Abstract: Objective To investigate and analyze the related factors that affect the career intention of rural-oriented tuition-waived medical students (RTMS) and put forward countermeasures to improve RTMS's career intention.Methods The changes and influencing factors of RTMS's career intention were investigated through structured questionnaire and in-depth interviews.Results RTMS's career intention decreased as grade increased after understanding Enrollment, employment policy, institutions of higher learning, education, career environment and subsequent career development which seriously restricted students' learning enthusiasm and initiative, restricting the implementation of national rural free medical student training policy effect and the construction of urban and rural grassroots health personnel.Conclusions System optimization for enhancing m RTMS's career intention are as follows: improving government enrollment and employment policies, strengthening college education, promoting general practitioners' social status and occupation protection in rural and urban grassroots health institutions.

Key words: Rural-oriented tuition-waived medical student, Career intention, Education strategy, Investigation, Reflection