中国全科医学 ›› 2023, Vol. 26 ›› Issue (04): 494-503.DOI: 10.12114/j.issn.1007-9572.2022.0260

• 论著·全科医学教育研究 • 上一篇    下一篇

海南省农村订单定向医学毕业生基层工作情况及职业规划调查研究

林芸芸1,2, 黄珊珊3, 宋艳玲1,2, 张云波1,2, 刘学军4,*(), 顾申红1,2,*()   

  1. 1.570102 海南省海口市,海南医学院全科医学与继续教育学院
    2.570000 海南省海口市,海南医学院第一附属医院全科医学科
    3.571528 海南省万宁市东澳镇中心卫生院全科医学科
    4.570000 海南省海口市,海南省卫生健康委员会基层卫生健康处
  • 收稿日期:2022-03-25 修回日期:2022-10-27 出版日期:2023-02-05 发布日期:2022-12-01
  • 通讯作者: 刘学军, 顾申红
  • 林芸芸和黄珊珊共同为第一作者 林芸芸,黄珊珊,宋艳玲,等.海南省农村订单定向医学毕业生基层工作情况及职业规划调查研究[J].中国全科医学,2023,26(4):494-503.[www.chinagp.net]
    作者贡献:林芸芸、黄珊珊、顾申红进行文章的构思与设计;张云波进行文章的可行性分析;林芸芸、黄珊珊、宋艳玲进行文献/资料收集;林芸芸、黄珊珊、张云波进行文献/资料整理;林芸芸、黄珊珊撰写论文;刘学军、顾申红进行论文的修订,负责文章的质量控制及审校,并对文章整体负责,监督管理;林芸芸进行英文的修订。
  • 基金资助:
    2022年海南省高等学校教育教学改革研究重点项目课题(Hnjg2022ZD-30); 2021年海南医学院教育科研重点课题(HYZD202108); 2021年度海南省卫生健康行业科研项目课题(21A200086); 2022年海南医学院教学成果奖培育项目(HYjcpx202212); 2022年度海南省高等学校教育教学改革研究一般项目(Hnjg2022-69); 2021年海南医学院教育科研一般课题(HYYB202104)

Working Status in Primary Care and Career Planning in Targeted Admission Medical Graduates: a Study from Hainan Province

LIN Yunyun1,2, HUANG Shanshan3, SONG Yanling1,2, ZHANG Yunbo1,2, LIU Xuejun4,*(), GU Shenhong1,2,*()   

  1. 1. College of General Practice and Continuing Education, Hainan Medical University, Haikou 570102, China
    2. Department of General Practice, the First Affiliated Hospital of Hainan Medical University, Haikou 570000, China
    3. Department of General Practice, Wanning Dong'ao Town Health Center, Wanning 571528, China
    4. Primary Health Department of Hainan Provincial Health Commission, Haikou 570000, China
  • Received:2022-03-25 Revised:2022-10-27 Published:2023-02-05 Online:2022-12-01
  • Contact: LIU Xuejun, GU Shenhong
  • About author:
    LIN Y Y, HUANG S S, SONG Y L, et al. Working status in primary care and career planning in targeted admission medical graduates: a study from Hainan Province[J]. Chinese General Practice, 2023, 26 (4) : 494-503. LIN Yunun and Huang Shanshan are the first authors

摘要: 背景 我国从2010年开始开展农村订单定向医学生免费培养工作,为基层医疗卫生机构培养从事全科医疗的卫生人才。农村订单定向医学毕业生在基层的工作情况和职业规划,以及基层用人单位对其各方面的评价情况,都需要进一步的研究。 目的 全面了解海南省正在履约的经"5+3"模式培养的农村订单定向医学毕业生(简称"5+3"订单定向全科医生)在基层的工作情况(包括服务能力、岗位满意度、专业能力提升意愿等)及其职业规划状况,探讨其履约期满后留任的意愿及其影响因素,旨在为今后调整优化全科医生培养与使用激励政策提供依据,为医学院校确立全科医学院(系)的定位与发展方向提供参考。 方法 于2021-04-25至2021-05-06,采用整群抽样法,选取海南省19个市(县)的"5+3"订单定向全科医生309例及其所在单位的经"3+2"模式培养的助理全科医生56例、转岗全科医生250例为研究对象,采用自设问卷对其进行调查,邀请其对服务能力进行自我评价,了解其对岗位的满意度及专业能力提升意愿。同时邀请"5+3"订单定向全科医生所在单位的管理者及其他医务工作者共1 574例对其服务能力进行评价。采用二分类Logistic回归分析"5+3"订单定向全科医生履约期满后留任意愿的影响因素。于2021年5月7—8日,分别从海口市、琼中县、三亚市选取1家基层医疗卫生机构,线下调研组到3家基层医疗卫生机构开展实地调研并召开专题座谈会,邀请市(县)卫生健康委员会相关负责人、基层医疗卫生机构主要负责人,以及随机抽取的38例"5+3"订单定向全科医生共同参与座谈会,了解"5+3"订单定向全科医生的工作、生活和思想等方面的情况,听取有关方面的意见与建议。 结果 309例"5+3"订单定向全科医生自评服务能力总得分为(19.31±2.59)分,低于经"3+2"模式培养的助理全科医生〔(20.46±2.72)分〕和转岗全科医生〔(20.77±2.73)分〕,差异有统计学意义(P<0.05);"5+3"订单定向全科医生岗位满意度总得分为(39.77±4.66)分,低于经"3+2"模式培养的助理全科医生〔(41.59±4.56)分〕和转岗全科医生〔(41.10±5.19)分〕,差异有统计学意义(P<0.05);"5+3"订单定向全科医生专业能力提升意愿总得分为(7.80±2.25)分,低于转岗全科医生〔(9.10±3.17)分〕,差异有统计学意义(P<0.05)。单位的管理者及其他医务工作者对"5+3"订单定向全科医生服务能力的评分为(20.29±3.43)分,高于其自我评价结果(t'=5.735,P<0.001)。36.89%(114/309)的"5+3"订单定向全科医生表示在履约期满后愿意留任。职称、个人月收入、"一名全科医生的情怀"是"5+3"订单定向全科医生履约期满后留任愿意的影响因素(P<0.05)。根据专题座谈会上各方反馈的信息:"5+3"订单定向全科医生在工作岗位上有较高的热情,且富有团队精神;一半以上"5+3"订单定向全科医生拥有明确的职业规划。同时"5+3"订单定向全科医生在基层工作中面临诸多问题,例如:薪酬待遇水平整体偏低,基层全科医疗执业环境欠佳,相关行政管理部门对全科医生和全科医疗工作了解不够、重视程度不高,有关政策落实存在偏差,以及知识更新、接受继续教育情况受到基层医疗卫生机构现有条件限制。 结论 "5+3"订单定向全科医生服务能力较强、对岗位的满意度较高,但其专业能力提升意愿及履约期满后留任愿意不强;其所在单位的管理者及其他医务工作者对其服务能力普遍表示认可。基层医疗卫生机构对基层卫生人才激励机制的执行力偏低,存在政策落实有偏差的问题。建议相关部门多措并举,形成合力,切实落实全科医生培养与使用激励机制的实施方案。

关键词: 全科医生, 农村订单定向医学毕业生, 基层服务意愿, 职业规划, 教育,医学, 卫生政策, 卫生人力, 初级卫生保健, 海南

Abstract:

Background

The program of targeted medical education program has been carried out since 2010 in China, aiming to train general medical talents working in primary care. Further research is needed to explore the working status and career planning in targeted admission medical graduates (TAMG) , as well as the overall assessment for them by the employing unit.

Objective

To comprehensively understand the working status (competencies, satisfaction, intention to improve professional capabilities) , career planning, retention intention and associated factors after fulfilling the preadmission commitments in TAMG working in Hainan's primary care after completing the "5+3" standardized general residency program, providing a basis for the optimization of incentive policies for training and retaining general practitioners (GPs) , and for medical colleges to determine the orientation and development direction of a general practice school (department) .

Methods

From April 25 to May 6, 2021, by use of cluster sampling, 615 GPs (including 309 TAMG trained with the "5+3" standardized general residency program who work as a GP in primary care after graduation, 56 assistant GPs trained with the "3+2" program, and 250 GPs trained with general medicine before shifting to the post) were selected from 19 cities (counties) in Hainan Province to attend a self-administered questionnaire survey for collecting information about their capabilities, satisfaction and intention to improve professional capabilities. At the same time, 1 574 leaders and colleagues of the TAMG were invited to evaluate the capabilities of the TAMG. The factors influencing the retention intention of the TAMG after fulfilling their preadmission commitments in primary care were analyzed by binary Logistic regression. For further understanding the working status, life and thoughts on the job of the TAMG, the offline research team of this study conducted field investigation in three primary hospitals (one in Haikou, one in Qiongzhong, and one in Sanya) , and held a group discussion with directors of health committees of Haikou, Qiongzhong and Sanya, and directors of the three primary hospitals, as well as 38 randomly selected TAMG from May 7 to 8, 2021.

Results

TAMG had lower mean score of self-rated capabilities than assistant GPs trained with the "3+2" program〔 (19.31±2.59) vs (20.46±2.72) 〕, and GPs trained with general medicine before shifting to the post〔 (19.31±2.59) vs (20.77±2.73) 〕 (P<0.05) . TAMG had lower mean score of self-rated job satisfaction than assistant GPs trained with the "3+2" program〔 (39.77±4.66) vs (41.59±4.56) 〕, and GPs trained with general medicine before shifting to the post〔 (39.77±4.66) vs (41.10±5.19) 〕 (P<0.05) . TAMG had lower mean score of self-rated intention to improve professional capabilities than GPs trained with general medicine before shifting to the post〔 (7.80±2.25) vs (9.10±3.17) 〕 (P<0.05) . However, the mean score of capabilities of TAMG rated by TAMG' leaders and colleagues was higher than that rated by themselves〔 (20.29±3.43) vs (19.31±2.59) 〕 (t'=5.735, P<0.001) . One hundred and fourteen of TAMG (36.89%) intended to stay on after the expiration of the contract. The main factors affecting their retention intention were professional title, current income, and wanting to be a GP (P<0.05) . According to the group discussion, TAMG had high level of enthusiasm at their work and a great sense of team spirit. Moreover, more than half of them had a clear career plan. The challenges faced by TAMG in primary care were the following: overall low level of remuneration, unsatisfactory working environment, insufficient understanding and insufficient understanding and undervaluing of GPs and general practice in relevant administrative departments, inadequate implementation of relevant policies, and limited conditions in primary care hindering the acquisition of the latest advances in general medicine and continuing education.

Conclusion

The TAMG had high levels of capabilities and job statistician, but low level of intention to improve professional capabilities and to stay on after the expiration of the contract. Their capabilities were recognized by their leaders and colleagues. The implementation of incentive policies was un-ideal in Hainan, which may be due to satisfactory implementation of the incentive system for health talents in primary care. In view of this, it is suggested that relevant departments in Hainan take multiple measures collaboratively to effectively implement the incentive regimen of training and retaining GPs.

Key words: General practitioners, Targeted admission medical graduates, Willingness of working at grassroots, Career planning, Education, medical, Health policy, Health workforce, Primary health care, Hainan