目的 探讨医学生对卫生资源下沉改革的认知和下沉改革对其从医意愿的影响。方法 2018年6月至2019年2月,本研究选择浙江省8所高校1 456名医学生为研究对象并对其进行问卷调查,采用描述性分析、方差分析和有序logistic回归等方法对数据进行分析。结果 医学生对卫生资源下沉改革认知度“很低”和“较低”的比例分别为44.3%(645/1 456)和21.5%(313/1 456);获取公共渠道改革信息、接受卫生政策和反医疗暴力教育的医学生与获取私人渠道信息及未接受相关教育的医学生相比,其改革认知度、支持度和改革效应评价差异均具有统计学意义(均P<0.05)。接受卫生政策教育可以增加医学生从医意愿(OR=1.288,95%CI:1.053-1.576,P=0.014),53.2%(774/1 456)的医学生未接受过政策教育;88.5%(1289/1 456)的医学生认为医疗暴力高发,医疗暴力发生率的上升降低了医学生的从医意愿(OR=0.671,95%CI:0.612~0.735,P<0.01),却提升了其基层就职意愿(OR=1.099,95%CI:1.003~1.205,P=0.044)。反医疗暴力法律环境不影响医学生的从医意愿(OR=0.927,95%CI:0.825~1.041,P=0.201),但增加其基层就职意愿(OR=1.357,95%CI:1.207~1.527,P<0.01)。结论 医学生对卫生资源下沉改革认知度较低,公共渠道信息获取不足;应当重视医疗暴力对医学生从医意愿的负面影响,向医学生进行充分的卫生资源下沉改革政策和反医疗暴力的教育。

Objective To explore the cognition of medical students on the sinking reform of health resources and the influence of the sinking reform on the medical students' willingness to practice medicine. Methods From June 2018 to February 2019, 1 456 valid questionnaires were collected from 8 medical universities of Zhejiang province, and then descriptive analysis, ANOVA and ordinal logistic model were utilized to do empirical study. Results It was found that 44.3% (645 / 1 456) and 21.5% (313 / 1 456) of students, had a low awareness of the sinking reform. Medical students with information by public channels, health policy and anti-violence education have significantly enhanced reform awareness, support and perceived reform effect compared with those without relevant education and by private channel (P<0.05). Health policy education has significant impact on intention to practice medicine (OR=1.274,95%CI:1.043~1.557,P=0.018), but 53.2%(774/1 456) did not received policy education. but 53.2% (774/1 456) did not received policy education. 88.5%(1 289/1 456) interviewees regard incidence of healthcare workplace violence as high, with its negative impact on working intention(OR=0.658,95%CI:0.601~0.721,P<0.01), and positive effect for low-level hospitals (OR=1.111,95%CI:1.014~1.216,P=0.023). The improvement of legal environment shows no impact for working intention(OR=0.932,95%CI:0.831~1.045,P=0.229), but positive impact exists for low-level hospitals (OR=1.363,95%CI:1.213~1.532,P<0.01). Conclusions Medical students have low reform awareness with limited information through public channel, and insufficient health policy and anti-violence education. More attention should be paid to the impacts of healthcare workplace violence on medical students' working intention, which may be incentivized by more powerful law enforcement.