Early outcomes of a rural-oriented physician education programme against rural physician shortages in Guangxi province: a prospective cohort study

Abstract

ObjectivesThis study aimed to investigate early outcomes of one of the first medical undergraduate education programmes with a goal of mitigating severe rural physician shortages in China, which was developed by Guangxi Medical University (GXMU) and was called the Rural-oriented Free Tuition Medical Education (RTME)-GXMU programme.DesignA prospective cohort study comprising a baseline investigation and follow-up research was conducted to dynamically observe the evolution of the RTME-GXMU programme that began since 2010.Participants380 RTME-GXMU graduates and 383 non-RTME-GXMU graduates from GXMU who completed trainings between 2015 and 2018 were recruited in the baseline investigation. Among them, 285 RTME-GXMU and 283 non-RTME-GXMU graduates responded to the follow-up research.Main outcome measuresGraduate practice location, registered specialty, passing rate of the National Medical Licensing Examination (NMLE), specialty of residency programme and contract compliance for the RTME-GXMU graduates.ResultsBy the end of 2018, 100% of the 2015 RTME-GXMU graduates enrolled in this study practised in rural township health centres and registered themselves as general practitioners (GPs). All the RTME-GXMU graduates had completed or were attending residency programmes of general practice (GP). The above data stood in stark contrast to that of the non-RTME-GXMU graduates among whom as few as 1.06% worked in rural areas, 2.13% registered as GPs and less than 3% chose GP residency programmes. No significant differences were detected on passing rates of the NMLE between the two groups. Only one RTME-GXMU graduate broke the contract and dropped off the programme.ConclusionsThe RTME-GXMU programme has achieved encouraging early outcomes. Reduced entry score and proper usage of urban primary care institutions are two key approaches contributing to these positive early results.

Recruitment of general practitioners in China: a scoping review of strategies and challenges

“…Semi-structured interviews with all 45 students found that the low success rate promoting General Practice was attributed to: the relatively low salary and poor working conditions of GPs (41, 91%); low social status; concerns about career prospects(45, 100%); not able to focus on medical work because of multiple roles including preventive medicine, public education etc. (42, 93%); the living conditions at the working locations are not desirable (43, 95%) 2010 Rural-on-Demand-Oriented-bonded-GP Training Programme [ 21 , 53 , 55 – 58 , 60 ] Students enrolled in this five-years programme are predominantly recruited from rural areas, and priority is given to those from areas designated most in need of health care. Students are exempt from tuition and accommodation fees and central government provides 6,000 Yuan (approximately USD913) per year for living expenses.…”

“…Students are exempt from tuition and accommodation fees and central government provides 6,000 Yuan (approximately USD913) per year for living expenses. On course completion graduates are obligated to serve in a rural primary medical and health institutions for a minimum of 6 years or pay a penalty Six studies [ 21 , 53 , 56 – 58 , 60 ] [ 55 ] from Guangxi, Zhejiang, Yunnan, Anhui and one unspecified locations report on the outcome of this programme. Three studies [ 21 , 56 , 57 ] reported that the majority of the students were willing to or did become GPs after graduation.…”

“…Three studies [ 21 , 56 , 57 ] reported that the majority of the students were willing to or did become GPs after graduation. One study reported that only one out of 380 graduates broke the contract [ 55 ]. A longitudinal study in Anhui reported 97.5% of graduates between 2015 and 2017 served their bond at the designated workplace.…”

“…China has promoted rural practice by encouraging students from rural areas to be recruited on GP training schemes, through provision of free medical education and stipends. After graduation, they are obligated to return to their hometown to work as GPs for six years, and encouragingly it seems that many of the graduates on these schemes do become GPs [ 21 , 53 , 55 – 58 , 60 ]. As yet the retention rates and career trajectories after their bonded period remain largely unknown.…”

Policy perception, job satisfaction and intentions to remain in rural area: evidence from the National Compulsory Service Programme in China

“…Twenty two provinces that suffered severe rural physician shortage in central and western China were targeted. Students with rural backgrounds were exclusively recruited and were subsidized to complete the 5-years undergraduate studies [ 12 ]. In return, students are obligated to provide rural health service as general practitioners (GPs) in designated THCs for 6 years, during which 3 years were required for the standardised residency training (SRT) [ 13 ].…”