Systematic Review Research on education of graduates of bonded medical program for rural health in China: A systematic review

Abstract

Background: The government funded bonded medical program for rural health for graduates of bonded medical program for rural health is an essential strategy to alleviate the shortage of healthcare professionals in rural areas of China and to enhance the quality of the primary care professionals. However, previous studies have lacked a comprehensive analysis of the educational methods, current state, and effectiveness across various institutions.

Objective: This study aims to examine the development, research quality, and future trends in the education of graduates of rural oriented general practice education program from 2010 to 2023, providing insights for future initiatives.

Methods: Literature on the training of graduates of rural oriented general practice education program published between January 1, 2010, and December 31, 2023, was retrieved from seven databases: CNKI, Wanfang, VIP, PubScholar, PubMed, Web of Science, and the Cochrane Library. Two researchers independently screened the literature, extracted data according to inclusion and exclusion criteria, and assessed the quality of studies using the Medical Education Research Study Quality Instrument (MERSQI) and the Newcastle-Ottawa Scale for Education (NOS-E). Descriptive analysis was performed to summarize and interpret the findings.

Results: A total of 37 studies were included, of which 36 were in Chinese and 1 in English. The most common research design was the pre-post test control group (46 %), followed by single-group post-test (22 %) and randomized controlled post-test (22 %). Only 8 % of studies employed a single-group pre-post test design. Of the studies, 97 % focused on undergraduate education, with the primary areas of focus being course adjustments (89 %), teaching method modifications (81 %), and the construction of training models(8 %). Notably, 8 % of training model studies and 19 % of course adjustment studies included courses specifically aimed at rural areas, primary care, or general practice. Outcome evaluations were primarily centered on student feedback (70 %) and improvements in knowledge and skills (86 %), with minimal attention given to behavioral changes (3 %) or benefits to patients and healthcare facilities (3 %). Overall, the quality of the studies was moderate, with a mean MERSQI score of 10.4±2.4 (maximum 14.0). Factors such as sample size, validity of evaluation tools, and outcome indicators contributed to lower scores. The NOS-E score averaged 2.5±1.5 (maximum 5.0), with low scores primarily due to control group comparability and blinding.

Conclusion: Although there has been an increase in research on the education and training of graduates of rural oriented general practice education program, the overall quality of the research remains low. Limitations such as insufficient cross-institutional and cross-regional studies, lack of research focusing on the unique characteristics of targeted training, and limited attention to postgraduate and continuing education remain prevalent. Future research should focus on enhancing multi-institutional cooperation, improving research design quality, establishing a unified evaluation system with a focus on rural and general practice education, and integrating continuous curriculum that includes postgraduate and continuing education.

Keywords

Graduates of bonded medical program for rural health / Educational research / Training model / Kirkpatrick's four-level model of evaluation / Systematic review

Declarations

Not applicable.

Authors' contributions

Conceptualization, H.X.; Methodology, H.X.; Data curation, C.M. and W.J.; Formal analysis, C.M., W.J. and Z.C.; Funding acquisition, not applicable; Project administration, not applicable; Resources, not applicable; Supervision, D.H.; Validation, D.H.; Writing-original draft, H.X.; Writing-review and editing, C.M., W.J. and D.H. All authors have read and agreed to the published version of the manuscript.

Ethical approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data and materials

Not applicable.

Declaration of competing interest

All authors declare that there are no competing interests.

Funding

Not applicable.

Acknowledgements

Not applicable.

Authors' other information

Not applicable.

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