三明医改背景下临床医学本科教育的变革与适配路径综述

A Review of the Reform and Adaptation Path of Undergraduate Clinical Medical Education in the Context of Sanming Medical Reform

摘要: 2012年，福建省三明市率先开展了医药卫生体制改革，成为我国深化医改进程的标志性实践，其核心目标是“破除以药养医、回归医疗服务本质”。通过重构医务人员薪酬体系、推动分级诊疗落地、实施全周期人才培养工程等关键举措，三明医改重塑了当地医疗行业格局，其经验逐步向全国推广。临床医学本科教育作为医学人才培养的基石，其培养目标、课程设置、实践模式及就业导向均受医改政策系统性牵引。本文将结合对三明医改政策的研究和临床医学本科教育的实践观察，立足医改核心导向，梳理医改对本科医学人才培养定位、教学改革、实践体系、招生就业及辅导员工作的具体影响，剖析适配过程中的突出挑战，提出针对性优化路径，为培养“下得去、用得上、留得住”的高素质应用型医学人才提供理论参考与实践指引。

Abstract: In 2012, Sanming City in Fujian Province took the lead in implementing reforms to the medical and health system, becoming a landmark initiative in China’s efforts to deepen medical reform. Its core objective was to “break the model of supporting medical institutions through drug sales and return medical services to their essential purpose”. Through key measures—including overhauling the salary system for healthcare workers, promoting the hierarchical medical system, and launching a full-cycle talent development program—the Sanming Medical Reform has reshaped the local healthcare landscape, and its experience is now being scaled nationwide. As the cornerstone of medical talent cultivation, undergraduate clinical medicine education has seen its training objectives, curriculum design, practical training models, and employment orientation systematically influenced by medical reform policies. Based on policy analysis of the Sanming Medical Reform and field observations of undergraduate clinical medicine education, this article—aligned with the reform’s core orientation—examines how medical reform specifically affects the positioning of undergraduate medical talent cultivation, teaching innovation, practice systems, recruitment and employment pathways, and counselor roles; identifies prominent challenges in institutional adaptation; and proposes targeted optimization strategies, thereby offering theoretical insights and practical guidance for cultivating high-quality, application-oriented medical professionals capable of “serving at the grassroots level, delivering tangible value, and remaining committed to local communities”.