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.

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) .

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.

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.

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.

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。

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。

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。

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。

"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。