Japanese regional-quota medical students in their final year are less motivated to work in medically underserved areas than they were in their first year: a prospective observational study
Japanese regional-quota medical students in their final year are less motivated to work in medically underserved areas than they were in their first year: a prospective observational study
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DOI：
10.22605/rrh4840
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发表时间：
2018-01-01
影响因子：
2.1
通讯作者：
Maeno, Tetsuhiro
中科院分区：
文献类型：
--
作者：
Kataoka, Yoshihiro;Takayashiki, Ayumi;Maeno, Tetsuhiro
简介：在日本医学院，一种特殊的区域配额（chiikiwaku）制度已经被广泛实施，以增加医疗服务不足地区（MUAs）的医生数量。地区配额学生需要申请学生贷款，但在完成大约9年的义务实习期后可以免除还款。本研究调查了最后一年区域配额学生在义务实习期结束后继续留在mua的预期意愿，以及学生第一年这种意愿的相关因素。方法：本前瞻性观察研究的参与者均为日本医学院校的区域配额学生。基线数据是在学生第一年收集的，他们在义务实习期后继续留在mua的预期意愿是主要结果，在学生的最后一年通过问卷调查确定。通过X-2检验和逻辑回归分析基线数据与留在mua的意愿之间的关系。结果：在基线时，38所医学院的405名一年级学生回答了问卷；其中208名（51.4%）学生在5年后接受了随访。5年后，预计愿意留在mua的地区配额学生比例从52.3%下降到19.2%。在多变量分析中，预计第六年留在mua的意愿与农村教育（比值比（OR） 2.1）、收入对工作偏好的影响（OR 0.3）以及第一年评估的留在mua的意愿（OR 3.3）有关。结论：区域配额学生继续留在mua的预期意愿随着他们在医学院的进展而下降。为了增加MUAs的医生数量，招收来自农村地区的区域配额学生可能是有用的，这些学生不把预期收入放在首位，并且最初期望留在MUAs的意愿。
Introduction: In Japanese medical schools, a special regional quota (chiikiwaku) system has been widely implemented to increase the number of physicians in medically underserved areas (MUAs). Regional quota students are required to take out a student loan but are exempted from repayment after fulfilling an approximately 9-year obligatory practice period. This study investigated the anticipated willingness of final-year regional quota students to remain in MUAs after their obligatory practice period, as well as factors associated with this willingness during students' first year.Methods: The participants in this prospective observational study were all regional quota students at Japanese medical schools. Baseline data were collected when students were in their first year, and their anticipated willingness to remain in MUAs after their obligatory practice period was the primary outcome, determined by questionnaire during the students' final year. The association between baseline data and willingness to remain in MUAs was analyzed by the X-2 test and logistic regression analysis.Results: At baseline, 405 first-year students in 38 medical schools answered the questionnaire; of these, 208 (51.4%) students were followed up 5 years later. The proportion of regional quota students who anticipated being willing to remain in MUAs decreased from 52.3% to 19.2% after 5 years. In multivariate analysis, anticipated willingness to remain in MUAs in the sixth year was associated with rural upbringing (odds ratio (OR) 2.1), influence of income on work preference (OR 0.3) and willingness to remain in MUAs as assessed during the first year (OR 3.3).Conclusions: Regional quota students' anticipated willingness to remain in MUAs decreased as they progressed through medical school. To increase the number of physicians in MUAs, it may be useful to recruit regional quota students who come from rural areas, who do not place a high priority on expected incomes, and who initially anticipate a willingness to remain in MUAs.