Association between rural clinical clerkship and medical students’ intentions to choose rural medical work after graduation: A cross-sectional study in western China

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.

研究背景
多国已推出多项举措，旨在扩充农村及偏远地区的医疗人力储备。面向医学生的农村早期接触项目已被证实为行之有效的策略。但目前国内尚未见相关研究报道。本研究旨在探讨中国西部医学院校医学生参与农村临床见习（rural clinical clerkships）与毕业后选择农村医疗工作意向之间的关联。
研究方法
本研究采用两阶段随机抽样方法，在中国西部10个省份开展横断面调查（cross-sectional survey）。通过医学生填写的简易问卷完成数据采集。共计4278名医学生参与本研究，有效回收率约为90.34%。数据分析采用皮尔逊卡方检验（Pearson’s chi-squared tests）与二元logistic回归分析（binary logistic regression analyses）。
研究结果
约52.0%的医学生表示毕业后愿意在农村医疗机构工作。仅有五分之一的参与者拥有农村临床见习经历。农村临床见习与医学生毕业后前往农村医疗机构工作的意向显著相关（OR=1.24，95%CI：1.05~1.46）；进一步分析显示，此类见习仅对城市背景的医学生存在显著影响（OR=2.10，95%CI：1.48~2.97）。在社会人口学特征层面，年龄较轻、父母受教育水平偏低、主修全科医学专业以及就读于低层级医学院校的医学生，其投身农村医疗工作的意向比值更高；但农村出身是唯一具有正向预测价值的单变量因子。此外，农村背景与城市背景的医学生，其选择农村医疗工作意向的预测因子存在显著差异。
研究结论
农村临床见习可提升中国西部医学生毕业后前往农村医疗机构工作的意向比值，尤其对城市背景的医学生效果更为显著。相关政策制定者可考虑制定强制性农村见习项目，并在医学生群体中推行，以提升其早期农村医疗接触体验。