1
|
He Y, Wang P, Du Y, Li H, Chen Y, Zhu J. Policy perception, job satisfaction and intentions to remain in rural area: evidence from the National Compulsory Service Programme in China. Glob Health Res Policy 2024; 9:16. [PMID: 38689363 PMCID: PMC11059768 DOI: 10.1186/s41256-024-00348-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/07/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Exploring factors that may influence general practitioners (GPs)' intentions to remain in rural area is necessary to inform the training and placement of future medical workforce in rural area. However, little is known about how GPs' perception towards the National Compulsory Service Programme (NCSP) and job satisfaction impact their turnover intention. This paper explores GPs' intentions to remain in rural China and how their policy perception and job satisfaction predict the intentions. METHODS We conducted a cross-sectional, online survey from December 2021 to February 2022 to investigate GPs' perception towards NCSP, job satisfaction, and intentions to remain in rural area. Eligible participants were GPs who were required to provide health services as part of NCSP at township health centres of 9 provinces which could represent all NCSP GPs in China. Multinomial logistic regression analyses were performed to explore the associations between policy perceptions, job satisfaction, and intentions to remain. RESULTS Of 3615 GPs included in the analysis, 442 (12.2%) would like to remain in rural area and 1266 (35.0%) were unsure. Results of the multinomial logistic regression analyses showed that compared with GPs who would leave, GPs with higher perception scores for the restriction on taking postgraduate exam (RRR: 1.93, 95% CI 1.72, 2.16) and the commitment to work for six years (RRR: 1.53, 95% CI 1.31, 1.78) were more likely to remain. In contrast, GPs who had higher perception scores for completing standardised residency training (RRR: 0.75, 95% CI 0.64, 0.88) and passing National Medical Licensing Examinations (RRR: 0.74, 95% CI 0.62, 0.87) were more likely to leave. GPs who were satisfied with the freedom of choosing work methods (RRR: 1.52, 95% CI 1.25, 1.84) and chances of promotion (RRR: 1.60, 95% CI 1.32, 1.94) were more likely to remain. CONCLUSIONS This study highlights the significance of policy perception and job satisfaction on GPs' intentions to remain in rural area. Factors such as career advancement and the empowerment of GPs to build on and use their skills and abilities should be taken into account when designing rural placement programmes.
Collapse
Affiliation(s)
- Yanrong He
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
| | - Peicheng Wang
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Yanrong Du
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
| | - Hange Li
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China
| | - Yanhua Chen
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.
- School of Medicine, Tsinghua University, Beijing, China.
| | - Jiming Zhu
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.
- Institute for Healthy China, Tsinghua University, Beijing, China.
| |
Collapse
|
2
|
Jin R, Chen Y. Job satisfaction of village doctors in a rural-oriented tuition-waived medical education program in China. Front Psychol 2023; 14:1184430. [PMID: 37560095 PMCID: PMC10408449 DOI: 10.3389/fpsyg.2023.1184430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/22/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION To address health inequity and relieve shortage of rural doctors, China initiated Rural-oriented Tuition-waived Medical Education (RTME) to train doctors in rural areas for free since 2010. Little is known about job satisfaction of this particular group of rural doctors. METHODS Job Satisfaction Questionnaires for Village Doctors were distributed to 240 village doctors with RTME program in China, and 40 received in-depth semi-structured interviews. Descriptive analysis, chi-square test, univariate and multivariate logistic regressions in SPSS23.0 were conducted, and thematic analysis was applied to interviews. RESULTS Job satisfaction rate of village doctors with RTME program was 56.50%. Full understanding of RTME policy, recognition of rural medical work, relevance of RTME curriculum with present job, education background, rural origin and renumeration were positively correlated with job satisfaction. Preferential policies of RTME program, relaxing working atmosphere, more promotion opportunity, and easier access to higher technical titles were the key factors to retain rural doctors. CONCLUSION Our findings may interest healthcare authorities, medical colleges and primary healthcare establishments. Studying the job satisfaction of village doctors in China may also be beneficial in developing community and rural health services, and provide valuable insights into the training and retention of primary healthcare providers in other countries.
Collapse
Affiliation(s)
- Renmin Jin
- Party School of Anhui Provincial Committee of C.P.C, Hefei, China
| | - Yan Chen
- Anhui Medical College, Hefei, China
| |
Collapse
|
3
|
Zhang X, Sun B, Tian Z, Yu B, Wei C, Zhang Y, Zheng C, Chen X, Liu Q. Relationship between honesty-credit, specialty identity, career identity, and willingness to fulfill the contract among rural-oriented tuition-waived medical students of China: a cross-sectional study. Front Public Health 2023; 11:1089625. [PMID: 37529424 PMCID: PMC10388187 DOI: 10.3389/fpubh.2023.1089625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/26/2023] [Indexed: 08/03/2023] Open
Abstract
Background The fulfillment of contractual obligations by rural-oriented tuition-waived medical students (RTMSs) to work in rural medical institutions after graduation directly impacts the improvement of rural health quality. This study aimed to not only quantitatively measure the direct impact of honesty-credit, specialty identity, and career identity on willingness to fulfill the contract of RTMSs but also to quantify the intermediary role of specialty identity and career identity between honesty-credit and willingness to fulfill the contract. The research results provided recommendations for the rural-oriented tuition-waived medical education (RTME) program to achieve its goal of training rural primary healthcare personnel. Methods From March to May 2022, 1162 RTMSs were selected as the research objects. The honesty-credit, specialty identity, career identity, and willingness to fulfill the contract were quantitated using a self-completed questionnaire. Pearson's correlation analysis and structural equation modeling were used for statistical analysis and mediating effect evaluation. Results A total of 455 (42.3%) RTMSs had high willingness to fulfill the contract, and honesty-credit had a significant direct positive effect on willingness (β = 0.198, P < 0.001), specialty identity (β = 0.653, P < 0.001), and career identity (β = 0.180, P < 0.001). In the intermediary path between honesty-credit and willingness, career identity [95% confidence interval (CI): 0.007-0.051] had significant mediating effects. Career identity (95% CI: 0.030-0.149) also had significant mediating effects between specialty identity and willingness, and specialty identity (95% CI: 0.465-0.760) had significant mediating effects between honesty-credit and career identity. These results strongly confirmed that honesty-credit, specialty identity, and career identity are early and powerful predictors of the willingness to fulfill the contract of RTMSs. Conclusion The honesty-credit of RTMSs can predict their willingness to fulfill the contract early, significantly and positively. For the students who fail to pass the credit assessment for many times and have a strong tendency to default, their training qualifications should be canceled in time, so that students who are truly willing to serve rural areas can enter the project, and finally achieve the policy goal of "strengthening the rural primary medical and health system".
Collapse
Affiliation(s)
- Xuewen Zhang
- School of Integrated Traditional Chinese and Western Medicine, Jining Medical University, Jining, China
| | - Bing Sun
- School of Integrated Traditional Chinese and Western Medicine, Jining Medical University, Jining, China
| | - Zhuang Tian
- School of Public Health, Jining Medical University, Jining, China
| | - Bin Yu
- School of Integrated Traditional Chinese and Western Medicine, Jining Medical University, Jining, China
| | - Chao Wei
- School of Integrated Traditional Chinese and Western Medicine, Jining Medical University, Jining, China
| | - Ying Zhang
- School of Integrated Traditional Chinese and Western Medicine, Jining Medical University, Jining, China
| | - Canlei Zheng
- School of Integrated Traditional Chinese and Western Medicine, Jining Medical University, Jining, China
| | - Xuejun Chen
- School of Integrated Traditional Chinese and Western Medicine, Jining Medical University, Jining, China
| | - Qing Liu
- School of Integrated Traditional Chinese and Western Medicine, Jining Medical University, Jining, China
| |
Collapse
|
4
|
Guilfoyle C, Huang PH, Forster L, Shulruf B. Factors predicting rural location employment intent and choice among medical students and graduates. KOREAN JOURNAL OF MEDICAL EDUCATION 2022; 34:273-280. [PMID: 36464898 PMCID: PMC9726234 DOI: 10.3946/kjme.2022.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Workforce shortage is a contributing cause of health inequality in rural Australia. There is inconclusive evidence demonstrating which factors cause doctors to choose rural practice. This study's objective is to determine predictive factors for medical students' intent to work rurally and for graduates' current rural employment location choice. METHODS This prospective cohort study, utilized data gathered from the University of New South Wales about students and graduates who had spent one or more years in a Rural Clinical School. Participants were final year students and graduates already working in Australia. Stepwise logistic regression was used to determine predictive factors for the two outcomes. RESULTS Predictors for student intent to work rurally are rural background (odds ratio [OR], 7.16; 95% confidence interval [CI], 2.59-19.53), choosing to study at the Rural Clinical School (OR, 8.72; 95% CI, 1.32-57.63), and perceiving rural areas as opportunistic for career advancement (OR, 1.69; 95% CI, 1.15-2.49). Predictors for graduates currently working in a rural location are Bonded Medical Program participation (OR, 6.40; 95% CI, 1.15-35.59) and personal altruism (OR, 1.91; 95% CI, 1.02-3.57). CONCLUSION While intent is predicted by having a rural background, choosing to study at the Rural Clinical School and perception of rural areas as having positive career opportunities, a current rural workplace location among graduates is predicted by holding a bonded medical position and a desire to serve an under-resourced population. Maintaining the Bonded Medical Program and clear communication regarding training pathways may increase numbers of rural doctors.
Collapse
Affiliation(s)
| | - Pin-Hsiang Huang
- The University of New South Wales, Sydney, NSW, Australia
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Boaz Shulruf
- The University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
5
|
Amiresmaeili M, Jamebozorgi MH, Jamebozorgi AH. Identifying factors affecting dentists retention in deprived areas in Iran. Int J Health Plann Manage 2021; 37:1340-1350. [PMID: 34897804 DOI: 10.1002/hpm.3400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/26/2021] [Accepted: 11/30/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND One of the concerns of health managers in regard to improving the oral health of residents in deprived areas is to increase the tendency of dentists to stay in those areas. The purpose of this study was to explore factors affecting the intention of dentists to stay in deprived areas. METHODS The present qualitative study was carried out using semi-structured interviews. We interviewed 22 informants (4 oral health managers and 18 dentists) who were identified purposefully. Informants were asked what factors affecting retention in remote and deprived areas. Content analysis through the 7-step Colaizzi approach was used for data analysis. RESULTS Fifteen subthemes under five themes of individual factors, the development level of the region, social and cultural factors, financial issues, and managerial and organizational factors were identified as factors affecting tendency of dentist to stay and work in deprived areas. CONCLUSION According to the results of our study, health policymakers and managers should focus on culture and attitudes of the residents, Provision of financial incentives, structural problems and underdevelopment of the region, and high workload to increase the tendency of dentists to stay in remote and deprived areas.
Collapse
Affiliation(s)
- Mohammadreza Amiresmaeili
- Department of Health Management, Policy and Economics, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | | | | |
Collapse
|
6
|
Putri LP, O’Sullivan BG, Russell DJ, Kippen R. Factors associated with increasing rural doctor supply in Asia-Pacific LMICs: a scoping review. HUMAN RESOURCES FOR HEALTH 2020; 18:93. [PMID: 33261631 PMCID: PMC7706290 DOI: 10.1186/s12960-020-00533-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 11/03/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND More than 60% of the world's rural population live in the Asia-Pacific region. Of these, more than 90% reside in low- and middle-income countries (LMICs). Asia-Pacific LMICs rural populations are more impoverished and have poorer access to medical care, placing them at greater risk of poor health outcomes. Understanding factors associated with doctors working in rural areas is imperative in identifying effective strategies to improve rural medical workforce supply in Asia-Pacific LMICs. METHOD We performed a scoping review of peer-reviewed and grey literature from Asia-Pacific LMICs (1999 to 2019), searching major online databases and web-based resources. The literature was synthesized based on the World Health Organization Global Policy Recommendation categories for increasing access to rural health workers. RESULT Seventy-one articles from 12 LMICs were included. Most were about educational factors (82%), followed by personal and professional support (57%), financial incentives (45%), regulatory (20%), and health systems (13%). Rural background showed strong association with both rural preference and actual work in most studies. There was a paucity in literature on the effect of rural pathway in medical education such as rural-oriented curricula, rural clerkships and internship; however, when combined with other educational and regulatory interventions, they were effective. An additional area, atop of the WHO categories was identified, relating to health system factors, such as governance, health service organization and financing. Studies generally were of low quality-frequently overlooking potential confounding variables, such as respondents' demographic characteristics and career stage-and 39% did not clearly define 'rural'. CONCLUSION This review is consistent with, and extends, most of the existing evidence on effective strategies to recruit and retain rural doctors while specifically informing the range of evidence within the Asia-Pacific LMIC context. Evidence, though confined to 12 countries, is drawn from 20 years' research about a wide range of factors that can be targeted to strengthen strategies to increase rural medical workforce supply in Asia-Pacific LMICs. Multi-faceted approaches were evident, including selecting more students into medical school with a rural background, increasing public-funded universities, in combination with rural-focused education and rural scholarships, workplace and rural living support and ensuring an appropriately financed rural health system. The review identifies the need for more studies in a broader range of Asia-Pacific countries, which expand on all strategy areas, define rural clearly, use multivariate analyses, and test how various strategies relate to doctor's career stages.
Collapse
Affiliation(s)
- Likke Prawidya Putri
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, IKM Building 2nd Floor, Jl. Farmako, Sekip Utara, 55281 Yogyakarta, Indonesia
- School of Rural Health, Monash University, 26 Mercy Street, Bendigo, VIC 3550 Australia
| | | | | | - Rebecca Kippen
- School of Rural Health, Monash University, 26 Mercy Street, Bendigo, VIC 3550 Australia
| |
Collapse
|
7
|
Are Medical Graduates' Job Choices for Rural Practice Consistent with their Initial Intentions? A Cross-Sectional Survey in Western China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183381. [PMID: 31547407 PMCID: PMC6765869 DOI: 10.3390/ijerph16183381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 11/24/2022]
Abstract
Global concerns persist regarding the shortage and misdistribution of health workers in rural and remote areas. Medical education is an important input channel of human resources for health. This study aimed to identify the association between medical graduates’ job choices for rural practice and their initial intentions when they began to look for a job in China. Data were extracted from a cross-sectional survey among medical students in ten western provinces in China in 2013. Only medical students who were in the last year of study (i.e., medical graduates) and had found a job were included in this study. Of the 482 participants, 61.04% (293) presented an initial intention of rural practice when they began to look for a job, and 68.88% (332) made a final job choice for rural practice. However, of the 332 graduates with a final job choice of rural practice, only 213 (64.55%) had an initial intention. A univariate association was identified in which medical graduates who were more likely to make final job choices for rural practice were those having initial intentions (OR: 1.59; 95% CI: 1.08–2.36); however, after adjusting for controlled variables, it became insignificant and was reduced to a 1.31-fold increase (95% CI: 0.82–2.07). The initial intentions of medical graduates are not assurance of ultimate job outcomes, and it cannot be deduced that all medical graduates who made a final job choice for rural practice had authentic desires for rural practice. Twenty years of age or below, low-income families, majoring in non-clinical medicine, and studying in a junior medical college or below were associated with medical graduates’ final job choices for rural practice. More studies are required on how to translate medical student’s intention of rural medical practice into reality and how to retain these graduates via a job choice in rural practice in the future.
Collapse
|
8
|
Zhang Z, Hu Y, Zou G, Lin M, Zeng J, Deng S, Zachariah R, Walley J, Tucker JD, Wei X. Antibiotic prescribing for upper respiratory infections among children in rural China: a cross-sectional study of outpatient prescriptions. Glob Health Action 2018; 10:1287334. [PMID: 28462635 PMCID: PMC5496075 DOI: 10.1080/16549716.2017.1287334] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Overuse of antibiotics contributes to the development of antimicrobial resistance. OBJECTIVE This study aims to assess the condition of antibiotic use at health facilities at county, township and village levels in rural Guangxi, China. METHODS We conducted a cross-sectional study of outpatient antibiotic prescriptions in 2014 for children aged 2-14 years with upper respiratory infections (URI). Twenty health facilities were randomly selected, including four county hospitals, eight township hospitals and eight village clinics. Prescriptions were extracted from the electronic records in the county hospitals and paper copies in the township hospitals and village clinics. RESULTS The antibiotic prescription rate was higher in township hospitals (593/877, 68%) compared to county hospitals (2736/8166, 34%) and village clinics (96/297, 32%) (p < 0.001). Among prescriptions containing antibiotics, county hospitals were found to have the highest use rate of broad-spectrum antibiotics (82 vs 57% [township], vs 54% [village], p < 0.001), injectable antibiotics (65 vs 43% [township], vs 33% [village], p < 0.001) and multiple antibiotics (47 vs 15% [township], vs 0% [village], p < 0.001). Logistic regression showed that the likelihood of prescribing an antibiotic was significantly associated with patients being 6-14 years old compared with being 2-5 years old (adjusted odds ratio [aOR] = 1.3, 95% CI 1.2-1.5), and receiving care at township hospitals compared with county hospitals (aOR = 5.0, 95% CI 4.1-6.0). Prescriptions with insurance copayment appeared to lower the risk of prescribing antibiotics compared with those without (aOR = 0.8, 95% CI 0.7-0.9). CONCLUSIONS Inappropriate use of antibiotics was high for outpatient childhood URI in the four counties of Guangxi, China, with the highest rate found in township hospitals. A significant high proportion of prescriptions containing antibiotics were broad-spectrum, by intravenous infusion or with multiple antibiotics, especially at county hospitals. Urgent attention is needed to address this challenge.
Collapse
Affiliation(s)
- Zhitong Zhang
- a China Global Health Research and Development , Shenzhen , China
| | - Yanhong Hu
- b School of Public Health and Primary Care , Chinese University of Hong Kong , Hong Kong , China
| | - Guanyang Zou
- c School of Public Health , Sun Yat-sen University , Guangzhou , China
| | - Mei Lin
- d Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control , Nanning , China
| | - Jun Zeng
- d Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control , Nanning , China
| | - Simin Deng
- a China Global Health Research and Development , Shenzhen , China
| | - Rony Zachariah
- e Medical Department, Operational Research Unit, Médecins sans Frontières , Brussels Operational Center , Luxembourg City , Luxembourg
| | - John Walley
- f Nuffield Centre for International Health and Development , University of Leeds , Leeds , UK
| | - Joseph D Tucker
- g Institute for Global Health and Infectious Diseases , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Xiaolin Wei
- h Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada
| |
Collapse
|
9
|
Liu J, Zhang K, Mao Y. Attitude towards working in rural areas: a cross-sectional survey of rural-oriented tuition-waived medical students in Shaanxi, China. BMC MEDICAL EDUCATION 2018; 18:91. [PMID: 29720164 PMCID: PMC5932863 DOI: 10.1186/s12909-018-1209-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/20/2018] [Indexed: 05/08/2023]
Abstract
BACKGROUND Attracting and recruiting health workers to work in rural areas is still a great challenge in China. The rural-oriented tuition-waived medical education (RTME) programme has been initiated and implemented in China since 2010. This study aimed to examine the attitudes of rural-oriented tuition-waived medical students (RTMSs) in Shaanxi towards working in rural areas and the related influencing factors. METHODS A cross-sectional survey was conducted in 2015 among 232 RTMSs in two medical universities from the first group of students enrolled in the RTME programme in Shaanxi. Descriptive and analytical statistics were used for the data analyses. RESULTS Of the 230 valid responses, 92.6% expressed their intentions of breaking the contract for working in rural township hospitals for 6 years after their graduation under the RTME programme. After the contract expired, only 1.3% intended to remain in the rural areas, 66.5% had no intention of remaining, and 32.2% were unsure. The factors related to a positive attitude among the RTMSs towards working in rural areas (no intention of breaking the contract) included being female, having a mother educated at the level of primary school or below, having a good understanding of the policy, having a good cognition of the value of rural medical work, and being satisfied with the policy. The factors related to a positive attitude of the RTMSs towards remaining in rural areas included being female, having a rural origin, having no regular family monthly income, having a father whose occupation was farmer, having a mother educated at the level of postsecondary or above, having the RTMSs be the final arbiter of the policy choice, having a good understanding of the policy, having a good cognition of the value of rural medical work, and being satisfied with the educational scheme. CONCLUSIONS Related policy makers and health workforce managers may benefit from the findings of this study. Appropriate strategies should be implemented to stimulate the RTMSs' intrinsic motivation and improve their willingness to work in rural areas and to better achieve the objectives of RTME policy. Meanwhile, measures to increase the retention of RTMSs should also be advanced.
Collapse
Affiliation(s)
- Jinlin Liu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Kun Zhang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
- Xi’an Health and Family Planning Commission, Xi’an, China
| | - Ying Mao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| |
Collapse
|
10
|
Liu J, Zhu B, Mao Y. Association between rural clinical clerkship and medical students' intentions to choose rural medical work after graduation: A cross-sectional study in western China. PLoS One 2018; 13:e0195266. [PMID: 29608624 PMCID: PMC5880380 DOI: 10.1371/journal.pone.0195266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 02/23/2018] [Indexed: 11/18/2022] Open
Abstract
Background A large number of programs have been implemented in many countries to increase the healthcare workforce recruitment in rural and remote areas. Rural early exposure programs for medical students have been shown to be effective strategies. However, no related studies have been reported before in China. This study was carried out to determine the association between medical students’ participation in rural clinical clerkships and their intentions to choose rural medical work after graduation from western medical schools in China. Methods Based on a two-stage random sampling method, the cross-sectional survey was carried out in ten western provinces in China. A brief questionnaire filled in by medical students was used for data collection. A total of 4278 medical students participated in the study. The response rate was approximately 90.34%. Pearson’s chi-squared tests and binary logistic regression analyses were performed for data analyses. Results Approximately 52.0% of medical students disclosed intentions to work in rural medical institutions after graduation. Only one in five participants had experience with a rural clinical clerkship. Rural clinical clerkships were significantly associated with medical students’ intentions to work in rural medical institutions (OR: 1.24, 95%CI: 1.05–1.46); further analyses indicated that such clerkships only had a significant impact among the medical students with an urban background (OR: 2.10, 95%CI: 1.48–2.97). In terms of the sociodemographic characteristics, younger age, low level of parental education, majoring in general practice, and studying in low-level medical schools increased the odds of having intentions to engage in rural medical work among medical students; however, rural origins was the only positive univariate predictor. In addition, the predictors of intentions to choose rural medical work were different between medical students with a rural background and those with an urban background. Conclusions Rural clinical clerkship is likely to increase the odds of having intentions to work in rural medical institutions after graduation among medical students in western China, especially for those with an urban background. Related policy makers could consider developing compulsory rural clerkship programs and implement them among medical students to increase early rural exposure.
Collapse
Affiliation(s)
- Jinlin Liu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Bin Zhu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- Department of Public Policy, City University of Hong Kong, Hong Kong, China
| | - Ying Mao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
- * E-mail:
| |
Collapse
|
11
|
Mo Y, Hu G, Yi Y, Ying Y, Huang H, Huang Z, Lin J. Unmet needs in health training among nurses in rural Chinese township health centers: a cross-sectional hospital-based study. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2017; 14:22. [PMID: 29026060 PMCID: PMC5729214 DOI: 10.3352/jeehp.2017.14.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/04/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Maintaining a sufficient and competent rural nursing workforce is an important goal of the Chinese health delivery system. However, few studies have investigated the health training status or conducted a needs assessment of rural Chinese nurses during this time of great transformations in health policy. This study was conducted to explore the current health training status of nurses working in rural Chinese township health centers (THCs) and to ascertain their perceived needs. METHODS A cross-sectional survey using a self-administered structured questionnaire was conducted among 240 THC nurses in Guangxi Zhuang Autonomous Region, China from March 2014 to August 2014. The survey questionnaire was adapted from the Second Chinese Survey of Demographic Data and Training Demand for Health Professionals in THCs developed by the Ministry of Education. RESULTS The nurses in THCs were young, with a low educational level. Their perceived needs for health training included further clinical studies at city-level hospitals to improve their skills and theoretical studies at medical universities in emergency medicine and general practice. Overall, 71.9% of the nurses with a secondary technical school background expected to pursue junior college studies, and 68.5% of the nurses with a junior college education expected to pursue a bachelor's degree. A decentralized program with theoretical studies at medical universities and practical studies at county hospitals was regarded as feasible by 66.9% of the respondents. CONCLUSION Health-training programs for nurses in Chinese THCs must be improved in terms of coverage, delivery mode, and content. A decentralized degree-linked training program in which medical universities and city hospitals collaborate would be an appropriate mode of delivery.
Collapse
Affiliation(s)
- Yan Mo
- First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Guijie Hu
- The Maternal and Child Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Yanhua Yi
- Department of Plastic and Aesthetic Surgery, Nan Fang Hospital, Southern Medical University, Guangdong, China
| | - Yanping Ying
- First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Huiqiao Huang
- First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Zhongxian Huang
- First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Jiafeng Lin
- First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| |
Collapse
|
12
|
Delavari S, Arab M, Rashidian A, Nedjat S, Souteh RG. A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran. J Prev Med Public Health 2016; 49:386-393. [PMID: 27951631 PMCID: PMC5160132 DOI: 10.3961/jpmph.16.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/17/2016] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. METHODS A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran's health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. RESULTS Iran's medical education is faced with several challenges that were categorized in four main themes including student selection, medical students' perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. CONCLUSIONS Challenges that were found could have negative effects on retention. Modification in student's perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas.
Collapse
Affiliation(s)
- Sajad Delavari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Arab
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of Public Health, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|