Influencing Factors,Pathways And Strategies Of Medical Students’ Professional Commitment

The shortage of medical and health talents in my country has been increasing year by year.How to promote medical students to maintain loyalty to their majors and consciously strengthen their attitude and hard work in professional learning is an important issue that needs to be resolved urgently in medical higher education.Active professional commitment provides strong support for the professional growth and career path of medical students.Medical students and educators need to start with the influencing factors of professional commitments,follow a certain path,and improve the cultivation,maintenance and promotion of professional commitments,so as to send more qualified talents to the country’s medical and health professionals.Objectives:The core content of this research is to explore the development trend of medical students’ professional commitment and the mechanism of its influencing factors.Through qualitative research,guided by grounded theory,through interviews with medical students and other medical personnel and analysis of the interview data,indepth exploration of the influencing factors of medical students’ professional commitments,and discussion of professional commitments and influencing factors and influences The path relationship between the factors,and then construct the theoretical model of the influencing factors of medical students’ professional commitment.A crosssectional quantitative study was conducted to understand the current situation of medical students’ professional commitment,to screen for meaningful influencing factors,and to verify the path relationship between influencing factors and professional commitment based on the theoretical model constructed by qualitative research.The "three good things" approach was used to intervene and follow up with medical students to map and analyse the developmental trajectories of perceived stress,psychological capital and professional commitment of medical students during this period,and to observe the short-term and long-term effects of positive psychological interventions,with a view to providing support and reference for the development of strategies to improve professional commitment of medical students.Methods:Study 1: A qualitative study on the influencing factors of professional commitment of medical students.During the qualitative study,a combination of intensity sampling and stratified sampling was used to conduct semi-structured interviews with school students in clinical medicine or Chinese medicine who were not yet practising,medical professionals who were already practising and school students and graduates who had abandoned their medical professions in Jilin Province.Their texts were coded using qualitative analysis software NVivo 12.0 to assist in completing the data coding,and the coding was analysed to construct a theoretical model.Study 2: Analysis of influencing factors of medical students’ professional commitment.In the cross-sectional study,questionnaires were administered to students of clinical medicine and Chinese medicine in three higher education institutions in Jilin Province using stratified random whole-group sampling method.Descriptive statistics were used to describe the basic profile of the respondents;independent sample t-tests or variance tests were used to describe the differences in professional commitment among medical students by gender,institution,major,grade,family location,whether their parents were in the medical profession and family economic status;Pearson’s bivariate correlation statistics were used to describe the correlation between medical students’ professional commitment and possible influencing factors;multiple linear regression and random forest regression models were used to identify influences that were significant on professional commitment.Study 3: Path analysis of influencing factors of medical students’ professional commitment.Based on the data of the study 2,the moderating effect was tested using the plugin PROCESS 3.2 in SPSS 24.0;the mediating effect of each pathway and the overall model was tested using AMOS 24.0.Study 4: The effect of positive psychological intervention on medical students’ professional commitment and its influencing factorsIn the Positive Psychological Intervention study,the participants committed to voluntarily undergo the full intervention and survey were divided into a practice group,which was given the "Three Good Things" method of intervention for 9 months and a6-month follow-up;an equal number of students were randomly selected from those who committed to voluntarily undergo the full survey but did not want to undergo the intervention as the control group.Both groups completed one round of the questionnaire every three months for a total of six rounds over a 15-month period.Missing values were filled in using multiple interpolation.Mplus Version 7.4 was used to construct an unconditional latent variable growth curve model for depicting the trajectory of each variable in the two study groups and to compare them;the Shapiro-wilk test was used to determine whether the data for each variable were normally distributed.Independent samples t-tests or Mann-Whitney U-tests were used to compare the differences in the observed variables between the two groups of medical students at each time point.A repeated measures variance model was used to determine whether there were differences within groups over time and differences in trends between groups.Pairedsamples t-tests or Wisconsin tests were used to compare differences in each observed variable for each group of medical students before and after practice and at final followup.Results:Study 1: A qualitative study on the influencing factors of professional commitment of medical students.Through qualitative research,the influencing factors of professional commitment of medical students were identified as self-worth,career outcome expectations,professional interests,psychological factors,environmental factors and others.Psychological factors include psychological capital,mental health impairment,perceived stress and achievement motivation;environmental factors include social support,family function and whether parents are engaged in medical-related occupations;other factors include cognition of one’s own professional ability level and familiarity with policies and regulations degree.The relationship between the above influencing factors was summarized,and a theoretical model of medical students’ professional commitment influencing factors was constructed,which included four main path relationships: the "self-worth"-"career outcome expectation"-"professional commitment" pathway,the "psychological factors"-" self-worth"-"career outcome expectation"-"professional commitment" pathway,the "environmental factors"-"selfworth"-"career outcome expectation"-"professional commitment" pathway,and moderating effects pathway.Study 2: Analysis of influencing factors of medical students’ professional commitment.(1)The level of professional commitment of medical students was 3.19 ± 0.45;the results of the univariate analysis showed significant differences(p < 0.01)in grade,parental occupation and monthly family income;no differences were found in gender,institution,major and family location.(2)In the multivariate analysis,the results of the multiple linear regression equation showed that the five independent variables of self-worth,mental health impairment,psychological capital,perceived social support and perceived stress were significant predictors of professional commitment(p < 0.05).The results of the random forest regression model showed that the nine independent variables of professional interest,career outcome expectancy,self-worth,psychological capital,mental health impairment,perceived stress,achievement motivation,family caring and perceived social support were significant factors influencing professional commitment(p < 0.05).The predictive validity of the random forest regression model constructed from these nine independent variables was higher than that of the aforementioned five independent variables,so the results of the nine independent variables as significant influencing factors were adopted.Mental health impairment and perceived stress were negatively associated with professional commitment(r =-0.49 to-0.48,p < 0.01);the other influences were positively associated(r = 0.12 to 0.50,p < 0.01).Study 3: Path analysis of influencing factors of medical students’ professional commitment.The four pathways in the theoretical model of influencing factors of professional commitment of medical students were basically confirmed by the mediating and moderating effect model tests.The effect of self-worth on professional commitment was influenced by the chain of career outcome expectation and professional interest,and the mediating effect was 0.15,accounting for 60.0% of the total effect.The mediating effects of psychological capital,mental health impairment,perceived stress and perceived social support on professional commitment were 0.28,-0.08,-0.22 and1.45,respectively,accounting for 65.1%,80.0%,73.3% and 70.7% of the total effect.Self-worth completely mediated the effect of achievement motivation and family care on professional commitment,with a mediating effect of 0.10 and 1.50,accounting for90.9% and 92.6% of the total effect.The evaluation of medical students’ professional competence moderated the effect of professional interest on professional commitment(β = 0.45,p = 0.041).In the overall model,the relationship between professional interest,career outcome expectation,self-worth,psychological capital,mental health impairment and perceived social support on professional commitment still holds.However,the direct effect of perceived stress on professional commitment is no longer significant.Family care was only a direct promoter of professional commitment,and no longer mediated by self-worth and career outcome expectation.The moderating effect of influencing factors on professional commitment is not significant.Study 4: The effect of positive psychological intervention on medical students’ professional commitment and its influencing factorsDuring the positive psychological intervention and follow-up,there was a significant difference in the trend of perceived stress,psychological capital and professional commitment between the practice group and the control group(p < 0.001);compared with the control group,the practice group showed significant improvement in perceived stress,psychological capital and professional commitment.Conclusions:(1)Professional commitment reflects the level of attitude and effort individuals put into their professional studies.Currently,medical students’ professional commitment is at an intermediate level and needs to be further strengthened.(2)There are significant differences in the level of professional commitment among medical students in terms of grade,parents’ occupation and monthly family income,suggesting that we should adopt flexible and targeted promotion strategies according to the characteristics of medical students in different grades and family backgrounds.(3)The higher the level of professional interest,career outcome expectations,selfworth,psychological capital,achievement motivation,family caring and perceived social support of medical students,the more conducive to the development of professional commitment;whereas mental health impairment and perceived stress may be detrimental to medical students’ professional commitment.(4)The chain mediating effect test results between the influencing factors and professional commitment verified the validity of the theoretical model of influencing factors of medical students’ professional commitment constructed in this study,and reinforce the critical role of expectations and values in the development of professional commitment.Therefore,higher medical educators and related personnel should pay attention to the positive or negative driving effects of the above-mentioned factors on medical students’ professional commitment,and enhance their professional commitment by strengthening classroom vitality,maintaining psychological resources,preventing psychological aggression,and increasing social support,in order to increase students’ interest in and expectations of the medical profession,maintain their positive psychological qualities,and strengthen their family functions,among other measures.(5)Under the single pathway,medical students’ assessment of their own level of professional competence and familiarity with policies and regulations can play a moderating effect in the role of professional interest on professional commitment.In the overall condition,this moderating effect was not significant.(6)The significant interaction between psychological capital,mental health impairment,perceived stress,achievement motivation,family caring and perceived social support,together as previous experience and perception and awareness of experience,triggered the "expectation × value" process,providing further validation of the theoretical model of influencing factors proposed in this study and suggesting that we should consider the development and maintenance of professional commitment in terms of psychological factors,environmental support and perceptions of these factors.(7)A positive psychological intervention using the "three good things" approach was found to be effective in improving medical students’ perceived stress and psychological capital,and in promoting their professional commitment.(8)This study explores the factors influencing medical students’ professional commitment and their pathways through a variety of methods,constructs a theoretical model and empirically validates it,providing a literature base for research on professional commitment and a meaningful reference for medical higher education institutions to understand the internal drivers of students’ professional learning process and professional commitment enhancement.