Analysis of content validity index
To interpret proper meaning from responses of questionnaire items, it is important to design a rigorous and high-quality questionnaire [17]. If the questionnaire is poorly designed, it can affect the overall responses and fail to find out essential data from participants [17]. Therefore, we included the content validity test in the process of designing questionnaire.
The content validity experts who were professors gave relatively low scores to questionnaire items including the latent variable of ‘requiring personal and clinical skills.’ They reported that manual skills are not representative of KM treatment. This decision was made based on their real field experience as KM doctors. Medical practice is not simply related to manual skills, but includes all processes of examination, diagnosis, treatment, and teaching. Therefore, questionnaire items were modified with reference to the field-based medical practices. As a result, when the examples of acupuncture and moxibustion, which are KM medical practices, were included in the statement, the I-CVI scored much higher.
Analysis of questionnaire scores
The score of questionnaire items about stable incumbency was high (Mean±SD: 4.08±0.7) because in South Korea, professionals have relatively high job stability. Questionnaire items about high income also had high scores (Mean±SD: 3.93±0.8) because pay is an important factor when choosing a career. This is aligned with the results of previous studies that pay is a significant factor for medical and dental students in their career choice [7].
The score of the questionnaire regarding students’ interest in KM theory was relatively low (Mean±SD: 2.99 ±1.1). As Korean medicine is a specific major that is taught only after students enter a KM college, it is rare for students to learn KM theory until graduating from high school. The score of this item increased slightly after students entered college. Thus, students may have an increased interest in their major due to the experience of learning KM theory while attending college.
The score of the questionnaire item asking about the treatment method was low due to the lack of experience of learning KM theory (Mean±SD: 2.99±1.1). The score of its sub-questionnaire slightly increased (Mean±SD: 3.13±1.0), implying that students developed an interest in KM treatment methods during their education experience.
The score of the questionnaire item concerning students’ perception that Korean medicine is based on modern science as an entrance factor was relatively low (Mean±SD: 2.65±1.0). As students have not yet learned extensively about KM, they may think that KM adopts inappropriate methodologies and has low-evidence, which in fact contradicts numerous KM research results [26]. The score of the sub-questionnaire item slightly increased, but the score was still low (Mean±SD: 2.90±0.9). The score of the questionnaire item asking whether KM has potential for future development was also low (Mean±SD: 3.48±1.0), and the score of its sub-questionnaire item remained almost unchanged (Mean±SD: 3.40±0.9).
Cutting-edge systemic biology research takes place in the field of KM, such as network pharmacology-based research. In vitro and in vivo research is also widely conducted [27, 28]. Still, the low scores of such questionnaire items (item 6, 6-1, 7, 7-1) imply that the knowledge of KM matriculants is at a superficial level even though they have decided to enter a KM college, as the public strongly insists the necessity of scientificization and technological development of KM, and that herbal medicine has adverse effects [29]. Therefore, scientific research on KM must be promoted more actively to members of the public who show interest in KM, and the results of KM research must be widely shared with KM college students.
Only few students consider diverse career choices before their entrance by seeing KM college graduates who take diverse career path, including professors who conduct research on KM. In contrast, the score of the questionnaire item regarding students’ willingness to conduct clinical activities was very high (Mean±SD: 4.00±1.0). Almost every KM doctor conducts clinical activities after their graduation [30]. Therefore, performing clinical activities as a KM doctor is a major factor of entrance. In contrast, the score of the questionnaire item related to the construction of policies and the performance of social activities related to KM was relatively low (Mean±SD: 2.60±1.0). This can be understood in the same context.
Nonetheless, the scores of the sub-questionnaire items asking about students’ willingness to research KM, and policy making and performing social activities related to KM were slightly increased (Mean±SD: 2.92±1.0 and Mean±SD: 2.88±1.0, respectively). In contrast, the score of the sub-questionnaire item asking about students’ willingness to do clinical activities was slightly decreased (Mean±SD: 3.83±0.9). Many curricular experiences, including lectures, strongly influence students’ career decisions [2]. Therefore, while they attend college, students become able to consider different career paths that are not limited to engaging in clinical activities.
The scores of questionnaire items asking about students’ interactions with people who need examinations and treatments as an entrance factor, and of learning to perform clinical skills as a KMD were relatively high (Mean±SD: 3.62±1.1 and Mean±SD: 3.85±1.0, respectively). Scores of sub-questionnaire items (item 12-1, item 13-1) of each questionnaire item did not decrease compared to their related questionnaire items. However, the scores of questionnaire items asking about performing psychological treatments were relatively low compared to former ones. Furthermore, after the entrance, the score of sub-questionnaire items asking about performing psychological treatments was further decreased (Mean±SD: 3.44±1.1). Even though the counseling ability of medical professionals is clearly important, the score of this questionnaire item is low because of the little experience of clinical subjects due to the curriculum of KM colleges and low acknowledgement of psychological treatment, which is actually performed in the KM clinical field [31]. This coincides with previous research that has reported that the young generation considers acupuncture and herbal medicine as the major clinical skills of KM, and that the major area of KM clinical treatment is related to physical health conditions [32], while only 1% of participants reported that KM could treat psychological and behavioral disorders [33]. This is because the depth of KM college matriculants’ knowledge of KM is substantially the same as matriculants of non-KM colleges. Therefore, even though neuropsychiatry is not a major subject of premedical students’ educational curriculum, it would be worthwhile to introduce examples of psychological clinical skills and the Department of Korean Neuropsychiatry when teaching about the clinical skills of KM. KM college students would then focus more on those issues and will have a wider recognition range of KM clinical skills.
College entrance examinations as college entrance factors reflect realistic aspects of job incumbency rather than job characteristics as medical professionals. Many students want to go to the highest-ranking schools possible with their examination scores. Therefore, examination score becomes a significant factor (Mean±SD: 4.03±0.9).
Mass media had a relatively low effect on students’ college entrance choices (Mean±SD: 2.30±1.1). Many medical students meet a medical role model during their college life [34]. In contrast, premedical students lack this type of experience because of the relatively short time they have attended college. Mass media not only give information regarding college major choices, it can also change students’ thoughts about their major choice [35]. However, mass media had a relatively low effect on college entrance choice, and the score of the questionnaire item asking about students’ independent choices to attend college was relatively high (Mean±SD: 3.85±1.0). This is because there are relatively few chances to see KM doctors and KM in the mass media compared to other medical professionals. For this reason, KM should be promoted more actively in the media.
Analysis of correlation between entrance factors at entrance time and present satisfaction
The greater the correlation between questionnaire items and sub-questionnaire items, the greater the degree to which students’ pre-admission perceptions of those factors affect them even after admission. For this reason, the items with high correlation coefficients could be interpreted as factors that have great significance for students’ adjustment and satisfaction on current enrollment. These factors should be taken into consideration in students’ college major choices.
A positive experience with KM treatment and interest in KM treatment methods can be interpreted as items related to the treatment of KM. These experiences could be faced only when they enroll in a KM college. Therefore, the high correlation coefficient of those items can imply that students who had interest in KM theory, students who had interest during their education in KM theory and treatment, and those who experienced KM treatment can be satisfied with attending KM colleges for those reasons.
The high correlation coefficient of the questionnaire item and sub-questionnaire item about military duty can be interpreted as the same meaning of the high overall score of those items (items 15 and item 15-1). In South Korea, public health doctors can have an alternative role in military duty service system. Students who have not finished their military service may apply at an alternative military duty service and prefer to perform their activities as a KM doctor. Students who have to fulfill their military duty can replace their military duty with public health doctor duty when they have a KMD license; therefore, they seem to be satisfied with their current enrollment.
Analysis of Pearson’s correlation between students’ satisfaction, willingness to re-enter, and questionnaires asking their motivation
Students dropping out of educational institutions that aim to train and educate medical professionals deplete meaningful personnel resources beyond such students’ lack of motivation to become medical professionals [36]. Therefore, it is clearly important to identify the factors that contribute to satisfaction with college enrollment and willingness to re-enter. Students who entered KM colleges due to factors that have high correlation coefficients with satisfaction with the current enrollment could be more satisfied than others.
Factors that affect students’ satisfaction with their current enrollment in a KM college are related to social status (item 1-1) and stable incumbency (item 2-1). Students who independently chose to enter college seem to have high satisfaction levels. This high correlation coefficient is a consequence of their independent choice, not of others’ opinions. Therefore, such students can be viewed as ones who wished to enter KM colleges before their enrollment.
Students may wish to re-enter a different major because their current major does not fit their vocation or they have a low interest in people [5]. Hence, students who consistently show interest in KMDs’ activities related to their job competency have a lower probability of dropping out. Factors related to re-entering the KM colleges can be considered as factors that could bring interest to KMDs’ activities related to job competency. Therefore, factors with a high correlation coefficient with the item about re-entering KM colleges may be related to the aptitude for students’ major or students’ satisfaction.
Theory of KM, interest in clinical activity, and thinking of being a KMD as a calling are closely related to internal factors. Apart from the factor of calling, these factors are closely related to KM doctors’ job competency and KM college curriculum. Previous research shows that medical students who enter college because of those internal factors show higher creativity and academic achievement [37]. Therefore, when guiding the college choices of students wishing to go to KM colleges, one should determine the extent to which they want to enter the school due to these internal factors.
The irrelevance of satisfactory level with one’s examination score as the important factor corresponds with the results of previous research [18], in which participants who entered KM colleges because of their examination scores had lower satisfaction levels. Because of the characteristics of the College Scholastic Ability Test (CSAT), it is difficult for students to obtain scores in proportion to their interest in specific disciplines, and it is important in high school for students to focus on CSAT preparation [38]. Hence, students who mainly focused on CSAT scores probably selected their college major in reference to the score ranking of the college rather than internal factors, and those who are at the state of high career indecision probably had lower satisfaction with their current major [39]. Therefore, those students have less satisfaction with KM college enrollment.
Limitations and further studies
Although there are enough participants in this study for statistical analysis, there is always the possibility of gathering more participants. The limitations of this study are that the participation rate of students from different schools was not even. This could be overcome to some extent by delivering web survey links in a variety of ways, if further studies were conducted. Focus group interviews were conducted with medical first and second year students rather than premedical second years, and the contents of the questionnaires were modified slightly. Although the positive Pearson’s correlation coefficient between questionnaires indicates students’ satisfaction with their current enrollment, it may also imply students’ rationalization of their choices.
Further research could also be conducted on students who participated in this study at the time of admission, constructing a long-term study that examines changes in KM students’ perceptions throughout their academic career. The methodology used in this study can also be adopted in research on other types of medical students.