Analysis of Standardized Training for Free Medical Students from Rural Areas in Yunnan Province: A Multi-center Cross-sectional Survey

Analysis of Standardized Training for Free Medical Students from Rural Areas in Yunnan Province: A Multi-center Cross-sectional Survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of Standardized Training for Free Medical Students from Rural Areas in Yunnan Province: A Multi-center Cross-sectional Survey Xing Wang, Anye Lei, Qiaoyun Huang, Yingyurui Liu, Yali Li, Weiming Li This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6576248/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Nov, 2025 Read the published version in BMC Medical Education → Version 1 posted 11 You are reading this latest preprint version Abstract Background Primary health care personnel worldwide are confronted with challenges including a paucity of personnel, imbalanced regional development and unstandardized services. Rural-oriented tuition-waived medical students (RTMSs) play a crucial role as the main body of Standardized residency training (SRT) in enhancing primary healthcare capabilities and achieving universal health coverage and sustainable development goals.To date, there has been a relative paucity of research, both nationally and internationally, on rural-oriented tuition-waived medical students (RTMSs) in primary health care workforce development. The present dissertation focuses on the analysis of factors influencing the training satisfaction of medical students in rural areas who are targeted by the programme in eight hospitals in Yunnan Province. Methods A multicenter cross-sectional observational study was conducted in June 2022 in eight hospitals in Yunnan Province, and a questionnaire survey was administered to 643 RTMS participating in the SRT program. The data were analyzed using descriptive analysis and analytical statistics. Results The study revealed that 91.29% of respondents expressed support for standardized residency training(SRT), with 45.37% of respondents believing that it has the potential to enhance medical skills. However, 46.50% of respondents indicated that they would not continue working in rural grassroots settings after completing their contractual services. The survey revealed that training hospitals exhibited the lowest levels of satisfaction with living conditions and salary. This was associated with several factors, including expectations of higher income, positive psychological state, frequent skills training and lectures, regular counselling and team-building activities, and identification with the status of rural-oriented tuition-waived medical students (RTMSs). Conclusions It is crucial for rural-oriented tuition-waived medical students (RTMSs) to improve their medical skills through standardized residency training (SRT) Enhancing their engagement and satisfaction in SRT, and encouraging them to stay in rural areas, will more effectively achieve the goals of the rural-oriented tuition-free medical education (RTME). Clinical trial number Not applicable Standardized training general practitioner Free medical education Figures Figure 1 Introduction A global shortage of human resources for primary health care and health is especially prevalent in rural and remote areas. This predicament exerts a substantial influence on the health development of the local population, consequently engendering deficiencies in the timely diagnosis and treatment of prevalent diseases and impeding the implementation of public health programmers[ 1 ]. This, in turn, engenders the emergence of more profound health complications. In order to address this challenge, countries have continued to optimize the system of general medicine training, improve the system of standardized residency training, and implement a talent training model in which medical students remain at the grassroots level. For instance, the "5 + 2 + 3" model in the United Kingdom and the training system in Australia are both relatively mature and undergoing rapid development. A number of relevant studies have analyzed the training of medical personnel in these countries and found that focusing on trainees' stressors and mental health to enhance training effectiveness[ 2 ], as well as practice-based learning and improvement programs to motivate students to take the initiative to learn, has improved the effectiveness of residency training[ 3 ]. The RTME programme provides financial support in the form of tuition waivers and living grants, with the objective of training general practitioners for rural areas in China. The programme mandates that graduates commit to a six-year tenure in township health centers, complemented by a three-year commitment to SRT. SRT in Yunnan Province has been piloted since the 1980s[ 4 ], and a standardized training system covering 34 specialties was fully established in 2013 [ 5 , 6 ].In 2015, the training requirements were further standardized [ 7 ], and by 2020 a relatively uniform and standardized residency training model was formed [ 8 ]. At present, the number of RTMSs who have successfully completed standardized residency training in Yunnan Province exceeds 7,000, a development which has had a significant impact on the local primary care situation. The distribution of medical professionals between urban and rural areas in China is imbalanced, and the shortage of primary medical personnel has seriously constrained the improvement of rural medical services [ 9 , 10 ]. It is evident that rural physicians constitute a mere 14.98% of the total number of practising physicians in the country [ 11 ]. Research has indicated that RTMSs exhibit low levels of satisfaction and a limited willingness to pursue a career in rural areas following their participation in residency training programmes [ 11 ]. In Yunnan Province, the participation rate of RTMSs in SRT is approximately 85%, but the dropout rate is as high as 8–10%. Research shows that medical students consider career opportunities and workplace to be the most important, and they also want diversity such as fair pay, reasonable hours, autonomy, etc [ 12 ]. Furthermore, the concentration of SRT bases in provincial centres gives rise to elevated transportation costs and constrained training opportunities for Yunnan RTMSs in remote areas, and grassroots training that places greater emphasis on clinical operations than on theoretical instruction [ 13 ]. It has been demonstrated that RTMSs in Yunnan have expressed a lower level of satisfaction with SRT in comparison to their counterparts in developed eastern regions. The investigation has identified that career development pathways and mentorship are pivotal factors in determining satisfaction levels [ 14 ].However, there are fewer studies on the relationship between RTMSs' satisfaction and salary income, training activities, psychological status, and self-identity. Therefore, this study focused on eight hospitals in Yunnan Province to conduct a cross-sectional survey on RTMSs' participation in SRT, to analyze their training status and satisfaction levels, and to explore the mechanisms of influence of the SRT program. Methods Design, setting, and participants This cross-sectional study was conducted in June 2022, and a multicenter survey study was undertaken. A total of eight hospitals were ultimately included in the study, four of which were provincial and four prefecture. The selection of hospitals was conducted through a stratified sampling method, with the recruitment criteria encompassing the stratification and geographic distribution of general hospitals' general practice residency training bases at the provincial and prefecture levels within Yunnan Province. Additionally, the operational capacity of the training programs was considered, along with data on the enrolment and graduation rates of RTMSs and the availability of qualified general practice trainers. The study incorporated a total of 643 RTMSs. It should be noted that this is a non-interventional observational study focusing on educational methods for a non-patient population in medical education. Since it involves no direct medical interventions on human subjects, there is no applicable clinical trial registration number.To protect the privacy of the interviewees, an anonymous approach was used.The inclusion criteria for the study are as follows: (1)Free-order medical students participating in SRT;(2)Training in designated hospitals and the capacity to provide complete training record data;(3)Voluntary participation in the study and the signing of informed consent. Exclusion criteria: (1)Non-free directed medical students or those who did not sign the service contract.(2)Those who withdrew from the training with incomplete data for various reasons.(3)Those who were not willing to cooperate with the research study. Measures Questionnaire design The survey questionnaire was designed independently through literature review, group discussion, and expert consultation. The full English version of the questionnaire is provided in Supplementary Material aims to evaluate the implementation effect of RTMSs in Yunnan Province and assess their satisfaction with SRT. After informing the free targeted medical students about the purpose and content of the RTMSs questionnaire, data collection was conducted, and verbal consent was obtained. The questionnaire includes basic information about the targeted medical students, their awareness of standardized residency training, evaluation and assessment situations, and institutional satisfaction. The reliability of the questionnaire Cronbach's alpha coefficient of 0.887, and its validity is 0885, indicating good reliability and validity, allowing for further analysis. primary outcome : identification and future job intention. The primary indicators of our study were the identification of RTMSs, their enthusiasm for the training following the signing of the agreement, and their future career plans upon completion of the service period. The satisfaction scale comprised nine items, and the scale was subjected to a reliability test, resulting in a Cronbach's alpha coefficient of 0.858. The data collection process involved the utilization of a five-point Likert scale to evaluate the levels of satisfaction experienced by the participants. This scale ranged from 1(very dissatisfied), to 3(neutral), to 4(somewhat dissatisfied), and finally to5 (very satisfied). A score of ≥ 3 (median = 3) for each item was indicative of satisfaction with that particular aspect. The total score on the satisfaction scale ranges from 9 to 45. For the purposes of this study, participants with total scores of 27 or above were categorized as overall satisfied with the SRT, whereas participants with total scores of 27 or below were categorized as overall dissatisfied with the SRT. Secondary outcome: participation in training The training participation index comprised eight items, including the participants' level of support for the training, knowledge of the training standards, the hospital's training methods, the pass rate of the physician licence exam, and their psychological state during the training. The evaluation of each item was conducted using a five-point Likert scale, which delineated various levels of satisfaction as follows: 1(very dissatisfied), 2(somewhat satisfied), 3(neutral),4(mildly discontented), and 5(very satisfied). Covariates The identification of relevant factors was based on the following criteria: identity, intention to participate in future training, and hospital level(provincial-level/prefecture-level). The inclusion of additional factors was as follows: gender, age, marital status, and monthly income after tax (6,000). Statistical Analysis Data were analyzed using SPSS 26.0. Continuous variables are presented as mean ± SD, while categorical variables are expressed as proportions. Univariable analyses (χ² tests for categorical variables, independent t-tests for continuous variables) were conducted to preliminarily identify factors associated with training satisfaction among RTMSs. Variables with p < 0.05 in univariable analyses were entered into a multivariable logistic regression model to assess independent predictors, with results reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Multicollinearity was evaluated using variance inflation factors (VIFs), confirming no significant collinearity (VIF < 5). Missing data were excluded from the analysis. Statistical significance was defined as p < 0.05 (two-tailed). Data entry was performed using a dual-entry method to minimize potential bias. Clinical trial number Not applicable Results Demographic characteristics In the context of residency training, a survey was conducted. Initially, 685 students were enrolled. Subsequently, 42 students who were lost to follow - up were excluded for various reasons. The remaining students were from 4 provincial - level hospitals (298 students) and 4 local and municipal - level hospitals (345 students). Finally, a total of 643 free medical students were included in the analysis(Fig. 1). As illustrated in Table 1 , the demographic characteristics of the participants are delineated as follows: 280 (43.55%) of the participants were male, and 363 (56.45%) of the participants were female, with a mean age of (25.65 ± 1.26) years. The demographic composition of the sample was as follows: 98 participants were married, constituting 14.77% of the total, while 548 participants were unmarried, representing 85.23% of the total. Of the participants, 298 (46.35%) were drawn from provincial training hospitals, while 345 (53.65%) were from local training hospitals. With regard to the year of training, the numbers were as follows: 247 (38.41%) first year participants, 245 (38.10%) second year participants, and 151 (23.49%) third year participants. With regard to monthly income after tax, 115 participants (17.88%) received less than RMB 3,000, 135 participants (21.00%) received between RMB 3,000 and 4,500, and 227participants indicates that 35.30% of the participants earned between RMB 4,500 and RMB 6,000, while 25.82% of the participants earned more than RMB 6,000. Table 1 Demographic characteristics of the participants(N = 643) Demographic characteristic Frequency(n) Percent (%) Gender Male 280 43.55 Female 363 56.45 Age ≤ 23 9 1.40 24 ~ 26 485 75.43 27 ~ 29 144 22.40 ≥ 30 5 0.77 Marital status Unmarried 548 85.23 Married 95 14.77 Hierarchy of training hospital Provincial-level 298 46.35 Prefecture-level 345 53.65 Years of accepting training First-year 247 38.41 Second-year 245 38.10 Third-year 151 23.49 After-tax monthly income(CNY) 6 000 166 25.82 Training situation of RTMSs in SRT Among the participants, 587 (91.29%) expressed support for the SRT program. A total of 342 (53.19%) participants reported a complete understanding of the residency standards. The frequency of clinical skills training was reported as "≥1 time per month" by 469 (72.94%) participants. Regarding specialized academic lectures, 356 (55.37%) participants indicated a frequency of "≥1 time per month". A total of 427 (66.41%) participants reported participating in psychological counseling activities organized by the hospital. In terms of team-building activities, 321 (49.92%) participants stated that the hospital regularly organizes such events. Among the participants, 428 (66.56%) had passed the medical licensing examination. Furthermore, 326 (50.70%) participants reported a positive psychological state during the training period(Table 2 ). Table 2 Training situation of the participants in SRT Statements Frequency(n) Percent (%) Whether you support the SRT program.(N = 643) Yes 587 91.29 No 56 8.71 Level of understanding regarding the standards of SRT.(N = 643) Not familiar 43 6.69 Moderate 258 40.12 Fully acquainted 342 53.19 Frequency of participation in clinical skills training.(N = 643) More than once every two month 83 12.91 Once every two month 91 14.15 Once every month 213 33.13 Once every two weeks 81 12.60 Once every week 175 27.21 Frequency of participation in specialized academic lectures.(N = 643) More than once every two month 123 19.13 Once every two month 162 25.19 Once every month 218 33.90 Once every two weeks 41 6.38 Once every week 97 15.09 Whether you participate in psychological counseling activities organized by the hospital.(N = 643) Yes 427 66.41 No 216 33.59 Whether the hospital regularly organizes team-building activities.(N = 643) Yes 321 49.92 No 322 50.08 Whether you passed the medical licensing examination.(N = 643) Yes 428 66.56 No 215 33.44 Psychological state during the training period.(N = 643) Negative 44 6.84 Moderate 273 42.46 Positive 326 50.70 Identity and future work intentions Among the participants, 358 (55.68%) identified themselves as RTMSs and believed they could serve in areas of national need. A total of 108 (16.80%) participants stated that their identity as RTMSs influenced their training motivation. Regarding future work intentions, 299 (46.50%) participants expressed that they would not continue working in rural grassroots settings after completing their service period. Further investigation into the work intentions of these participants who planned to leave after their service period revealed that their main choices were pursuing further education (26.42%), taking civil service examinations (19.73%), and working in larger hospitals (53.85%). The Identity and future work intentions of RTMSs are presented in Table 3 . Table 3 Identity and future work intentions of the participants Statements Frequency(n) Percent (%) Whether you identified youself as a RTMS.(N = 643) Agree 358 55.68 Neutral 101 15.71 Disagreement 184 28.61 Whether the identity of being a RTMS affect the level of motivation in training.(N = 643) Significantly influential 44 6.84 Moderately influential 64 9.95 Neutral 232 36.08 Slightly influential 200 31.10 Not influential 97 16.03 Whether you choose to continue working in rural areas after the completion of the contractual service period.(N = 643) Yes 201 31.26 Undecided 143 22.24 No 299 46.50 Satisfaction with training The survey revealed that the overall average score for training satisfaction among the 643 participants was (3.03 ± 0.30) on a scale of 1 to 5. When examining specific items, the two highest-rated satisfaction items were "assessment methods during training" and "teaching/training content," while the two lowest-rated items were "living conditions at the training hospital" and "salary and benefits during training." The training satisfaction scores of RTMSs are presented in Table 4 . Table 4 Satisfaction rating of RTMSs towards SRT( ± ) Items Satisfaction rating Ranking Assessment methods of training 3.60 ± 0.76 1 Content of teaching and training 3.50 ± 0.85 2 Development of generalist thinking 3.48 ± 0.82 3 Overall effectiveness of training 3.28 ± 0.93 4 Teacher teaching level 3.08 ± 0.99 5 Teaching and training methods 2.65 ± 1.02 6 Hospital management level 2.63 ± 0.81 7 Living conditions at the training hospital 2.56 ± 0.88 8 Salary and benefits during training 2.51 ± 0.83 9 To investigate the factors influencing training satisfaction among RTMSs, a univariate analysis was performed on 16 potential factors, including gender, age, marital status, and others. The results indicated that there were no statistically significant differences in training satisfaction scores among RTMSs based on gender, age, marital status, and other factors (P > 0.05).However, statistically significant differences in training satisfaction scores were observed among RTMSs with different attitudes towards SRT, post-tax monthly income, self-perceived psychological state during training, frequency of hospital-organized clinical skills training, frequency of hospital-organized specialized lectures, participation in hospital-organized psychological counseling activities, engagement in regular team-building activities organized by the hospital, and levels of identity formation (P < 0.05). To conduct a multivariate logistic regression analysis, we used satisfaction with SRT as the dependent variable (0 = dissatisfied, 1 = satisfied), incorporating the eight factors identified as statistically significant in the univariate analysis as independent variables.The results indicated that higher post-tax monthly income, positive self-perceived psychological state during training, higher frequency of hospital-organized clinical skills training and specialized lectures, engagement in hospital-organized psychological counseling activities and regular team-building activities, and a stronger sense of identity among RTMSs were associated with higher levels of training satisfaction (P < 0.05). The factors influencing training satisfaction among RTMSs are presented in Table 5 . Table 5 Multivariable Logistic Regression Analysis of Factors Influencing Training Satisfaction Variables B S.E. Wald 2 OR 95%CI P After-tax monthly income(CNY).(Taking "<3 000" as a reference) 3 000 ~ 4 500 0.817 0.261 9.816 2.263 (1.358,2.263) 0.002 4 500 ~ 6 000 0.843 0.235 12.920 2.324 (1.467,3.681) 6 000 0.805 0.248 10.504 2.237 (1.375,3.640) 0.001 Psychological state during the training period.(Taking "Negative" as a reference) Moderate 0.971 0.330 8.664 2.640 (1.383,5.039) 0.003 Positive 2.040 0.343 35.287 7.691 (3.923,15.077) < 0.001 Frequency of participation in clinical skills training.(Taking "More than once every two month" as a reference) Once every two month 0.919 0.314 8.585 2.506 (1.355,4.633) 0.003 Once every month 0.748 0.226 10.952 2.113 (1.357,3.291) 0.001 Once every two weeks 2.206 0.421 27.480 9.080 (3.980,20.716) < 0.001 Once every month 1.650 0.370 19.930 5.207 (2.523,10.744) < 0.001 Frequency of participation in specialized academic lectures.(Taking "More than once every two month" as a reference) Once every two month -0.116 0.404 0.083 0.890 (0.404,1.964) 0.774 Once every month 0.342 0.262 1.701 1.408 (0.842,2.353) 0.192 Once every two weeks 1.118 0.306 13.380 3.060 (1.681,5.572) < 0.001 Once every month 1.304 0.332 15.429 3.683 (1.922,7.060) < 0.001 Psychological counseling activities organized by the hospital.(Taking "No" as a reference) No 0.796 0.190 17.467 2.216 (1.526,3.218) < 0.001 Hospital regularly organizes team-building activities(Taking "No" as a reference) No 1.191 0.201 35.259 3.291 (2.221,4.877) < 0.001 Whether you identified youself as a RTMS.(Taking "Disagreement" as a reference) Neutral -0.081 0.282 0.083 0.922 (0.530,1.603) 0.773 Agree 0.789 0.214 13.572 2.202 (1.447,3.351) < 0.001 Bold values:P < 0.05 DISCUSSION The present study employed a cross-sectional survey to investigate the factors influencing the satisfaction of RTMSs participating in standardized residency training in eight hospitals in Yunnan Province. The results of the study demonstrated that the majority of RTMSs reported a moderate level of overall satisfaction with their residency training. Furthermore, approximately half of the RTMSs were not willing to remain in rural grassroots positions at the conclusion of their service period. It was evident that the students had a strong awareness of the importance of enhancing their medical skills and contributing to the healthcare needs of the nation. The study revealed that a significant proportion of RTMSs expressed support for SRT, with 53.19% demonstrating a comprehensive understanding of its standards.Furthermore, the results indicated that 66.56% of students successfully passed the physician qualification examination, and a notable percentage (55.68%) expressed a willingness to serve in areas of need. In addition, studies have reported that medical education needs to provide continuous education and training covering knowledge skills, attitude change, and interprofessional collaboration[ 15 ].In addition, studies have also shown that the use of efficient learning methods by medical students is effective in developing their teamwork and communication skills, which in turn improves teamwork, communication skills, and perceptions of other health professionals[ 16 ]. RTMSs satisfaction with SRT was found to be low, with a mean score of (3.03 ± 0.30), ranging from "mildly discontented" to "moderately satisfied". This finding is consistent with the results of the Chongqing 2021 study, which demonstrated that the requirements of SRT were not being met in an adequate manner [ 17 ]. The primary factors contributing to this dissatisfaction were identified as the quality of hospital-based education, living conditions, and salary and benefits. A significant proportion of the participants, approximately 46.50%, expressed an intention to relinquish their employment in rural areas upon the termination of their contracts. This observation underscores the necessity for the implementation of enhanced training support systems. Factors related to satisfaction in SRT,The study established that the income level of RTMSs had a significant impact on their satisfaction with SRT, with RTMSs with higher monthly incomes exhibiting greater satisfaction. This finding aligns with the results of a 2020 study conducted in Gansu Province, which observed that low income was associated with diminished medical student satisfaction [ 18 ]. The participants were unmarried trainees with an average age of 25 years old, of which 74.18% had a monthly income of no more than 6000 RMB. The subjects were experiencing financial constraints, which meant that they were under pressure to purchase a home, commute, get married and have children. Research has demonstrated that high-frequency skills training and specialized lectures provided by hospitals have a significant impact on RTMSs' satisfaction with SRT. This phenomenon can be attributed to the correlation between an increase in clinical knowledge and skills among medical students and an enhancement in their level of satisfaction[ 19 ]. The importance of skills training and lectures in improving clinical skills and academic perspectives is well-documented, and is especially critical for future healthcare providers in rural areas. Consequently, an augmentation in the frequency of these training activities has the potential to enhance satisfaction among RTMSs. Research has demonstrated that medical students who maintain a positive mental state report higher levels of satisfaction during SRT, a finding that aligns with previous studies [ 20 ]. A positive mindset has been demonstrated to facilitate enhanced coping mechanisms with training stress, thereby leading to more effective outcomes. Moreover, the implementation of ideology development and team-building activities within healthcare facilities has been demonstrated to enhance the mental well-being of RTMSs and concomitantly improve their overall performance. [ 21 ] The present study hypothesises that identity exerts a significant influence on the satisfaction of RTMSs with regard to their residency training. A substantial body of research has demonstrated that intrinsic motivation and identity exert a considerable influence on the satisfaction of medical students with their training. This phenomenon may be associated with their sense of responsibility for rural services, as evidenced by several studies [ 22 , 23 ]. It is evident that rural healthcare organizations exhibit distinct variations in their work environments and remuneration structures when compared to their developed area counterparts. These disparities serve as a catalyst for the heightened engagement of students in their training programmers, thereby fostering a sense of identity that fosters increased satisfaction [ 24 ]. With regard to the study's strengths, it is a multicenter study with a large sample size that RTMSs. The number of questionnaire entries was substantial, and a Likert scale was employed to correlate satisfaction with other adjustable factors. Furthermore, analytical methods were employed in multivariate regression models to exclude independent variable confounders and to further analyse the influencing factors.Nevertheless, the study is not without its limitations. Firstly, The sample is mainly from RTMSs in rural areas of Yunnan Province. Given the huge geographical and policy differences in China, the results may be different from other regions.Given that this was a cross-sectional study, it was not possible to determine the causal relationship between free orientation medical students to standardized residency training and the variables. Secondly, a self-administered questionnaire was utilized to collect data, which may be subject to recall bias and information bias.In addition, the cross-sectional design cannot track long-term results, which makes it difficult to assess the dynamic impact or short-term satisfaction of training policies Conclusions The results of this study indicate that the majority of RTMSs have moderate overall satisfaction with their residency training. Furthermore, almost half of the RTMSs indicated that they do not intend to choose to remain in rural-based positions after fulfilling their contractual service period. In order to achieve the goals of the RTME programme, it is necessary to strengthen publicity, increase student willingness, increase training remuneration, optimize learning opportunities, improve the working environment, and improve the mobility mechanism to support RTMSs' career development. Abbreviations RTME Rural-oriented tuition-waived medical education RTMSs Rural-oriented tuition-waived medical students SRT Standardized residency training Declarations Ethics approval and consent to participate This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was waived by the Medical Research Ethics Committee of Kunming Medical University (approval number: KMMU2025MEC159), with the reason that neither clinical trials nor disclosure of personal privacy information were involved. All participants were voluntary and informed consent was obtained. Consent for publication Not Applicable Clinical trial number Not applicable Trial registration Not applicable. Availability of data and availability Data used to support the findings of this study are available from the corresponding author upon request. Competing interests The authors declare no competing interests. Funding The study was supported by the Joint Special Fund Project of Yunnan Provincial Department of Science and Technology and Kunming Medical University for Applied Basic Research (Grant No. 2018FE001).The funder had no role in the study design, data collection and analysis,interpretation of data, and writing the manuscript. Authors’ Contributors XingWang and Anye Lei performed the analysis and wrote the manuscript. Yingyurui Liu and Yali Li performed data collection and interpreted the results. Weiming Li and Qiaoyun Huang revised it critically for important intellectual content. Xing Wang and Anye Lei are the guarantors and are responsible for the overall content. All authors read and approved the final manuscript. Acknowledgements The authors wish to thank the anonymous reviewers,associate editors,and editors for their thoughtful reviews and suggestions for this manuscript.Thanks to the Yunnan Provincial Health Commission.We also thank the Questionnaire respondents for their cooperation. Authors’ affiliations 1 School of Public Health, Kunming Medical University, Kunming,Yunnan,China 2 Yunnan General Practice Training Center, Kunming,Yunnan,China 3 Haiyuan College of Kunming Medical University, Kunming,Yunnan,China Supplementary Information Supplementary Material 1. References Hulme A, Thompson J, Brown A ,Argus G. The need for a complex systems approach in rural health research. BMJ Open. 2022 Oct 3;12(10):e064646. Fox JL, Doolan TD, Gurney TM, McGrail MR. Short-term medical student placements completed consecutively at a rural general practice positively impact chronic disease management. Rural Remote Health. 2023 Apr;23(2):7611. Yang B. 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Supplementary Files SupplementaryMaterial1EnglishQuestionnaire.docx Cite Share Download PDF Status: Published Journal Publication published 26 Nov, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 16 Jul, 2025 Reviews received at journal 30 Jun, 2025 Reviews received at journal 27 Jun, 2025 Reviewers agreed at journal 13 Jun, 2025 Reviewers agreed at journal 13 Jun, 2025 Reviewers agreed at journal 12 Jun, 2025 Reviewers agreed at journal 11 Jun, 2025 Reviewers invited by journal 10 Jun, 2025 Editor assigned by journal 29 May, 2025 Submission checks completed at journal 25 May, 2025 First submitted to journal 25 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6576248","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":469883919,"identity":"c3b5bf3f-d903-4ab2-bc4d-838875e68470","order_by":0,"name":"Xing Wang","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xing","middleName":"","lastName":"Wang","suffix":""},{"id":469883920,"identity":"d2d28ad9-a64a-4d47-bf5f-40b4f15994c5","order_by":1,"name":"Anye Lei","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Anye","middleName":"","lastName":"Lei","suffix":""},{"id":469883921,"identity":"ad0c871f-ae95-492b-b810-567487279a0e","order_by":2,"name":"Qiaoyun Huang","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qiaoyun","middleName":"","lastName":"Huang","suffix":""},{"id":469883922,"identity":"76eeefe8-23ce-4566-9fb2-5128d01258f2","order_by":3,"name":"Yingyurui Liu","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yingyurui","middleName":"","lastName":"Liu","suffix":""},{"id":469883923,"identity":"12244572-1dad-4639-81cb-07222aae2899","order_by":4,"name":"Yali Li","email":"","orcid":"","institution":"Kunming Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yali","middleName":"","lastName":"Li","suffix":""},{"id":469883924,"identity":"9d0ecc30-3c74-48b8-a30e-a2484fb3afca","order_by":5,"name":"Weiming Li","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYBACPmYgkcAgwcAgf/7hg4SKGsJa2OBaJHiYDR6cOUaEFjhLgodN8mELMxFa2HkMHzzMsciTj+49VpHYwMbA396dQMBhPMYGidskig3vnEu7kbhDhkHizNkNBLTwbpMAaknc2JBgdiPxDBuDgUQuQS3bf8C0FCS2MROlZRsDSMt8iRwzBiK18H8GO2wDz7FkiYQzx3gI+oWf/1jix5/b6hLntzcf/PijokaOv70XvxY4MDgAoXmIUw4C8g3Eqx0Fo2AUjIIRBgDkS0ZLwj9CbgAAAABJRU5ErkJggg==","orcid":"","institution":"Haiyuan College of Kunming Medical University","correspondingAuthor":true,"prefix":"","firstName":"Weiming","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2025-05-02 07:23:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6576248/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6576248/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-025-08231-2","type":"published","date":"2025-11-26T15:57:24+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":84474033,"identity":"e00d4519-f8d8-439c-a07b-18f885e2e0c0","added_by":"auto","created_at":"2025-06-12 11:00:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25194,"visible":true,"origin":"","legend":"\u003cp\u003eFlow Chart of the Screening of RTMSs in 8 Residency Training Bases in Yunnan Province\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6576248/v1/7f2187763451936f3c2a88b3.png"},{"id":97178583,"identity":"f33c9e42-0c9f-42dc-850b-e2150709df2b","added_by":"auto","created_at":"2025-12-01 16:11:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":995280,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6576248/v1/7ab35387-9389-4805-a59d-1f29ff1709d4.pdf"},{"id":84474485,"identity":"e298347b-6439-4498-b643-2fbedb5b5646","added_by":"auto","created_at":"2025-06-12 11:08:23","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":18190,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial1EnglishQuestionnaire.docx","url":"https://assets-eu.researchsquare.com/files/rs-6576248/v1/d2a197ad85dbf609e233794f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAnalysis of Standardized Training for Free Medical Students from Rural Areas in Yunnan Province: A Multi-center Cross-sectional Survey\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eA global shortage of human resources for primary health care and health is especially prevalent in rural and remote areas. This predicament exerts a substantial influence on the health development of the local population, consequently engendering deficiencies in the timely diagnosis and treatment of prevalent diseases and impeding the implementation of public health programmers[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This, in turn, engenders the emergence of more profound health complications. In order to address this challenge, countries have continued to optimize the system of general medicine training, improve the system of standardized residency training, and implement a talent training model in which medical students remain at the grassroots level. For instance, the \"5\u0026thinsp;+\u0026thinsp;2\u0026thinsp;+\u0026thinsp;3\" model in the United Kingdom and the training system in Australia are both relatively mature and undergoing rapid development. A number of relevant studies have analyzed the training of medical personnel in these countries and found that focusing on trainees' stressors and mental health to enhance training effectiveness[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], as well as practice-based learning and improvement programs to motivate students to take the initiative to learn, has improved the effectiveness of residency training[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe RTME programme provides financial support in the form of tuition waivers and living grants, with the objective of training general practitioners for rural areas in China. The programme mandates that graduates commit to a six-year tenure in township health centers, complemented by a three-year commitment to SRT. SRT in Yunnan Province has been piloted since the 1980s[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and a standardized training system covering 34 specialties was fully established in 2013 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].In 2015, the training requirements were further standardized [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and by 2020 a relatively uniform and standardized residency training model was formed [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. At present, the number of RTMSs who have successfully completed standardized residency training in Yunnan Province exceeds 7,000, a development which has had a significant impact on the local primary care situation.\u003c/p\u003e \u003cp\u003eThe distribution of medical professionals between urban and rural areas in China is imbalanced, and the shortage of primary medical personnel has seriously constrained the improvement of rural medical services [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. It is evident that rural physicians constitute a mere 14.98% of the total number of practising physicians in the country [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Research has indicated that RTMSs exhibit low levels of satisfaction and a limited willingness to pursue a career in rural areas following their participation in residency training programmes [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In Yunnan Province, the participation rate of RTMSs in SRT is approximately 85%, but the dropout rate is as high as 8\u0026ndash;10%. Research shows that medical students consider career opportunities and workplace to be the most important, and they also want diversity such as fair pay, reasonable hours, autonomy, etc [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Furthermore, the concentration of SRT bases in provincial centres gives rise to elevated transportation costs and constrained training opportunities for Yunnan RTMSs in remote areas, and grassroots training that places greater emphasis on clinical operations than on theoretical instruction [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. It has been demonstrated that RTMSs in Yunnan have expressed a lower level of satisfaction with SRT in comparison to their counterparts in developed eastern regions. The investigation has identified that career development pathways and mentorship are pivotal factors in determining satisfaction levels [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].However, there are fewer studies on the relationship between RTMSs' satisfaction and salary income, training activities, psychological status, and self-identity. Therefore, this study focused on eight hospitals in Yunnan Province to conduct a cross-sectional survey on RTMSs' participation in SRT, to analyze their training status and satisfaction levels, and to explore the mechanisms of influence of the SRT program.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign, setting, and participants\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted in June 2022, and a multicenter survey study was undertaken. A total of eight hospitals were ultimately included in the study, four of which were provincial and four prefecture. The selection of hospitals was conducted through a stratified sampling method, with the recruitment criteria encompassing the stratification and geographic distribution of general hospitals' general practice residency training bases at the provincial and prefecture levels within Yunnan Province. Additionally, the operational capacity of the training programs was considered, along with data on the enrolment and graduation rates of RTMSs and the availability of qualified general practice trainers. The study incorporated a total of 643 RTMSs. It should be noted that this is a non-interventional observational study focusing on educational methods for a non-patient population in medical education. Since it involves no direct medical interventions on human subjects, there is no applicable clinical trial registration number.To protect the privacy of the interviewees, an anonymous approach was used.The inclusion criteria for the study are as follows: (1)Free-order medical students participating in SRT;(2)Training in designated hospitals and the capacity to provide complete training record data;(3)Voluntary participation in the study and the signing of informed consent. Exclusion criteria: (1)Non-free directed medical students or those who did not sign the service contract.(2)Those who withdrew from the training with incomplete data for various reasons.(3)Those who were not willing to cooperate with the research study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire design\u003c/h2\u003e \u003cp\u003eThe survey questionnaire was designed independently through literature review, group discussion, and expert consultation. The full English version of the questionnaire is provided in Supplementary Material aims to evaluate the implementation effect of RTMSs in Yunnan Province and assess their satisfaction with SRT. After informing the free targeted medical students about the purpose and content of the RTMSs questionnaire, data collection was conducted, and verbal consent was obtained. The questionnaire includes basic information about the targeted medical students, their awareness of standardized residency training, evaluation and assessment situations, and institutional satisfaction. The reliability of the questionnaire Cronbach's alpha coefficient of 0.887, and its validity is 0885, indicating good reliability and validity, allowing for further analysis.\u003c/p\u003e \u003cp\u003e \u003cb\u003eprimary outcome : identification and future job intention.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe primary indicators of our study were the identification of RTMSs, their enthusiasm for the training following the signing of the agreement, and their future career plans upon completion of the service period. The satisfaction scale comprised nine items, and the scale was subjected to a reliability test, resulting in a Cronbach's alpha coefficient of 0.858. The data collection process involved the utilization of a five-point Likert scale to evaluate the levels of satisfaction experienced by the participants. This scale ranged from 1(very dissatisfied), to 3(neutral), to 4(somewhat dissatisfied), and finally to5 (very satisfied). A score of \u0026ge;\u0026thinsp;3 (median\u0026thinsp;=\u0026thinsp;3) for each item was indicative of satisfaction with that particular aspect. The total score on the satisfaction scale ranges from 9 to 45. For the purposes of this study, participants with total scores of 27 or above were categorized as overall satisfied with the SRT, whereas participants with total scores of 27 or below were categorized as overall dissatisfied with the SRT.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSecondary outcome: participation in training\u003c/h3\u003e\n\u003cp\u003eThe training participation index comprised eight items, including the participants' level of support for the training, knowledge of the training standards, the hospital's training methods, the pass rate of the physician licence exam, and their psychological state during the training. The evaluation of each item was conducted using a five-point Likert scale, which delineated various levels of satisfaction as follows: 1(very dissatisfied), 2(somewhat satisfied), 3(neutral),4(mildly discontented), and 5(very satisfied).\u003c/p\u003e\n\u003ch3\u003eCovariates\u003c/h3\u003e\n\u003cp\u003eThe identification of relevant factors was based on the following criteria: identity, intention to participate in future training, and hospital level(provincial-level/prefecture-level). The inclusion of additional factors was as follows: gender, age, marital status, and monthly income after tax (\u0026lt;\u0026thinsp;3,000/3,000\u0026ndash;4,500/4,500-6,000/\u0026gt;6,000).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS 26.0. Continuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, while categorical variables are expressed as proportions. Univariable analyses (χ\u0026sup2; tests for categorical variables, independent t-tests for continuous variables) were conducted to preliminarily identify factors associated with training satisfaction among RTMSs. Variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in univariable analyses were entered into a multivariable logistic regression model to assess independent predictors, with results reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Multicollinearity was evaluated using variance inflation factors (VIFs), confirming no significant collinearity (VIF\u0026thinsp;\u0026lt;\u0026thinsp;5). Missing data were excluded from the analysis. Statistical significance was defined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (two-tailed). Data entry was performed using a dual-entry method to minimize potential bias.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eClinical trial number\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eNot applicable\u003c/h2\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics\u003c/h2\u003e \u003cp\u003eIn the context of residency training, a survey was conducted. Initially, 685 students were enrolled. Subsequently, 42 students who were lost to follow - up were excluded for various reasons. The remaining students were from 4 provincial - level hospitals (298 students) and 4 local and municipal - level hospitals (345 students). Finally, a total of 643 free medical students were included in the analysis(Fig.\u0026nbsp;1). As illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the demographic characteristics of the participants are delineated as follows: 280 (43.55%) of the participants were male, and 363 (56.45%) of the participants were female, with a mean age of (25.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26) years. The demographic composition of the sample was as follows: 98 participants were married, constituting 14.77% of the total, while 548 participants were unmarried, representing 85.23% of the total. Of the participants, 298 (46.35%) were drawn from provincial training hospitals, while 345 (53.65%) were from local training hospitals. With regard to the year of training, the numbers were as follows: 247 (38.41%) first year participants, 245 (38.10%) second year participants, and 151 (23.49%) third year participants. With regard to monthly income after tax, 115 participants (17.88%) received less than RMB 3,000, 135 participants (21.00%) received between RMB 3,000 and 4,500, and 227participants indicates that 35.30% of the participants earned between RMB 4,500 and RMB 6,000, while 25.82% of the participants earned more than RMB 6,000.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the participants(N\u0026thinsp;=\u0026thinsp;643)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic characteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u0026thinsp;~\u0026thinsp;26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e485\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u0026thinsp;~\u0026thinsp;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e548\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85.23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHierarchy of training hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProvincial-level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrefecture-level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e345\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears of accepting training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst-year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond-year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird-year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfter-tax monthly income(CNY)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;3 000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 000\u0026thinsp;~\u0026thinsp;4 500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 500\u0026thinsp;~\u0026thinsp;6 000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6 000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTraining situation of RTMSs in SRT\u003c/h2\u003e \u003cp\u003eAmong the participants, 587 (91.29%) expressed support for the SRT program. A total of 342 (53.19%) participants reported a complete understanding of the residency standards. The frequency of clinical skills training was reported as \"\u0026ge;1 time per month\" by 469 (72.94%) participants. Regarding specialized academic lectures, 356 (55.37%) participants indicated a frequency of \"\u0026ge;1 time per month\". A total of 427 (66.41%) participants reported participating in psychological counseling activities organized by the hospital. In terms of team-building activities, 321 (49.92%) participants stated that the hospital regularly organizes such events. Among the participants, 428 (66.56%) had passed the medical licensing examination. Furthermore, 326 (50.70%) participants reported a positive psychological state during the training period(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTraining situation of the participants in SRT\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatements\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether you support the SRT program.(N\u0026thinsp;=\u0026thinsp;643)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e587\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of understanding regarding the standards of SRT.(N\u0026thinsp;=\u0026thinsp;643)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot familiar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFully acquainted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of participation in clinical skills training.(N\u0026thinsp;=\u0026thinsp;643)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than once every two month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every two month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every two weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of participation in specialized academic lectures.(N\u0026thinsp;=\u0026thinsp;643)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore than once every two month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every two month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every two weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.09\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether you participate in psychological counseling activities organized by the hospital.(N\u0026thinsp;=\u0026thinsp;643)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e427\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether the hospital regularly organizes team-building activities.(N\u0026thinsp;=\u0026thinsp;643)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether you passed the medical licensing examination.(N\u0026thinsp;=\u0026thinsp;643)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychological state during the training period.(N\u0026thinsp;=\u0026thinsp;643)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eIdentity and future work intentions\u003c/h2\u003e \u003cp\u003eAmong the participants, 358 (55.68%) identified themselves as RTMSs and believed they could serve in areas of national need. A total of 108 (16.80%) participants stated that their identity as RTMSs influenced their training motivation. Regarding future work intentions, 299 (46.50%) participants expressed that they would not continue working in rural grassroots settings after completing their service period. Further investigation into the work intentions of these participants who planned to leave after their service period revealed that their main choices were pursuing further education (26.42%), taking civil service examinations (19.73%), and working in larger hospitals (53.85%). The Identity and future work intentions of RTMSs are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIdentity and future work intentions of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatements\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether you identified youself as a RTMS.(N\u0026thinsp;=\u0026thinsp;643)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagreement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether the identity of being a RTMS affect the level of motivation in training.(N\u0026thinsp;=\u0026thinsp;643)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificantly influential\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerately influential\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSlightly influential\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot influential\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhether you choose to continue working in rural areas after the completion of the contractual service period.(N\u0026thinsp;=\u0026thinsp;643)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUndecided\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSatisfaction with training\u003c/h2\u003e \u003cp\u003eThe survey revealed that the overall average score for training satisfaction among the 643 participants was (3.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30) on a scale of 1 to 5. When examining specific items, the two highest-rated satisfaction items were \"assessment methods during training\" and \"teaching/training content,\" while the two lowest-rated items were \"living conditions at the training hospital\" and \"salary and benefits during training.\" The training satisfaction scores of RTMSs are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSatisfaction rating of RTMSs towards SRT(\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u0026plusmn;\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSatisfaction rating\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRanking\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssessment methods of training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.60\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContent of teaching and training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDevelopment of generalist thinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall effectiveness of training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeacher teaching level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching and training methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital management level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.63\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving conditions at the training hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSalary and benefits during training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTo investigate the factors influencing training satisfaction among RTMSs, a univariate analysis was performed on 16 potential factors, including gender, age, marital status, and others. The results indicated that there were no statistically significant differences in training satisfaction scores among RTMSs based on gender, age, marital status, and other factors (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).However, statistically significant differences in training satisfaction scores were observed among RTMSs with different attitudes towards SRT, post-tax monthly income, self-perceived psychological state during training, frequency of hospital-organized clinical skills training, frequency of hospital-organized specialized lectures, participation in hospital-organized psychological counseling activities, engagement in regular team-building activities organized by the hospital, and levels of identity formation (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eTo conduct a multivariate logistic regression analysis, we used satisfaction with SRT as the dependent variable (0\u0026thinsp;=\u0026thinsp;dissatisfied, 1\u0026thinsp;=\u0026thinsp;satisfied), incorporating the eight factors identified as statistically significant in the univariate analysis as independent variables.The results indicated that higher post-tax monthly income, positive self-perceived psychological state during training, higher frequency of hospital-organized clinical skills training and specialized lectures, engagement in hospital-organized psychological counseling activities and regular team-building activities, and a stronger sense of identity among RTMSs were associated with higher levels of training satisfaction (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The factors influencing training satisfaction among RTMSs are presented in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable Logistic Regression Analysis of Factors Influencing Training Satisfaction\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eS.E.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWald\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95%CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eAfter-tax monthly income(CNY).(Taking \"\u0026lt;3 000\" as a reference)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 000\u0026thinsp;~\u0026thinsp;4 500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.817\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.816\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.263\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(1.358,2.263)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4 500\u0026thinsp;~\u0026thinsp;6 000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.920\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.324\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(1.467,3.681)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;6 000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.805\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.237\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(1.375,3.640)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003ePsychological state during the training period.(Taking \"Negative\" as a reference)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.664\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.640\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(1.383,5.039)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(3.923,15.077)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eFrequency of participation in clinical skills training.(Taking \"More than once every two month\" as a reference)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every two month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.585\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(1.355,4.633)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.952\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(1.357,3.291)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every two weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.421\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.480\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(3.980,20.716)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.650\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.930\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(2.523,10.744)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eFrequency of participation in specialized academic lectures.(Taking \"More than once every two month\" as a reference)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every two month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.404,1.964)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.774\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.701\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.408\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.842,2.353)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every two weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.380\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(1.681,5.572)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnce every month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(1.922,7.060)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003ePsychological counseling activities organized by the hospital.(Taking \"No\" as a reference)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.796\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(1.526,3.218)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eHospital regularly organizes team-building activities(Taking \"No\" as a reference)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(2.221,4.877)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eWhether you identified youself as a RTMS.(Taking \"Disagreement\" as a reference)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.922\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.530,1.603)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.773\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.572\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(1.447,3.351)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003cp\u003eBold values:P\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe present study employed a cross-sectional survey to investigate the factors influencing the satisfaction of RTMSs participating in standardized residency training in eight hospitals in Yunnan Province. The results of the study demonstrated that the majority of RTMSs reported a moderate level of overall satisfaction with their residency training. Furthermore, approximately half of the RTMSs were not willing to remain in rural grassroots positions at the conclusion of their service period.\u003c/p\u003e \u003cp\u003eIt was evident that the students had a strong awareness of the importance of enhancing their medical skills and contributing to the healthcare needs of the nation. The study revealed that a significant proportion of RTMSs expressed support for SRT, with 53.19% demonstrating a comprehensive understanding of its standards.Furthermore, the results indicated that 66.56% of students successfully passed the physician qualification examination, and a notable percentage (55.68%) expressed a willingness to serve in areas of need. In addition, studies have reported that medical education needs to provide continuous education and training covering knowledge skills, attitude change, and interprofessional collaboration[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].In addition, studies have also shown that the use of efficient learning methods by medical students is effective in developing their teamwork and communication skills, which in turn improves teamwork, communication skills, and perceptions of other health professionals[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRTMSs satisfaction with SRT was found to be low, with a mean score of (3.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.30), ranging from \"mildly discontented\" to \"moderately satisfied\". This finding is consistent with the results of the Chongqing 2021 study, which demonstrated that the requirements of SRT were not being met in an adequate manner [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The primary factors contributing to this dissatisfaction were identified as the quality of hospital-based education, living conditions, and salary and benefits. A significant proportion of the participants, approximately 46.50%, expressed an intention to relinquish their employment in rural areas upon the termination of their contracts. This observation underscores the necessity for the implementation of enhanced training support systems.\u003c/p\u003e \u003cp\u003eFactors related to satisfaction in SRT,The study established that the income level of RTMSs had a significant impact on their satisfaction with SRT, with RTMSs with higher monthly incomes exhibiting greater satisfaction. This finding aligns with the results of a 2020 study conducted in Gansu Province, which observed that low income was associated with diminished medical student satisfaction [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The participants were unmarried trainees with an average age of 25 years old, of which 74.18% had a monthly income of no more than 6000 RMB. The subjects were experiencing financial constraints, which meant that they were under pressure to purchase a home, commute, get married and have children.\u003c/p\u003e \u003cp\u003eResearch has demonstrated that high-frequency skills training and specialized lectures provided by hospitals have a significant impact on RTMSs' satisfaction with SRT. This phenomenon can be attributed to the correlation between an increase in clinical knowledge and skills among medical students and an enhancement in their level of satisfaction[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The importance of skills training and lectures in improving clinical skills and academic perspectives is well-documented, and is especially critical for future healthcare providers in rural areas. Consequently, an augmentation in the frequency of these training activities has the potential to enhance satisfaction among RTMSs.\u003c/p\u003e \u003cp\u003eResearch has demonstrated that medical students who maintain a positive mental state report higher levels of satisfaction during SRT, a finding that aligns with previous studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. A positive mindset has been demonstrated to facilitate enhanced coping mechanisms with training stress, thereby leading to more effective outcomes. Moreover, the implementation of ideology development and team-building activities within healthcare facilities has been demonstrated to enhance the mental well-being of RTMSs and concomitantly improve their overall performance. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe present study hypothesises that identity exerts a significant influence on the satisfaction of RTMSs with regard to their residency training. A substantial body of research has demonstrated that intrinsic motivation and identity exert a considerable influence on the satisfaction of medical students with their training. This phenomenon may be associated with their sense of responsibility for rural services, as evidenced by several studies [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. It is evident that rural healthcare organizations exhibit distinct variations in their work environments and remuneration structures when compared to their developed area counterparts. These disparities serve as a catalyst for the heightened engagement of students in their training programmers, thereby fostering a sense of identity that fosters increased satisfaction [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith regard to the study's strengths, it is a multicenter study with a large sample size that RTMSs. The number of questionnaire entries was substantial, and a Likert scale was employed to correlate satisfaction with other adjustable factors. Furthermore, analytical methods were employed in multivariate regression models to exclude independent variable confounders and to further analyse the influencing factors.Nevertheless, the study is not without its limitations. Firstly, The sample is mainly from RTMSs in rural areas of Yunnan Province. Given the huge geographical and policy differences in China, the results may be different from other regions.Given that this was a cross-sectional study, it was not possible to determine the causal relationship between free orientation medical students to standardized residency training and the variables. Secondly, a self-administered questionnaire was utilized to collect data, which may be subject to recall bias and information bias.In addition, the cross-sectional design cannot track long-term results, which makes it difficult to assess the dynamic impact or short-term satisfaction of training policies\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe results of this study indicate that the majority of RTMSs have moderate overall satisfaction with their residency training. Furthermore, almost half of the RTMSs indicated that they do not intend to choose to remain in rural-based positions after fulfilling their contractual service period. In order to achieve the goals of the RTME programme, it is necessary to strengthen publicity, increase student willingness, increase training remuneration, optimize learning opportunities, improve the working environment, and improve the mobility mechanism to support RTMSs' career development.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRTME\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRural-oriented tuition-waived medical education\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRTMSs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRural-oriented tuition-waived medical students\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSRT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandardized residency training\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was waived by the Medical Research Ethics Committee of Kunming Medical University (approval number: KMMU2025MEC159), with the reason that neither clinical trials nor disclosure of personal privacy information were involved. All participants were voluntary and informed consent was obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eTrial registration\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and availability\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData used to support the findings of this study are available from the \u0026nbsp; corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study was supported by the Joint Special Fund Project of Yunnan Provincial Department of Science and Technology and Kunming Medical University for Applied Basic Research (Grant No. 2018FE001).The funder had no role in the study design, data collection and analysis,interpretation of data, and writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributors\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eXingWang and Anye Lei performed the analysis and wrote the manuscript. \u0026nbsp;Yingyurui Liu and Yali Li performed data collection and interpreted the results. Weiming Li and Qiaoyun Huang revised it critically for important intellectual content. Xing Wang and Anye Lei are the guarantors and are responsible for the overall content. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank the anonymous reviewers,associate editors,and editors for their thoughtful reviews and suggestions for this manuscript.Thanks to the Yunnan Provincial Health Commission.We also thank the Questionnaire respondents for their cooperation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; affiliations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003eSchool of Public Health, Kunming Medical University, Kunming,Yunnan,China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eYunnan General Practice Training Center, Kunming,Yunnan,China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003eHaiyuan College of Kunming Medical University, Kunming,Yunnan,China\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSupplementary Material 1.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHulme A, Thompson J, Brown A ,Argus G. The need for a complex systems approach in rural health research. BMJ Open. 2022 Oct 3;12(10):e064646. \u003c/li\u003e\n\u003cli\u003eFox JL, Doolan TD, Gurney TM, McGrail MR. Short-term medical student placements completed consecutively at a rural general practice positively impact chronic disease management. Rural Remote Health. 2023 Apr;23(2):7611.\u003c/li\u003e\n\u003cli\u003eYang B. Application of practice-based learning and improvement in standardized training of general practitioners. BMC Med Educ. 2024 Mar 1;24(1):214. \u003c/li\u003e\n\u003cli\u003eZhu J, Li W, Chen L. Doctors in China: improving quality through modernisation of residency education. Lancet 2016;388:1922-1929. \u003c/li\u003e\n\u003cli\u003eNational Health and Family Planning Commission. Measures for the Administration of Standardized Training of Resident Physicians (for Trial Implementation)[EB/OL]. (2014-08-22)[2025-04-30]. \u003c/li\u003e\n\u003cli\u003eGao Q, Li R, Xia Z,Qu X, Jiang L. Factors associated with graduation examination results from standardized residency training in Zhejiang Province, China: a cross-sectional analysis of medical examination results data from 2020. BMJ Open. 2023 Jul 12;13(7):e066167. \u003c/li\u003e\n\u003cli\u003eMorgan C, Jolles S, Ponsford M, Evans K, Carne E. Immunodeficient patient experience of emergency switch from intravenous to rapid push subcutaneous immunoglobulin replacement therapy during coronavirus disease 2019 shielding. Current opinion in allergy and clinical immunology 2022;22(6):371\u0026ndash;379. \u003c/li\u003e\n\u003cli\u003eTang Q, Zhang D, Chen J, Liu M, Xiang Y, Luo T , et al. Tests on a scale for measuring the core competencies of paediatric specialist nurses: An exploratory quantitative study. Nursing open 2023;10(8):5098\u0026ndash;5107. \u003c/li\u003e\n\u003cli\u003eYuan C, Dong Y, Chen H , Ma L, Jia L, Luo J,et al.Public health interventions against childhood obesity in China. Lancet Public Health. 2024 Dec;9(12):e1115-e1124.\u003c/li\u003e\n\u003cli\u003eZhao S, Wang Y, Chen Y ,Zhou M,Li H. Healthcare resource allocation and patient choice: evidence from rural China. Int J Equity Health. 2025 Mar 31;24(1):87. \u003c/li\u003e\n\u003cli\u003eNational Bureau of Statistics of China. [Internet]. Available from: http://www.stats.gov.cn/ [Accessed 1 January 2023].\u003c/li\u003e\n\u003cli\u003eTian Z, Guo W, Zhai M, Li H. Job preference of preventive medicine students during the COVID-19 pandemic: a discrete choice experiment survey in Shandong Province, China. BMC medical education, 2023, 23(1): 890.\u003c/li\u003e\n\u003cli\u003eLei A Y,Huang Q Y,Liu Y Y R,Li YL,Zi R, et al.Survey and analysis of the current situation of teaching management of residency standardized training bases in Yunnan Province based on the evaluation perspective of teaching teachers.Soft Science of Health.2023;11(37):76-82. \u003c/li\u003e\n\u003cli\u003eGao J, Zhang J, Shi C, Fan A, Zhang P. Factors influencing reselection of village doctors in rural-oriented tuition-waived medical education program in Shanghai, China: a cross-sectional study. Front Public Health. 2025 Jan 20;12:1511709. \u003c/li\u003e\n\u003cli\u003eMichielsen L,Bischoff E,Schermer T,Laurant M.Primary healthcare competencies needed in the management of person-centred integrated care for chronic illness and multimorbidity: Results of a scoping review. BMC primary care, 2023, 24(1): 98. \u003c/li\u003e\n\u003cli\u003eKim S, Jeong H, Cho H, Yu J. Extracurricular activities in medical education: an integrative literature review. BMC medical education, 2023, 23(1): 278. \u003c/li\u003e\n\u003cli\u003eLi Q,Huang J,Wang WL.Teaching practice and exploration of standardized training in general practice specialty.China Continuing Medical Education, 2024, 16 (22): 194-198.\u003c/li\u003e\n\u003cli\u003eSerraino R, Owachi D, Byekwaso S, Namara CM, Naigambi K, Castelli F, et al. From the Global North to the Global South: preparing students for away rotations. BMC medical education 2023;23(1):102. \u003c/li\u003e\n\u003cli\u003eSmith J, Brown K, Lee R. Clinical competency and trainee satisfaction: A longitudinal study of medical education outcomes. Acad Med 2021;96(5):720-8. \u003c/li\u003e\n\u003cli\u003eHou J, He Y, Zhao X, Thai J, Fan M, Feng Y, et al. The effects of job satisfaction and psychological resilience on job performance among residents of the standardized residency training: a nationwide study in China. Psychol Health Med 2020;25(9):1106-18. \u003c/li\u003e\n\u003cli\u003eRobins-Browne K, Lewis M, Burchill L, Gilbert C, Johnson C, O\u0026apos;Donnell M,et al. Interventions to support the mental health and well-being of front-line healthcare workers in hospitals during pandemics: an evidence review and synthesis. BMJ open 2022;12(11):e061317.\u003c/li\u003e\n\u003cli\u003eChen Q, Li M, Wu N,Peng X, Tang G, Cheng H,et al. A survey of resident physicians\u0026apos; perceptions of competency-based education in standardized resident training in China: a preliminary study. BMC Med Educ 2022;22(1):801. \u003c/li\u003e\n\u003cli\u003eTang L, Yang H, Mao Z,Li Q, Li S.The negative factors influencing the career intention of general practice trainees in eastern China: a qualitative study. BMC Med Educ 2022;22(1):393. \u003c/li\u003e\n\u003cli\u003eBarati JM, Ghorbani B, Khalid M, Lotfata A, Tabesh H. Impact assessment of e-trainings in occupational safety and health: a literature review. BMC public health 2023;23(1):1187.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Standardized training, general practitioner, Free medical education","lastPublishedDoi":"10.21203/rs.3.rs-6576248/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6576248/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003ePrimary health care personnel worldwide are confronted with challenges including a paucity of personnel, imbalanced regional development and unstandardized services. Rural-oriented tuition-waived medical students (RTMSs) play a crucial role as the main body of Standardized residency training (SRT) in enhancing primary healthcare capabilities and achieving universal health coverage and sustainable development goals.To date, there has been a relative paucity of research, both nationally and internationally, on \u0026nbsp;rural-oriented tuition-waived medical students (RTMSs) in primary health care workforce development. The present dissertation focuses on the analysis of factors influencing the training satisfaction of medical students in rural areas who are targeted by the programme in eight hospitals in Yunnan Province.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e A multicenter cross-sectional observational study was conducted in June 2022 in eight hospitals in Yunnan Province, and a questionnaire survey was administered to 643 RTMS participating in the SRT program. The data were analyzed using descriptive analysis and analytical statistics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e The study revealed that 91.29% of respondents expressed support for standardized residency training(SRT), with 45.37% of respondents believing that it has the potential to enhance medical skills. However, 46.50% of respondents indicated that they would not continue working in rural grassroots settings after completing their contractual services. The survey revealed that training hospitals exhibited the lowest levels of satisfaction with living conditions and salary. This was associated with several factors, including expectations of higher income, positive psychological state, frequent skills training and lectures, regular counselling and team-building activities, and identification with the status of rural-oriented tuition-waived medical students (RTMSs).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eIt is crucial for rural-oriented tuition-waived medical students (RTMSs) to improve their medical skills through standardized residency training (SRT) Enhancing their engagement and satisfaction in SRT, and encouraging them to stay in rural areas, will more effectively achieve the goals of the rural-oriented tuition-free medical education (RTME).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number \u003c/strong\u003eNot applicable\u003c/p\u003e","manuscriptTitle":"Analysis of Standardized Training for Free Medical Students from Rural Areas in Yunnan Province: A Multi-center Cross-sectional Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-12 11:00:18","doi":"10.21203/rs.3.rs-6576248/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-16T06:31:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-30T18:07:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-28T03:50:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7694877320019188793776732656188816623","date":"2025-06-13T12:54:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139142756118129449427184056300619465936","date":"2025-06-13T09:16:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"331562709653542171075670144436600375960","date":"2025-06-13T03:55:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"286690920458978863584247368562860902335","date":"2025-06-11T05:04:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-10T14:02:42+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-29T15:32:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-25T07:44:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-05-25T07:43:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f1570ffe-4d45-4ce6-8d94-f21e10d679ab","owner":[],"postedDate":"June 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T16:04:34+00:00","versionOfRecord":{"articleIdentity":"rs-6576248","link":"https://doi.org/10.1186/s12909-025-08231-2","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-11-26 15:57:24","publishedOnDateReadable":"November 26th, 2025"},"versionCreatedAt":"2025-06-12 11:00:18","video":"","vorDoi":"10.1186/s12909-025-08231-2","vorDoiUrl":"https://doi.org/10.1186/s12909-025-08231-2","workflowStages":[]},"version":"v1","identity":"rs-6576248","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6576248","identity":"rs-6576248","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}