目的 探讨社区实习对医学生的基层医疗卫生服务认知、兴趣和基层择业意愿的影响。方法 采用问卷调查方法。自行设计调查问卷,2023年11月至2024年6月,选取浙江大学临床医学专业142名参加社区实习的学生为研究对象,实习前后分别进行问卷调查。数据分析采用Mann-Whitney U检验、卡方检验和斯皮尔曼相关分析。结果 医学生对基层医疗卫生服务认知总分从实习前的22.0(20.5,24.0)分提升至实习后的28.0(27.0,28.5)分,其差异具有统计学意义(P＜0.05)。实习前52.7%(49/93)的医学生对社区实习感兴趣,实习后提高到67.4%(95/141),其差异具有统计学意义(P＜0.05)。实习前39.8%(37/93)的医学生选择社区医院就业,实习后提高到48.2%(68/141),选择全科医学领域就业的医学生比例从实习前的40.9%(38/93)提高到实习后的50.4%(71/141),实习前后差异均无统计学意义(均P>0.05)。医学生对基层医疗卫生服务认知与兴趣的相关系数实习前为0.289,实习后提高到0.636,均P＜0.05。结论 社区实习有助于提升医学生对基层医疗卫生服务的认知和学习兴趣,强化两者正向关联,但对医学生基层择业意愿的影响不明显。

Objective To explore the impact of community medicine internship on medical students′ cognition of and interest in primary healthcare, and their willingness to work in primary healthcare. Methods A survey was conducted using a self-designed questionnaire. From November 2023 to June 2024, 142 medical students from Zhejiang University who participated in the community medicine internship enrolled in the study, and surveys were conducted before and after the internship respectively. Data were analyzed using the Mann-Whitney U test, χ² test, and Spearman rank correlation analysis. Results The total score of medical students′ cognition of primary healthcare increased from 22.0 (20.5, 24.0) before the internship to 28.0 (27.0, 28.5) after the internship, with a statistically significant difference (P<0.05). The proportion of medical students interested in primary healthcare increased from 52.7% (49/93) before the internship to 67.4% (95/141) after the internship, with a statistically significant difference (P<0.05). The proportion of medical students willing to work in community health centers increased from 39.8% (37/93) before the internship to 48.2% (68/141) after the internship, and the proportion willing to engage in general practice increased from 40.9% (38/93) to 50.4% (71/141) after the internship; these differences were not statistically significant (all P>0.05). The Spearman correlation coefficient between medical students′ primary healthcare cognition and interest was 0.289 before the internship and increased to 0.636 after the internship (all P<0.05). Conclusions Community medicine internship improved medical students′ cognition of and interest in primary health care, and strengthened the positive correlation between the two factors, but it did not have a significant impact on their willingness to work in primary healthcare.