Abstract: Background　Based on the background of gradually advancing hierarchical medical system，general practitioner system and resident standardization training，tracking and researching the post-graduation situation of general medical students in Guangxi，and continuously improving resident standardization training of general practitioners，are of great significance to the follow-up development of hierarchical medical system at the grassroots level.Objective　To provide suggestions on the reform and development of community-level general practice through analyzing and discussing major constraints based on the status quo investigation of targeted-area graduates from general practice major in Guangxi Province（hereinafter referred to as targeted-area students）．Methods　A total of 199 targeted-area students who were enrolled from 2010 to 2012 and graduated from 2015 to 2017 were selected from July 2017 to January 2018.Self-made questionnaires were used to carry out the investigation，and the content of the questionnaire covered basic information，registration and transfer，employment，budget position placement，salary，satisfaction，willing to receive further education，willing to serve at community level，and salary expectancy.In the light of data provided by 2017 Guangxi Statistics Annual Report and the per capita GDP，14 cities in Guangxi were divided into high-production area，middle-production area and low-production area.Results　A total of 199 questionnaires were released and all questionnaires received，with an effective recovery rate of 100.0%.Among 199 graduates，41 graduated（20.6%）in 2015，78（39.2%）in 2016，and 80（40.2%）in 2017；56 graduates（28.1%）were sent to high-production area，79（36.7%）to middle-production areaand 64（35.2%）to low-production area．There were no significant differences in time of graduation，signed unit of service，employment，budget position placement，salary，willing to receive further education，work plan after standardized training，work plan after signed service period and salary expectancy（P>0.05）．Targeted-area students graduated in 2017 had higher satisfaction than those graduated in 2015（P<0.05）．There was no significant difference in satisfaction of students in different areas（P>0.05）．The main reason why the Health and Family Planning Bureau failed to place graduates in contracted service units within one month was that relevant departments had no experience（86.3%，44/51）.The major influencing factors for students continuing working at the community level was low salary（92.5%，184/199）．Conclusion　The transfer rate of targeted-area graduates in general practice in Guangxi should be improved，the employment agreement should be further regulated and the budget position placement should be followed up.Despite the higher willingness and satisfaction of targeted-area students of general practice in Guangxi，community healthcare services cannot retain more talents in general practice sector because of low salary and incomplete incentive system of further education and ensuing development.We suggest that the transfer and placement management system should be further perfected，connection should be enhanced among relevant departments and green channel for targeted-area students should be launched for the implementation of policy and follow-up inspection.In addition，the cultivation and incentive system for general practitioners should be carried out and the further education system of general practice graduates should be improved，so as to keep the sustainable development of general practitioners at community level.

Key words: General practice, Targeted-area student, Development at community level, Constraint, Questionnaires

摘要： 背景　基于分级诊疗制度、全科医生制度以及住院医师规范化培训逐步推进的大背景，充分跟踪和了解广西全科医学生的毕业后情况，不断完善全科医学住院医师规范化培训，对分级诊疗制度在基层的后续发展有重大意义。目的　通过对广西全科医学定向毕业生（以下简称定向生）毕业后情况的调查，分析、讨论其在基层发展的主要制约因素，为基层全科医疗的改革、发展提供有效建议。方法　2017年7月—2018年1月选取广西前3届（2010—2012年入学，2015—2017年毕业）全科医学定向生199例为调查对象。采用自制问卷对其进行调查，问卷内容包括：一般资料、报到转接情况、就业签约情况、编制落实情况、薪资水平、满意度、继续教育意愿、基层服务意愿、期待薪资水平。根据《2017广西统计年鉴》提供的数据，按照人均国内生产总值，分别将广西14个城市划分为高产值区、中产值区、低产值区。结果　共发放问卷199份，回收有效问卷199份，有效回收率为100.0%。199例定向生毕业时间：2015年41例（20.6%），2016年78例（39.2%），2017年80例（40.2%）；地区：高产值区56例（28.1%），中产值区79例（36.7%），低产值区64例（35.2%）。不同毕业时间、分区定向生签约服务单位落实情况、就业签约情况、编制落实情况、薪资水平、继续教育意愿、规培结束后的工作打算、签约服务期满后的工作打算、期待薪资水平比较，差异无统计学意义（P>0.05）。2017年毕业定向生十分满意度高于2015年（P<0.05）。不同分区定向生满意度比较，差异无统计学意义（P>0.05）。定向服务地卫生与计划生育局未能于定向生报到后1个月内顺利为其落实签约服务单位的主要原因为有关部门没有处理经验（86.3%，44/51）。影响定向生继续在基层服务的因素主要为薪资待遇较低（92.5%，184/199）。结论　广西全科医学定向生的毕业后报到转接效率有待提高，就业签约协议有待规范，编制落实进度有待跟进；尽管广西全科医学定向生的履约意愿高、满意度也有所提升，但基层薪资待遇偏低、继续教育与后续发展的激励机制不完善，仍不足以为基层留住更多的全科医学人才。建议完善定向生毕业后转接、履约管理等机制，切实加强各部门联系，开辟政策落实、监督跟进、长期持续的绿色通道。同时，加快全科医生培养与使用激励机制的贯彻落实、完善全科医学毕业后继续教育机制、保障基层全科医生稳定的可持续发展。

关键词: 全科医学, 定向毕业生, 基层发展, 制约因素, 问卷调查