Rural-oriented Free Tuition Medical Education (RTME) program is a key policy in China aiming to relieve general practitioner (GP) deficiency in rural areas and to enhance effectively competence trainings of rural primary health care workforce. However, its long-term effects of competence cultivation have not been examined soundly.

The research, via evaluating consultation competence of RTME graduates trained by the "5+3" pathway in real rural township health center settings in Guangxi Zhuang Autonomous Region, aimed to examine reliably effects of RTME upon talent competence cultivation and to provide optimization strategies for enhancing competence trainings of rural primary health care workforce.

From July to August, 2023, the research, by combining stratified sampling with cluster sampling, included 75 RTME graduates as the study group who were working in township health centers amid four cities in Guangxi Zhuang Autonomous Region, as referenced to Nanning, Wuzhou, Guigang, and Chongzuo, and 41 GPs and assistant GPs as the control group who had not been trained by the "5+3" pathway and were working in the same township health centers as the study group. A total of 8 standardized patients (SPs) with qualified simulations had been sent to the sampled township health centers, visited all the subjects, and videoed the whole process of each encounter between subject and SP. Relevant experts were invited to evaluate subjects' performance in videotapes according to the assessment indicator system for consultation competency of GP developed in our previous study. Cumulative Logistic model was used to identify potential factors influencing consultation competence.

The study group showed significantly higher total score for domain 1-7 combined and for domain 1-6 combined as well as for any single dimension than the control group did. However, the score for the dimension of encountering and taking history, of patient management, of doctor behavior and relationship with patients, and of preventive care in the study group failed to pass and so did all the 7 dimensions in the control group. The consultation competence of subjects correlated with attendance of residency program, writing health record, academic degree, consultation duration, and location, and the consultation competence of RTME graduates with academic degree and writing health record.

The RTME graduates trained via the "5+3" pathway displayed significantly higher consultation competence in practical rural primary healthcare settings than did local GPs and assistant GPs without the "5+3" cultivation, which suggests that the RTME program's long-term effects on competence cultivation have lived up to expectations. But, several measures, including sustainable implementation of RTME, reforming continuing medical education pattern in rural, enhancing trainings of basic clinical medicine knowledge and skills, amplifying undergraduate and postgraduate medical education with practices in rural primary health care settings, and emphasizing importance of writing health record, are needed to sustainably promote RTME graduates' clinical competence and to enhance competence cultivation of rural primary health care workforce.

农村订单定向医学生免费培养工作是我国旨在改善农村地区全科医生匮乏，切实加强农村基层医疗卫生队伍能力建设的一项重要举措，但其远期人才能力培养成效至今仍未得到有效检验。

通过在农村乡镇卫生院真实环境中评价广西壮族自治区经"5+3"路径培养的农村订单定向毕业生的应诊能力，客观检验农村订单定向医学生免费培养工作的人才能力培养成效，提出加强基层医疗卫生队伍能力建设的优化策略。

2023年7—8月，本研究采用分层抽样法和整群抽样法，纳入广西壮族自治区南宁市、梧州市、贵港市和崇左市4市75名正在乡镇卫生院工作的农村订单定向毕业生为研究组，41名在同一乡镇卫生院工作的非"5+3"培养的全科医生及助理全科医生为对照组。8名培训合格的标准化患者（SP）到乡镇卫生院挂号求诊研究对象，且录像应诊全过程，再邀请相关专家观看视频，依据前期构建的全科医生应诊能力评价指标体系为研究对象的应诊能力评分，采用多因素Logistic回归分析探讨应诊能力的相关影响因素。

研究组在乡镇卫生院实境下应诊能力总得分及1~7维度得分均高于对照组；但研究组在患者接诊和病史采集、患者管理、医生行为和与患者关系、预防性照顾4个维度的得分未合格，对照组所有维度的得分偏低。应诊时长、是否书写病历、是否规培、学历及地区是研究对象应诊能力的影响因素（P<0.05）；学历和是否书写病历是研究组应诊能力的影响因素（P<0.05）。

经"5+3"路径培养的农村订单定向毕业生在农村基层实境下展现出显著优于非"5+3"培养的当地全科医生及助理全科医生的应诊能力，农村订单定向医学生免费培养工作的远期人才能力培养成效达到预期。但是，仍需实施多种措施，包括持续开展农村订单定向医学生培养工作，改革农村基层继续医学教育模式，加强"三基"临床医学知识和技能培训，在本科教育和毕业后教育阶段增设农村基层实践环节，强调病历书写重要性等，持续提高农村订单定向毕业生的临床能力和加强农村基层医疗卫生队伍能力建设。