Background The Chinese government initiated a compulsory services programme (CSP) to provide skilled general practitioners (GPs) to rural regions. This study examined the early career trajectories of medical graduates with compulsory services and the factors influencing their retention in primary healthcare facilities.Methods A cohort of CSP graduates from four universities in central and western China was established in 2015 to examine the career development within rural healthcare settings. Annual online surveys followed up their career development. This study used baseline and follow-up data from 2015 to 2022, which involved 2041 CSP graduates. Descriptive analysis was used to report transition and job retention. Logistic regression models were used to assess factors that affect retention. Multiple chain equation imputation was employed to explore the impact of sample attrition on retention.Results After the CSP contract ended, 38.54% of the CSP graduates retained in primary healthcare facilities. Of those leaving primary healthcare, 34.65% chose hospitals above county-level, 25.41% chose county-level hospitals, 7.92% pursued higher degrees and 27.72% were unemployed. Multivariable analysis showed that signing contracts with hometown had a positive association with improved retention (OR=2.64, p=0.001). There is no significant effect of sample attrition on the retention of GPs in primary healthcare settings (p=0.247).Conclusion CSP significantly contributes to staffing rural health workforce in China. Ensuring signing contracts with hometown and lifting financial burden during school could increase retention in the long run. Increased attention should also be directed to GPs with a senior professional title to increase retention.

Objective Assess whether local health facilities can adequately support the performance of general practitioners (GPs) trained by China’s national compulsory services programme (CSP). Design Prospective cohort study. Setting Health facilities in middle and western rural areas in China, 2015–2022. Participants Cohorts of CSP graduates from 2015 to 2019 in four major medical universities. Main outcomes Job performance measured by a 12-item Job Performance Scale; productivity measured by outpatient volume per day; turnover measured by ever changing jobs within the past year. Results 91.2%, 92.0% and 90.5% GPs working in township health centres reported inadequate medication, equipment and external assistance from higher level hospitals, while CSP graduates working in secondary or tertiary hospitals reported a lower rate of less than 60%. The top three tests reported as lacking were blood gases (67.7%), microbiology (61.6%) and cancer biomarkers (49.7%); the top three lacked procedures were CT scan (64.8%), MRI scan (58.1%) and ambulatory BP monitoring (55.8%); and the top three lacked drugs were drugs for cardiovascular diseases (23.3%), systematic hormonal preparations (17.7%) and traditional Chinese medicines (13.0%). Multivariable analysis showed that facility support was positively associated with job performance—adequate medication increased job performance by 2.2 points (95% CI 0.7 to 3.8), and adequate external assistance increased job performance by 3.3 points (95% CI 1.8 to 4.8). Facility support was also positively associated with productivity—adequate medication increased outpatients seen per day by 20% (95% CI 0.1 to 0.3), and adequate equipment increased outpatients seen per day by 12% (95% CI 0.0 to 0.2). Facility support did not have significant impact on turnover, but GPs who changed jobs in the past year were 1.9–2.3 times more likely to report adequate facility support. Conclusion GPs in township health centres experienced a high prevalence of shortage in facility support. The identification of a positive association between facility support and performance and productivity has implications for future research and resources deployment in primary healthcare.

Background Since 2010, China has implemented a national programme to train general practitioners for rural areas. The programme enrolled medical students with a rural background who signed a contract for 6 years' compulsory rural service after graduation. China is transitioning its national COVID-19 strategies in view of the features of coronavirus Omicron variant, the vaccination coverage, and the need for socioeconomic development. Strengthening primary health care, especially the health workforce in rural areas, should be an important consideration during the policy transition. This study aims to evaluate the implementation process of enrolling medical students in the programme, their willingness to work in the rural settings and their actual job choice after graduation. Methods The study chose four medical universities in central and western China. A total of 2,041 medical graduates who have signed a contract for compulsory rural service and 1,576 medical graduates enrolled “as usual” (no compulsory rural service) were recruited in five campaigns–every June from 2015 to 2019. A survey was conducted 1 week before their graduation ceremony. Results The top three reasons for choosing this programme were: a recommendation of a family member or teacher, a guaranteed job after graduation and the waiver of the tuition fee. 23.0–29.7% of the study participants were not familiar with the policy details. 39.1% of the medical students signed a contract with a county other than that of their hometown. Medical graduates on the compulsory rural service programme had very low willingness (1.9%) to work in rural areas but 86.1% of them actually worked at township health centers. In contrast, the willingness to work at township health centers was 0.2% for the comparison group (medical graduates without the contract), and their actual job choice at township health centers was 0%. Conclusions Although the well-trained medical graduates on the compulsory rural service programme have low willingness to work in the township health centers, 86.1% of them choose to do so following their contract. This programme will strengthen the primary health workforce to deal with the increasing disease burden as China is transitioning its national COVID-19 strategies.

The presence of international students from China has been celebrated in Australia as an economic boon, but also-importantly-part of Australia's soft power; and the Department of Foreign Affairs and Trade has invested heavily in alumni engagement.COVID-19, however, has brought significant shifts in China's job market, which look set to hinder such 'influence building' by Western democracies. International education as a soft power strategyAustralia has consistently been a top-rated recipient of international students among English-speaking countries and international education was among the top four export industries even during the pandemic which promoted the closure of the national border.In addition to the economic benefits, it has also been seen as an important soft power strategy.For example, Australia's most recent Foreign Policy White Paper boasts that, among the more than 2.5 million international students who have studied in Australia in the past 50 years, there are '[m]any foreign government and business leaders, including heads of state, ministers and CEOs' who 'understand our institutions, values and perspective on the world.This is a significant asset for Australia.'

BACKGROUND:A major challenge of prospective cohort studies is attrition in follow-up surveys. This study investigated attrition in a prospective cohort comprised of medical graduates in China. We described status of attrition, identified participants with higher possibility of attrition, and examined if attrition affect the estimation of the key outcome measures.METHODS:The cohort study recruited 3,620 new medical graduates from four medical universities in central and western China between 2015 and 2019. Online follow-up surveys were conducted on an annual basis. Follow-up status was defined as complete (meaning that the participant completed all the follow-up surveys) and incomplete, while incomplete follow-up was further divided into 'always-out', 'rejoin' and 'other'. Multivariable logistic and linear regressions were used to examine factors predicting attrition and the influence on the outcome measures of career development.RESULTS:2364 (65.3%) participants completed all follow-up surveys. For those with incomplete follow-up, 520 (14.4%) were 'always-out', 276 (7.6%) rejoined in the 2020 survey. Willingness to participate in residency training (OR=0.80, 95%CI[0.66 - 0.98]) and willingness to provide sensitive information in the baseline survey predicted a lower rate of attrition (providing scores for university entrance exam OR=0.82, 95%CI[0.69 - 0.97]]; providing contact information (OR=0.46, 95%CI[0.32 - 0.66]); providing household income (OR=0.60, 95%CI[0.43 - 0.84]). Participants with compulsory rural service (OR=1.52, 95%CI[1.05 - 2.19]) and those providing university entrance scores (OR=1.64, 95%CI[1.15-2.33)) were more likely to rejoin in the follow-up survey. These factors associated with follow-up status did not have significant impact on key outcome measures of career development.CONCLUSIONS:Graduates who were unwilling to participate in residency training or not providing sensitive information should be targeted early in the cohort study to reduce attrition. More information about the study should be provided to those graduates early to facilitate their understanding of the meaning in participation. On the contrary, medical graduates with compulsory rural service and those who provided university entrance scores were more likely to rejoin in the cohort. The research team should invest more effort in contacting those graduates and returned them to the cohort.

Background Our state policy of free training of compulsory rural service oriented medical students (abbreviated as rural service orientation project) starts with the construction of a team of primary medical health talents and makes an excellent contribution to improve the accessibility and quality of medical services in rural areas of China. A comprehensive understanding of the current state of the rural service directed medical student team is important to evaluate the implementation effect of the free training policy, as well as the long-term development of the primary care health talent team. Objective To review the research progress of related studies on rural service orientation project in China and similar projects abroad, summarize the execution process and execution results of the projects inductively, and compare the similarities and differences between domestic and foreign studies. Methods The study was conducted from July to September 2021. A literature search for Chinese language was conducted in CNKI, Wanfang Data Knowledge Service Platform and VIP, and the search time was set from 2010-07-01 to 2021-07-01. A literature search in English was conducted in PubMed, web of science, Scopus, and the search time was set from 2000-01-01 to 2021-07-01. Literature screening was performed according to the inclusion and exclusion criteria, relevant information was extracted, and the literature was classified and analyzed according to the subjects and contents of the studies. Results A total of 443 articles were finally included, with 427 of them on our rural service orientation project in China and the rest 16 on similar projects abroad. The research topics that were studied in the literature included four broad categories: cultivation mode, enrollment, training process, and employment development. In 427 related literatures of China's rural service orientation project: 102 (23.9%) discussed the training mode of rural service oriented project. Ten (2.3%) analyzed the admission status of rural service directed medical students and found that rural service directed medical students had higher awareness rate of the related policies (>75.0%-90.9%) and the proportion of rural students sources was higher (57.6%-84.2%). 270 (63.2%) literatures used the cultivation process of rural service directed medical students as a starting point and focused on their learning situation, professional identification and performance willingness, and found that rural service directed medical students had lower academic performance and professional recognition than general clinical medical students. The results of studies on the performance willingness of rural service directed medical students varied greatly (42.4%-98.4%), and the average performance willingness was 66.2% when weighted by sample size. Only 25 (5.9%) studied employment development in rural service orientated graduates and found an average performance rate of 93.6%. Rural service directed medical students had a faster rate of completing standardized residency training and passing practitioner examination than other five-year clinical graduates. Of the 16 foreign related literatures included, 11 (68.8%) examined the employment development of rural service directed medical graduates and obtained results similar to those of domestic studies. Conclusion A larger number of current studies focused on rural service oriented project and had rich topics. It was found that the rural service directed free medical student training policy was better implemented, leading to a large number of excellent primary health talents in the Midwest. However, most of the current research focuses on the cultivation stage of rural service oriented medical students, and there is insufficient understanding of medical students who have joined the primary care team at elementary level. Future research should focus on three aspects: performance status after rural service directed medical students having completed the contract period, career development process after employment and the actual role they play in primary health care institutions.

Compulsory rural service directed medical student free training program is a medical education policy oriented to the cultivation of high-quality general medical talents for primary care system in rural areas, and is an important initiative to deepen the reform of the pharmaceutical and health system and accelerate the construction of a "healthy China", which is an important foundation for implementing the "poverty removal" and promotion of sustainable development of "poverty alleviation by health". Policy of compulsory rural service directed medical students free training program was designed scientifically and rationally, effectively combining motivating mechanisms with compulsory mechanisms, and is continuously refined in the practice process. In the course of policy implementation, various regions of our country have developed their characteristic implementation strategies accordingly in the links of enrollment, training, employment, and contract performance. The program based on the policy educated a large number of qualified GPs for rural primary care system. The compulsory rural service directed medical students fulfilled the contract well, and the career development trend was positive, which contributed to strengthening the construction of the primary health workforce, enhancing the level of primary health service, and promoting the establishment of a hierarchical diagnosis and treatment system. However, during the implementation of the policy, many challenges have been encountered, such as some students' low learning enthusiasm during the training period, limited capacity of local authorities to implement the policy, the need for improvement of pay incentives for primary GPs and the short service cycle. In this paper, we conducted a systematic analysis of the design concept and execution process of the policy of free training for compulsory rural service directed medical students, and suggested that further expansion of scale of the compulsory rural service directed free training program should be conducted to improve the quality of cultivation, enhance the effective collaboration among multiple parties and the contract fulfillment, which will collectively promote the effective implementation of the policy, thereby providing talent support for the hierarchical diagnosis and treatment system and the "Health China" strategy.

背景 新型冠状病毒肺炎(简称新冠肺炎)疫情防控期间,基层卫生工作者起到了十分重要的作用.我国于2010年发文启动实施农村订单定向医学生免费培养工作,从2015年起至今已有数届订单定向医学生完成了本科学业,其在疫情防控中的工作情况值得关注.目的 调查订单定向毕业生和其他临床五年制毕业生参与新冠肺炎疫情防控工作情况,分析订单定向毕业生在疫情防控中发挥的作用及存在的困难与挑战,并提出针对性政策建议.方法 本研究数据来源于"订单定向医学生队列研究"项目,本次随访调查于2020年9月采用电子问卷形式开展,有效随访我国中西部4所医学院校2015—2019届共1631例订单定向毕业生和1009例其他临床五年制毕业生,调查内容包括基本信息、基本工作情况、疫情期间工作情况等.结果 在调查期间处于工作状态的毕业生中,订单定向毕业生的疫情防控工作参与率高于其他临床五年制毕业生〔70.18％(1113/1586)比51.58％(293/568),P<0.05〕.订单定向毕业生中,男性参与率高于女性(P<0.05),2015—2016届参与率高于2017—2019届(P<0.05),已婚者参与率高于未婚/离异/其他婚姻状况者(P<0.05).在参与疫情防控工作的订单定向毕业生中,参与较多的服务类别为健康宣传与教育〔88.59％(986/1113)〕、社区防疫与管理〔85.62％(953/1113)〕、核酸检测与筛查〔67.30％(749/1113)〕,面临的常见挑战为缺少防护设备〔77.72％(865/1113)〕、工作量和/或工作压力太大〔41.87％(466/1113)〕、担心自己或家人被感染〔37.56％(418/1113)〕,认为疫情防控期间的日常临床工作量、日常公共卫生工作量增多的人员占比分别为57.50％(640/1113)和62.26％(693/1113).结论 订单定向毕业生在疫情防控过程中承担了多项重要工作,对全国的疫情防控发挥了不可忽视的作用,但是同时存在着防护设备不足、工作压力过大等问题.建议进一步改善基层卫生设施,为基层医务工作者提供更多的防护与支持.

目的 分析《学校卫生工作条例》实施以来中国学校校医队伍建设现状,为引发对中小学校医管理制度的思考提供依据.方法 在中国东、中、西部选择有代表性的省份(江苏、山东、江西、河北、青海、陕西),通过定量研究和定性访谈进行混合方法研究.结果 具有医学背景的校医占比为33.64％,部分校医(31.6％)尚未落实编制.校医在学校中地位较低,在收入、奖金分配、评优等方面较一线教师差距大,校医工资水平远低于教育行业和社会卫生保障福利业工资水平,有些地区甚至低于当地社会平均工资.薪酬水平呈现地域间不平衡,东部地区薪酬水平较高,中西部除个别地区,整体薪酬水平低.医学背景校医与非医学背景校医在最高学历、年收入水平、工作性质、是否在编、职业发展机会、收入满意度、福利待遇满意度和培训满意度之间差异均有统计学意义(x2值分别为10.73,26.64,313.44,14.13,29.14,13.22,12.97,19.44,P值均＜0.05).结论 需充分重视中小学校医队伍建设,将学校卫生纳入公共卫生管理体系,划分校医管理主体,规范校医务室工作办法,畅通校医人事薪酬及职称晋升通道.

国家卫生健康委《关于推进紧密型县域医疗卫生共同体建设的通知》(2019年5月)明确了构建县域紧密型医共体(以下简称"医共体")建设的政策目标.从现有的医疗资源分配机制来看,在政策执行过程中,推动县域医共体行动者间的有效互动和协调行动才能顺利达成政策目标,并切实优化医疗资源配置,提升县域医疗服务能力.本文基于行动者中心制度主义理论框架,分析县域紧密型医共体建设相关行动者的关系,揭示县域医共体构建中不同行动者受利益诉求、动机选择等多重博弈关系的影响状况.探讨紧密型县域医共体的建构进程中,如何促成行动者之间达成利益相容和联动,最大限度满足县域人民群众获得优质高效的一体化医疗服务.

在慢性病患病率快速上升的同时,各种传染病仍然威胁着人类的健康,从严重急性呼吸综合征(SARS)、埃博拉(Ebola virus)到此次的新型冠状病毒肺炎(COVID-19,以下简称新冠肺炎)疫情, 重大突发公共卫生事件使人类的身体健康和生命安全面对巨大的挑战,甚至对世界政治和经济带来极大影响.

目的:跟踪分析三届订单定向医学生与普通临床毕业生在毕业三年后的就业与规培情况,探讨首届定向生的实际履约情况、基层服务意愿与职业发展路径特点,并提出政策建议.方法:选取中西部四所医学院校,分别对2015—2017届订单定向生和普通五年制医学生在毕业当年建立队列,随后连续三年开展随访调查.结果:首届(2015届)订单定向毕业生到乡镇卫生院服务的履约率高于98％,2016届定向生表示"一定会履行合约"的学生占80.6％.2015、2016两届学生中有51.6％愿意在基层服务满3年以上,在完成服务期后,定向生平均愿意在基层继续服务4.8年.乡镇卫生院发放的月工资每提高1000元,学生平均愿意在基层多服务1.3年.结论:已毕业定向生在规培结束后回乡镇卫生院履约的比例很高,多数已毕业定向生愿意履约完成服务期,收入是唯一可以提高其基层服务意愿的激励因素.

目的 本文着重分析中国2019新型冠状病毒肺炎(Corona Virus Disease 2019,COVID-19)疫情暴发以来所暴露出来的临床医学、公共卫生人才培养方面的突出问题,并结合国际经验及我国相关现况,就如何加强我国医学人才培养提出解决问题的策略与建议.方法 通过新闻媒体报道、发表文章以及政策文件的查询,对此次疫情暴发、传播的影响因素进行系统分析,着重指出我国临床医学、公共卫生人才培养以及队伍建设等方面存在的突出问题.结果 我国临床医学生和临床医生普遍缺乏流行病学、传染病和医院感染防控等方面的系统培训;住院医师规范化培训缺乏公共卫生方面的轮转与疾病防控实践;临床医务人员自我防护意识普遍薄弱.结论 需进一步完善住院医师规范化培训制度,加强医学生和临床医生的预防医学、流行病学、生物统计、传染病防控和重大疫情防控能力的培养,建立传染病防控培训与演练制度.

本文结合文献综述和现场调查分析了加拿大一系列强化基层卫生服务的改革实践及其对我国的启示.研究发现,加拿大基层卫生发展取得进展主要有三方面原因:第一,重视家庭医学学科和人才队伍建设,使得许多医学生选择家庭医学执业.第二,组建家庭医学联合诊所,提高了基层医疗机构规模和管理水平,使得服务效果明显改善.第三,医院的改革为基层卫生发展起到了助推动作用.加拿大的经验提示:医疗保障、卫生服务和医学教育的政策协调是单一支付方的制度优势,是推动强基层的关键;"一专多能"的全科医学执业轨道是增加居民和专科医生对基层医生信任的有效路径;同时,应进一步推动公共卫生、医疗服务和社区服务在基层的整合.

新型冠状病毒肺炎(Corona Virus Disease 2019,COVID-19)是新中国成立以来我国发生的传播速度最快、感染范围最广、防控难度最大的一次重大突发公共卫生事件,正影响着全世界200个国家和地区.本文就此次新发传染病疫情发生以来,我国在应对新发传染病方面所表现出的不足,从医防结合、疫情应对机制等方面进行分析,并为我国的传染病防控体系建设提出相应的建议.

目的 了解中国中小学校卫生室及保健室建设及使用情况,为中小学卫生室及保健室的基础设施建设和管理提供参考建议.方法 采用分层整群随机抽样方法,选取中国东、中、西部各2个省,共6个省份的873所中小学校为研究对象,描述中小学校卫生室及保健室建设情况、卫生室设备配置及使用情况,并对地区差异进行分析.结果 294(33.7％)所学校设置了卫生室,177(20.3％)所设置了保健室,402(46.0％)所未设置卫生室或保健室.在294所卫生室中,仅56所(19.0％)具有医疗机构执业许可证;73所(24.8％)建筑面积≥40 m2;135所(45.9％)有正规诊室,38所(12.9％)有消毒供应室,2所(＜0.01％)有化验室,165所(56.1％)各科室间不独立;整体卫生室规范建设率不足5％.东、中、西部地区卫生室及保健室建设差异存在统计学意义(x2=237.33,P＜0.01),其中,东部地区卫生室建设率高于西部地区.设备配置上,体温计、视力表灯箱、杠杆式体重秤可正常使用的配置率分别为96.6％,83.0％和75.9％;紫外线灯可正常使用的配置率为66.7％;注射器和高压灭菌锅配置率低于50％.卫生室未能提供卫生服务的原因中,没有医务人员是最主要原因(43％).结论 中国中小学卫生室及保健室建设不足,区域差异明显,设备配置及使用情况参差不齐,西部尤为明显.应加强卫生室及保健室规范建设,合理配置及使用设备,保障中小学生健康.

目的:评价农村订单定向免费医学生培养政策实施效果,分析影响其效果的主要因素,探索培养的规律和模式,为农村基层卫生人才建设提供政策建议.方法:通过队列研究方法、采用问卷调查、定量和定性研究相结合的方法,在江西、青海和广西三个省份选取四所承担国家订单定向医学生培养项目的院校,对2015(首届)届和2016届医学毕业生开展现场调研,建立了订单定向医学生队列和非订单定向生队列,对737名医学毕业生进行了基线调查,跟踪随访了580人,开展了63次深入访谈和专题小组讨论.结果:订单定向生中农村生源占比由2015年73.8％降至2016年63.5％,低于非定向生.订单定向生家庭年收入低于非定向生家庭约1万元;选择订单定向政策的主要原因是毕业后有工作、高考分数限制和免学费;各地区政策实施过程中的合同签署和工作安排方面存在很大差异;收入和工作环境是影响毕业生就业意向的主要因素;仅1.6％的定向毕业生有意愿到乡镇卫生院,但实际上履约率达到90％以上,到乡镇卫生院报到率达到80％.结论:订单定向政策可有效解决农村基层人才缺乏问题;需要尽快完善保障订单定向政策顺利实施的相关政策;提高基层岗位收入和改善工作环境能够留住人才.

目的 了解中国中小学在职校医的分布特征、急救外伤处置技能情况及其影响因素,为提升校医的技能水平提供证据支持.方法 采用分层整群随机抽样方法,选取中国东、中、西部538名中小学在职校医作为研究对象,描述基本情况及8项急救外伤处置技能掌握情况,并分析影响因素.结果 我国中小学在职校医多为教育及其他专业背景人员兼职,女性占71.38％,年龄分布呈现枣核形状,本科及以上学历占50.96％,中级职称占50.74％,医学背景占33.46％.校医的急救外伤处置技能水平整体不高,尤其对气道异物阻塞处理方法、不同部位骨折固定处理方法的掌握情况较差,掌握人员仅分别占总人数的44.24％,44.80％.二分类Logistic回归分析结果显示,8项技能掌握情况均呈现东部优于中部优于西部地区,且工作年限、专业背景、有无编制、职称、工作性质和年龄是不同专业技能的影响因素.结论 中国中小学在职校医专业技能水平有待提升,且存在明显的地域差异.

Although China has achieved great success in the reform of its medical system,it still faces great challenges in national health education,medical and healthcare talent cultivation,and healthcare legal system construction.This paper summarizes domestic and international experiences,analyzes the current situation and challenges,and makes policy recommendations to improve China's national health education,medical and healthcare education,and healthcare legal system.These policy recommendations include:developing a compulsory national health education system,aligning medical education for healthcare talents with social needs,strengthening the cultivation of general practitioners,improving the service level and accessibility of primary medical care,and promoting the introduction of "Parent Law" into medicine and health.This paper also examines and analyzes existing medical and healthcare laws and regulations.