Abstract: Objective　Taking a medical college in Beijing as a sample, the current situation and impact mechanism of medical undergraduate students' willingness to work at the grassroots level were analyzed, aiming to provide scientific reference for improving medical students' willingness to seek employment at the grassroots level and high-quality employment.Methods　A questionnaire survey and descriptive analysis were conducted to discuss the current situation of medical students' willingness to seek employment at the grassroots level; and qualitative comparative analysis (QCA) was used to explore the path impact of different combinations of five antecedents, namely, salary, career development, work environment, emotional support, and self worth, on medical students' willingness to work at the grassroots level.Results　57.43% of medical students are willing to go to the grass-roots level for employment. Four equivalent paths lead to medical students willing to go to the grass-roots level for employment, and two paths lead to medical students not having willingness to go to the grass-roots level for employment.Conclusion　The five antecedent variables of salary, career development, work environment, emotional support, and self worth all play a key role in improving the willingness of medical students to seek employment at the grass-roots level. Specific measures include improving the environment of primary medical institutions, providing positive emotional support from families, and emphasizing theoretical education guidance and practical activities in schools.

Key words: medical students, primary medical and health institutions, employment willingness, qualitative comparative analysis