Chinese General Practice ›› 2025, Vol. 28 ›› Issue (34): 4290-4299.DOI: 10.12114/j.issn.1007-9572.2024.0581

• General Practice Education • Previous Articles     Next Articles

Research on Education of Rural-oriented Medical Students in China: a Systematic Review

  

  1. Department of General Practice, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
  • Received:2024-12-22 Revised:2025-05-13 Published:2025-12-05 Online:2025-10-21
  • Contact: DENG Huisheng

中国农村订单定向医学生的教育研究评价:一项系统综述

  

  1. 400016 重庆市,重庆医科大学附属第一医院全科医学科
  • 通讯作者: 邓辉胜
  • 作者简介:

    作者贡献:

    黄鑫涛负责文章的构思与设计、研究资料的收集与整理、论文撰写;陈沫、王俊羽负责研究资料的收集与整理、论文修订;张晨负责表格的编辑、整理;邓辉胜负责文章的质量控制及审校、监督管理、对文章整体负责。

    本文首次刊登于Chinese General Practice Journal 2025年第1期(https://www.sciencedirect.com/science/article/pii/S2950559325000070)

  • 基金资助:
    重庆市科卫联合医学科研项目(2020ZLXM003); 重庆医科大学第一临床学院2024年院级研究生导师团队项目(CYYY-DSTDXM-202406)

Abstract:

Background

The free training program for rural-oriented medical students (referred to as "bonded medical students" ) is a significant measure to alleviate the shortage of grassroots doctors in rural areas of China and to enhance the overall level of the grassroots medical and health workforce. Previous studies have lacked comprehensive analysis of the current state, methods, and effectiveness evaluations of educational research on bonded medical students across various institutions in China.

Objective

To explore the development status, research quality, and future trends of medical education research on five-year undergraduate bonded medical students in China from 2010 to 2023, providing references for subsequent work.

Methods

Literature on the training of bonded medical students published from January 1, 2010, to December 31, 2023, was retrieved from seven Chinese and English databases: CNKI, Wanfang, VIP, PubScholar, PubMed, Web of Science, and Cochrane Library. Two researchers independently screened the literature and extracted data according to inclusion and exclusion criteria. The quality of the literature was evaluated and comprehensively analyzed using MERSQI (The Medical Education Research Study Quality Instrument) and NOS-E (The Newcastle-ottawa Scale-education). Descriptive analysis was used to summarize and analyze the results.

Results

A total of 37 studies were included, of which 36 were in Chinese and 1 in English. In terms of research design, the pretest-posttest control design accounted for the largest proportion (46%, 17/37), while single-group posttest and randomized controlled posttest designs each accounted for 22% (8/37, 8/37), and single-group pretest-posttest accounted for 8% (3/37). A total of 97% of the studies were conducted at the undergraduate education level (36/37). The research focuses were mainly on curriculum adjustment (89%, 33/37), teaching method adjustment (81%, 30/37), and training model construction (8%, 3/37). Among them, 3 studies (8%, 3/37) on training model construction and 7 studies (19%, 7/37) on curriculum adjustment specifically designed courses targeting rural areas, primary-level institutions, or general practice. Outcome evaluation mainly focused on students' evaluation of teaching (70%, 26/37) and improvement of knowledge and skills after teaching (86%, 32/37), while fewer studies addressed actual behavior change (3%, 1/37) and benefits to patients and medical institutions (3%, 1/37). The overall research quality was not high, with a total MERSQI score of (10.4±2.4), and a maximum score of 14.0. The main items affecting low scores were the number of sample institutions, the validity of evaluation tools, and outcome indicators. The total NOS-E score was (2.5±1.5), with a maximum score of 5.0, with comparability of control groups and blinding as the main items affecting low scores.

Conclusion

The focus on educational training research for bonded medical students has increased, but there are issues such as generally low research quality, insufficient cross-institutional and cross-regional studies, insufficient incorporation of features specific to bonded medical training in research content and evaluation indicators, and limited attention to postgraduate and continuing education. Future research should strengthen multi-institutional cooperation and international exchanges, improve the quality of research design and methods, and establish a unified evaluation system with rural-oriented characteristics, and strengthen the design of rural-oriented characteristic courses related to rural and general practice, focusing on the continuity and integration of teaching design that includes post-graduate education and continuing education stages.

Key words: Education, medical, Rural-oriented medical students, Educational research, Training model, Kirkpatrick's four-level model of evaluation, Systematic review

摘要:

背景

农村订单定向医学生(简称定向医学生)的免费培养工作是缓解我国农村地区基层医生短缺和提升基层医疗卫生队伍整体水平的重要举措,既往研究对我国各院校定向医学生教育研究的现状、方法及其效果评价的综合性分析不足。

目的

探讨2010—2023年针对我国五年制本科定向医学生的医学教育研究的发展现状、研究质量和未来趋势,为后续工作提供参考。

方法

在中国知网、万方数据知识服务平台、维普网、PubScholar公益学术平台、PubMed、Web of Science、Cochrane Library共7个中英文数据库中检索2010—2023年收录的关于定向医学生培养的文献,由2名研究者根据文献纳入和排除标准,独立筛选文献、提取资料后,利用医学教育研究质量评价表(MERSQI)和纽卡斯尔·渥太华量表-教育版(NOS-E)对文献进行质量评价和综合分析,采用描述分析法对结果进行汇总、分析。

结果

共纳入文献37篇,其中中文36篇,英文1篇。研究设计中,对照前测-后测的研究设计占比最大(46%,17/37),单组后测和随机对照后测各占比22%(8/37,8/37),单组前测-后测占比8%(3/37)。97%的研究是围绕本科院校教育阶段开展的(36/37)。研究关注的内容依次是课程调整类(89%,33/37)、教学方法调整类(81%,30/37)、培养模式构建类(8%,3/37),其中,3项(8%,3/37)培养模式构建类研究和7项(19%,7/37)课程调整类研究开设专门针对农村、基层或全科的课程。结局评估主要针对学生对教学的评价(70%,26/37)和教学后的知识和技能提升(86%,32/37),较少涵盖实际行为改变(3%,1/37)及患者和医疗机构的获益(3%,1/37)。总体研究质量不高,MERSQI总分(10.4±2.4)分,最高分14.0分,其中样本机构数、评价工具效度、结局指标是影响低分的主要条目;NOS-E总分(2.5±1.5)分,最高分5.0分,其中对照组可比性、盲法是影响低分的主要条目。

结论

定向医学生的教育培训研究关注度增加,但存在研究质量普遍不高、跨机构跨地区研究不足、研究内容和评价指标缺乏订单定向特色、对毕业后教育和继续教育关注不足等问题。建议未来应加强多机构合作和国际交流,提高研究设计和方法的质量加强多机构合作研究及国际交流,提高研究设计与方法质量,并建立具有订单定向特色的统一评价体系;同时,加强农村及全科相关的订单定向特色课程设计,关注包含毕业后教育和继续教育阶段的连续性一体化教学设计。

关键词: 教育,医学, 农村订单定向医学生, 教育研究, 培养模式, 柯氏分级, 系统评价