A Study On The Willingness Of Rural-oriented Medical Students To Work At Rural Areas From The Perspective Of Social Exchange Theory In Zhejiang Province

ObjectiveFrom the perspective of social exchange theory,this study investigated the current situation of willingness to work at rural areas of rural-oriented medical students in Zhejiang Province.This article analyzed the influencing factors of willingness to work at rural areas,so as to improve the rural health human resources and provide scientific evidence for optimizing the "Rural-oriented Tuition-waived Medical Students' Education Policy".MethodsThree methods were adopted in this study.First was literature research.Collecting the theoretical research and survey methods of domestic and foreign from authoritative databases and consulting related policy literature on the enrollment standard,training content and job recruitment of rural-oriented tuition-waived medical students.Second,the questionnaire survey was carried out in "A" University and relevant data were collected in Zhejiang Province.The contents of the questionnaire included economic and social exchange scale,subjective socioeconomic status,willingness to work at rural areas and demographic variables.The third method was statistical analysis.SPSS 23.0 was used to conduct descriptive analysis,reliability and validity analysis,correlation analysis,and multiple linear regression to test the influencing factors.ResultsA total of 406 rural-oriented medical students majoring in five-year clinical medicine were investigated.Among them,188(46.3%)were boys and 218(53.7%)were girls.The age ranged from 17 to 23 years old,and most students(39.4%)were 19 years old.The number of rural household was 254(62.6%).More than half of families' have annual incomes of 50,000-200,000 yuan,and 34.0%of them have annual incomes of 100,000-200,000 yuan(including 200,000 yuan).Most parents' educational background of the students was high school or below,of which "junior high school" was the most option.One hundred and sixty-one(39.7%)student fathers' educational background was "junior high school" as well as 184(45.3%)student mothers' educational background was "juniorhigh school".As the results of rural areas work intention showed,40 students(9.9%)said they were highly willing to work at rural areas after graduation,meanwhile 217 students(53.4%)were relatively willing to work at rural areas after graduation.However,only 17 students(4.2%)answered that they were highly willing to stay at rural areas after six years of service,116 students(28.6%)were relatively willing to stay at rural areas after six years of service.The results of correlation analysis and multiple linear regression showed that among the demographic variables of students,gender,age,the number of the family members and type of household registration had no significant effect on rural areas work intention both after graduation and after six years of service.There was a significant negative correlation between students' grade and rural areas work intention after graduation.Family income and fathers' educational background also had a certain negative impact on rural areas work intention both after graduation and after six years of service.Through multiple linear regression analysis,we found that the economic exchange was negatively related to the rural areas work intention after graduation(?=-0.211,p<0.01)and the rural areas work intention after graduation after six years of service(?=-0.244,p<0.01).The social exchange was positively related to the rural areas work intention after graduation(?=0.545,p<0.01)and the rural areas work intention after graduation after six years of service 0.468,p<0.01).The relationships among economic exchange,social exchange,subjective socioeconomic status(SES)and rural areas work intention were discussed.It was found that the subjective SES of students played a moderating role in the influence of economic exchange on rural areas work intention:whether students with high level of subjective SES or low level of subjective SES,economic exchange was negatively related to the rural areas work intention(both after graduation and after six years of service);But for students with low level of subjective SES,economic exchange had a greater impact on the rural areas work intention,that was,economic exchange would lead to greater impact on the declining of the rural areas work intention among students with low level of subjective SES.ConclusionIt was found that the willingness to work at rural areas of rural-oriented medical students in Zhejiang province still needed to be improved.Students' willingness to work at rural areas was influenced by both economic exchange and social exchange,and their subjective socioeconomic status played a moderating role in the influence of economic exchange on the willingness to work at rural areas.In order to further improve the construction of rural health human resources and effectively enhance the capacity of rural health care services,relevant rural health institutions and medical universities should pay more attention to the emotional connection with rural-oriented medical students.Then improving the training practice process of these medical students,strengthening the education of responsibility were also necessary.