 等. 订单定向医学生专业认同感影响因素及提升策略研究[J]. 现代医药卫生, 2020, 36(14): 2276-2279.ZHENG H, HE J, QIN X L, et al. Research on the influencing factors and enhancement strategies of professional identity of order-oriented medical students[J]. Modern Medicine and Health, 2020, 36(14): 2276-2279. [13] 施星妤. 江苏省农村订单定向医学生政策执行满意度研究[D]. 南京: 南京农业大学, 2020.SHI X Y. Research on the satisfaction of policy implementation of rural order-oriented medical students in Jiangsu Province[D]. Nanjing: Nanjing Agricultural University, 2020. [14] 李明月, 左延莉, 张发斌, 等. 住院医师规范化培训对订单定向医学生执业医师资格考试通过率的影响研究[J]. 中国全科医学, 2022, 25(22): 2706-2713.LI M Y, ZUO Y L, ZHANG F B, et al. A study on the impact of standardized residency training on the pass rate of order-directed medical students ' practicing physician qualification examination[J]. Chinese Family Medicine, 2022, 25(22): 2706-2713. [15] 宋娟. 2015—2019年陕西省农村订单定向医学生就业履约情况分析[J]. 高教学刊, 2021(8): 193-196.SONG J. Analysis of employment performance of rural order-oriented medical students in Shaanxi Province from 2015-2019[J]. Journal of Higher Education, 2021(8): 193-196. [16] 黄星, 左延莉. 基于CIPP模型的农村订单定向医学生培养效果研究[J]. 中国农村卫生事业管理, 2021, 41(10): 709-713.HUANG X, ZUO Y L. Research on the cultivation effect of rural order-oriented medical students based on CIPP model[J]. China Rural Health Care Management, 2021, 41(10): 709-713. [17] 吴慧蕾, 李章平, 周少余, 等. 地方就业安置政策对定向医学生学业成绩和履约情况的影响[J]. 温州医科大学学报, 2021, 51(11): 938-942.WU H L, LI Z P, ZHOU S Y, et al. The impact of local job placement policies on the academic performance and fulfillment of oriented medical students[J]. Journal of Wenzhou Medical University, 2021, 51(11): 938-942. [18] 何晓敏, 谭欣圆, 杜清, 等. 订单定向医学生专业承诺情况及其影响因素调查研究: 以滨州医学院为例[J]. 卫生职业教育, 2019, 37(23): 100-102.HE X M, TAN X Y, DU Q, et al. Investigation and research on the professional commitment of order-oriented medical students and their influencing factors: taking Binzhou Medical College as an example[J]. Health Vocational Education, 2019, 37(23): 100-102. -
点击查看大图
表(4)
计量
- 文章访问数: 19
- HTML全文浏览量: 12
- PDF下载量: 2
- 被引次数: 0
