The continuous development of the rural-oriented tuition-free medical education program has greatly contributed to the increasingly expanding of team of general practitioners in primary care. And the service status of targeted admission medical graduates has become a focus of current concern.

To explore the barriers faced by targeted admission medical graduates during the contracted period of providing primary care, and to propose corresponding countermeasures and suggestions.

From January to March 2021, 73 targeted admission medical graduates (admitted in 2010 & 2011) who were working in primary hospitals in Guizhou were selected to attend a semi-structured interview with an outline involving brief introduction of the development of their hospitals, job duties, job progression, main problems existing in work, capability areas for improvement, current situation of continuing education, current living conditions, level of targeted admission medical graduates valued by hospitals, future work plan, and so on. The interview results were analyzed in accordance with the procedures of grounded theory.

One hundred and twenty-seven concepts, 21 categories, 7 main categories (work environment, policy guarantee, family factors, future planning, psychology and perception, person-job fit and career development needs) were identified by an analysis, forming four axes: working practice (primary medical conditions, environment, management and other factors restrict the development of targeted admission medical graduates, and they hope to get more organizational support and suitable job arrangements) , family factors (part of targeted admission medical graduates affected by factors such as family distance and economic pressure during the service period, it is difficult to take into account the responsibility of family care) , internal demand (targeted admission medical graduates are prone to psychological and cognitive gaps, think that their personal abilities and development are limited, and hope for better career development prospects) , policy driving (policy factors run through all aspects of primary care for targeted admission medical graduates, and the implementation and promotion of some policies are insufficient and need to be further strengthened) .

The targeted admission medical graduates in Guizhou mainly faced difficulties in career development, ability improvement, caring for families, economic treatment and other aspects during the contracted period of providing primary care. To improve the situation, retain them in primary care as well as promote their career development, it is suggested to establish a mechanism for receiving their feedback, providing long-term trainings and guidance for them, allocate targeted admission medical graduates from other places, speed up the construction of regional medical consortiums, set up special subsidy funds, and clarify the arrangements after the expiration.

随着我国农村订单定向医学生培养项目的持续开展，基层全科医学人才队伍得到不断的充实，农村订单定向医学毕业生（简称定向毕业生）的服务现状成为当前关注焦点。

探讨定向毕业生在履约期内服务基层过程中面临的困境，并提出相应的对策建议。

于2021年1—3月选取贵州省2010级和2011级已在基层卫生院工作的定向毕业生73例为访谈对象，进行半结构化访谈，访谈提纲内容包括：介绍单位发展概况和个人工作职责、个人工作开展情况、工作中存在的主要问题、个人能力存在的"短板"、现阶段继续教育情况、当前的生活条件、医院对定向毕业生的重视情况、今后工作打算等。遵循程序化扎根理论方法对访谈结果进行分析。

梳理出127个概念、21个范畴、7个主范畴（工作环境、政策保障、家庭因素、未来规划、心理与认知、工作匹配、成长需求）。形成4条脉络：工作实际脉络（基层医疗条件、环境、管理等因素制约了定向毕业生工作开展，其希望得到更多的组织支持和合适的岗位安排）、家庭因素脉络（部分定向毕业生基层服务期间受到家庭距离、经济压力等因素的影响，难以兼顾家庭照顾的责任）、内在需求脉络（定向毕业生易产生心理和认知上的落差，认为个人能力和发展受限，希望有更好的职业发展前景）、政策驱动脉络（政策因素贯穿定向毕业生基层服务的各环节，部分政策的落实和推广存在不足，有待进一步加强）。

贵州省定向毕业生在基层服务期间主要存在业务开展、能力提升、家庭照顾、经济待遇等方面的困难，建立反馈联络机制、长效培训指导、异地生源调配、加快医共体建设、设立专项补助资金及明确服务期满后安排等措施有助于改善当前定向毕业生的服务现状，使其能够在基层"留得住、有发展"。