Medical Education Program with Obligatory Remote Area Services:Factors associated with academic performance,obligation compliance, and retention.

• Main Authors: Yi-ling Yao, 姚依玲
• Other Authors: Nicole Huang
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/37338974202157214069

碩士 === 國立陽明大學 === 醫務管理研究所 === 101 === Medical manpower shortage in remote areas has always been an important public health issue. Various political, economic and educational efforts have been made to address the issue internationally and domestically. Taiwan is no exception. In 1968, due to unique ethnic backgrounds, and distinctive geographic environment (mountains and outlying islands) in Taiwan, a government-sponsored medical education program was launched to cultivate students with aborigine background or outlying island residence. The students graduating from this program have later become the most important source of medical manpower in mountains and outlying islands. This medical education program has been implemented for over four decades. To comprehend the effects of the policy, the students enrolled in this program between 1969 and 2006 were chosen as research subjects and classified into four professional groups: 1.doctors; 2.dentists; 3.nurses; 4.others. Related performance and practice information of the program students, which is collected and managed by the “Medical Management System” of the Department of Health in Taiwan, was reviewed. Three main aspects of student’s performance and practice decisions were evaluated: professional performance (graduation, acquisition of medical personnel certificate; acquisition of board-certified specialty certificate), fulfillment of obligatory commitment, and retention following obligatory commitment. The results of the study showed that over 90% of the program students graduated. Specific graduation rates were 91.3%, 83.3%, 99.1% and 92.2% for medical students, dental students, nursing students and other students, respectively. An exceedingly high dropout rate (78.4%) was observed among dental students with aborigine background. The average rate of passing the licensure test was over 80% (85.5%). Specific performance of each group was: 86.5%, 81.3%, 88.3%, and 75% for medical students, dental students, nursing students and other students, respectively. Among medical students, females were significantly less likely to pass a licensure test than males (OR=0.08). Among nursing student, those from outlying islands were significantly more likely to pass the licensure exam than aboriginal students (OR=2.66). Medical students of the program tended to choose specialties such as family medicine, internal medicine and surgery. They seldom chose emergency and critical care, gynecology and pediatrics. Furthermore, age at graduation, gender, and location of medical school were significant predictors of passing board-certified exams. Among those who passed the licensure exam, over 90% honored their obligatory commitment. Over 80% of those students stayed in the remote areas or outlying islands after their obligatory service years. Students trained in the non-Northern medical schools (OR=3.04), and students originally from outlying islands were significantly more likely to remain in their service areas. The findings suggest that this medical education program has successfully cultivated medical professionals for remote areas. The performances of the program enrollees were comparable to other students of medical and health disciplines. The retention rates were high, but varied by types of medical professions. The findings can serve as an important reference to policy makers in improving supply of medical manpower in remote areas.