Influence of the motivation of rural-ordered government-funded medical students in Shandong Province on their willingness to fulfill commitments
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摘要:
目的 探讨山东省公费医学生的报考动机对其履约意愿的影响，为提升公费医学生的履约意愿和培养质量提供参考。 方法 自行设计调查问卷，对山东省5所高等医学院校2019—2022级的2 058名公费医学生进行调查；采用描述性统计分析、单因素分析和多重线性回归模型分析公费医学生的报考动机对履约意愿的影响。 结果 单因素分析结果显示，是否以家长意见、政府安排工作、免费就读政策为报考动机的公费医学生履约意愿得分差异均有统计学意义(P < 0.001)；对政策是否认同、生源地与定向地是否匹配的公费医学生履约意愿得分差异均有统计学意义(P < 0.001)。多重线性回归分析结果显示，政府安排工作(P=0.021)和免费就读政策(P=0.001)这2个报考动机均为公费医学生履约意愿的影响因素；政策认同是公费医学生履约意愿的影响因素(P < 0.001)；家长意见与政策认同交互项对履约意愿具有显著性影响(P=0.025)。 结论 公费医学生的报考动机、政策认同情况及生源地与定向地匹配情况均对履约意愿有重要影响。 Abstract:Objective To explore the impact of application motivations on the commitment fulfillment willingness of government-funded medical students in Shandong Province, and provide reference for enhancing their commitment fulfillment willingness and cultivation quality. Methods A self-designed questionnaire was used to investigate 2 058 government-funded medical students from grade 2019 to grade 2022 in five medical colleges and universities in Shandong Province. Descriptive statistical analysis, one-way analysis of variance and multiple linear regression model were used to analyze the influence of the motivation of government-funded medical students on their willingness to perform the contract. Results The results of one-way analysis of variance showed that there were statistically significant differences in the scores of willingness to fulfill the contract between parents' opinions, government arrangement of work and free study policy (P < 0.001). There were also statistically significant differences in the scores of willingness to implement the policy and whether the place of origin and the place of destination were matched (P < 0.001). The regression results of the willingness of medical students to fulfill the contract showed that the two motivations of government arranged work (P=0.021) and free study policy (P=0.001) had a significant impact on the willingness of medical students to fulfill the contract. Policy identification had a significant effect on the willingness of medical students to perform the contract (P < 0.001). The interaction term between parental opinions and policy identification has a significant impact on willingness to fulfill the agreement (P=0.025). Conclusion The examination motivation, policy identification and matching of students' place of origin and orientation of public medical students have an important impact on their willingness to perform the contract. -
表 1 2 058名公费医学生的基本情况
Table 1. Basic information of 2, 058 publicly-funded medical students
项目 类别 人数(%) 学校 山东第二医科大学 520(25.27) 滨州医学院 622(30.22) 济宁医学院 453(22.01) 青岛大学 51(2.48) 山东第一医科大学 412(20.02) 年级 大二 324(15.74) 大三 585(28.43) 大四 545(26.48) 大五 604(29.35) 专业 临床医学 1 617(78.57) 中医学 130(6.32) 预防医学 208(10.11) 精神医学 103(5.00) 性别 男性 1 007(48.93) 女性 1 051(51.07) 户口所在地 农村 1 250(60.74) 城镇 404(19.63) 城市 404(19.63) 生源地与定向地是否匹配 是 999(48.54) 否 1 059(51.46) 
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表 2 2 058名公费医学生的报考动机分布情况
Table 2. The distribution of enrollment motivations among 2 058 publicly-funded medical students
报考动机 人数(%) 政府安排工作 符合 1 533(74.49) 不符合 525(25.51) 免费就读政策 符合 1 122(54.52) 不符合 936(45.48) 家长意见 符合 1 487(72.25) 不符合 571(27.75)
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表 3 2 058名公费医学生履约意愿影响因素的单因素分析
Table 3. One-way analysis of variance (ANOVA) on the willingness to fulfill the contract among 2, 058 publicly-funded medical students
项目 履约意愿得分(x±s，分) 统计量 P值 年级 38.061a < 0.001 大五 8.09±2.17 大四 8.66±2.13 大三 9.08±1.89 大二 9.41±1.83 专业 14.364a < 0.001 临床医学 8.59±2.08 中医学 9.25±2.29 预防医学 9.48±1.75 精神医学 8.79±2.09 性别 1.013b 0.156 男性 8.68±2.13 女性 8.78±2.04 户口所在地 0.911a 0.404 农村 8.78±2.01 城镇 8.67±2.15 城市 8.64±2.25 生源地与定向地匹配情况 4.717b < 0.001 是 8.96±2.00 否 8.52±2.14 政策认同 23.792b < 0.001 认同 9.56±1.70 不认同 7.60±2.03 家长意见 4.911b < 0.001 符合 8.87±2.00 不符合 8.37±2.24 政府安排工作 11.886b < 0.001 符合 9.04±1.91 不符合 7.83±2.32 免费就读政策 10.915b < 0.001 符合 9.18±1.87 不符合 8.20±2.20 注：a为F值, b为t值。
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表 4 变量赋值情况
Table 4. Variable assignment
变量 赋值方法 年级 大二=1，大三=2，大四=3，大五=4 专业 临床专业=(0，0，0)，中医学=(0，1，0)，预防医学=(0，0，1)，精神医学=(1，0，0) 生源地与定向地匹配情况 生源地与定向地匹配=1，生源地与定向地不匹配=0 家长意见 以家长意见为报考动机=1，不以家长意见为报考动机=0 政府安排工作 以政府安排工作为报考动机=1，不以政府安排工作为报考动机=0 免费就读政策 以免费就读政策为报考动机=1，不以免费就读政策为报考动机=0 政策认同情况 对政策认同=1，对政策不认同=0
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表 5 公费医学生履约意愿得分影响因素的多重线性回归分析
Table 5. Linear regression analysis on the willingness to fulfill the contract among publicly-funded medical students
变量 B SE β t值 P值 年级 -0.223 0.038 -0.114 -5.893 < 0.001 中医学 0.216 0.197 0.025 1.095 0.274 预防医学 0.082 0.213 0.009 0.388 0.698 精神医学 0.092 0.130 0.018 0.707 0.480 生源地与定向地是否匹配 0.176 0.079 0.043 2.233 0.026 家长意见 0.355 0.136 0.077 2.617 0.009 政府安排工作 0.736 0.143 0.155 5.131 < 0.001 免费就读政策 0.724 0.131 0.175 5.527 < 0.001 政策认同 2.441 0.184 0.583 13.274 < 0.001 政策认同*家长意见 0.409 0.182 0.098 2.248 0.025 政策认同*政府安排工作 0.401 0.204 0.097 1.971 0.049 政策认同*免费就读政策 0.337 0.175 0.077 1.930 0.054 注：调整后的R2=0.279，P < 0.05，*表示交互项。
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