| Summary: | Background Compulsory rural service directed medical student free training program is an important initiative to ameliorate the shortage of health human resources in rural areas of China, and the first graduates of the policy have now completed the contract performance. Analysis of the performance situation and influencing factors of these students is needed to improve the policy of compulsory rural service directed medical student free training program in time and improve and stabilize the performance rate of the rural service directed medical students. Objective To analyze the employment and performance status of compulsory rural service directed medical graduates of 2015—2019 in four Midwestern medical schools, and to analyze the influencing factors on the performance of the rural service directed medical students, so as to make recommendations to further improve the training policy of the rural service directed medical students. Methods A cohort of rural service oriented medical students was established from four medical schools including Qinghai University, Guangxi Medical University, Jiujiang college, and Gannan Medical College, and other five-year graduates of clinical medicine from the same session were selected as controls. A baseline questionnaire was administered to graduates before graduation, which included the basic information, family information, job expectations, and so on. An online follow-up survey was conducted annually thereafter and included graduates' employment, performance status, and so on. This study was conducted in July 2021 using data from a baseline survey of graduates of 2015—2019 from four institutions and a follow-up survey from September 2020. A total of 2 041 rural service directed medical graduates and 1 579 other 5-year clinical students were enrolled. Compare the difference in employment between rural service oriented medical graduates and other five-year clinical students. Multivariate Logistic regression was used to analyze the influencing factors on the performance of rural service directed medical graduates. Results In the baseline survey, 2.26% (46/2 038) of the rural service directed medical graduates were willing to work in township health institutes. In the 2020 follow-up survey, 86.04% (228/265) of the rural service directed medical graduates chose to work in township health institutes. In a 2018 follow-up survey of 2015 and 2016 rural service directed medical graduates, 43.67% (290/664) of graduates expressed reluctance to remain in township health institutes after the expiry of the contract. 97.48% (1 546/1 586) of rural service directed medical graduates were allocated as personnel in public institution, a higher proportion than other clinical 5-year graduates (P<0.05). The overall performance rate of 5-year rural service directed medical graduates was 97.84% (1 589/1 624), and the results of multivariate logistic regression analysis showed that male gender, desired job location as rural areas in the baseline survey, job having public institution quota, and contract location as home district (county) were the promoting factors for the performance of rural service directed medical graduates (P<0.05) . Conclusion Rural service directed medical students are more smoothly employed with high performance rates, and the recruitment of this type of medical students should focus on students who have willingness to work in rural areas and try to contract with the counties where the students are from.
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