Why should we learn medicine?——A questionnaire survey based on 2338 medical freshmen in 3 local medical colleges

doi:10.21203/rs.3.rs-2314198/v1

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Research Article

Why should we learn medicine?——A questionnaire survey based on 2338 medical freshmen in 3 local medical colleges

https://doi.org/10.21203/rs.3.rs-2314198/v1

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Objective: To explore the current situation and influencing factors with the willingness of desire to be doctors in medical freshmen from Chinese local medical colleges, and to provide references for the construction and improvement of courses, such as humanistic medicine courses and professional quality courses, for the formulation of the work plan of enrollment and employment departments, and student management.

Methods: In October 2021, 2338 freshmen majoring in clinical medicine from Gannan Medical College, Qiqihar Medical College, and Hunan University of Medicine were surveyed with the self-compiled questionnaire of medical freshmen's willingness to practice medicine and its influencing factors.

Results: In this sample, the medical freshmen had shown a high willingness with the desire to be doctors after graduation（58.04%）; the prevalence of willingness with the desire to be doctors after graduation among medical freshmen in urban areas（χ²=6.276， P=0.012） and medical staff in parents（χ²=10.154， P=0.001）was higher than that in rural areas and no medical staff in parents; The willingness of medical freshmen to practice medicine was affected by six factors: having medical staff in their parents (OR=1.630, P=0.001), thinking that doctors have high income (OR=2.878, P < 0.001), healing the wounded and rescuing the dying(OR=2.333, P < 0.001), and knowing the situation about resident physician normalized training policy in China (OR=1.430, P=0.001), teachers, relatives, and friends think medicine is a good major and suggest to study medicine (OR=0.480, P < 0.001) and COVID-19 (OR=1.561, P < 0.001).

Conclusions: The willingness of new medical students to practice medicine is affected by many factors and is different from the expectation. Medical colleges should take effective measures according to the influencing factors and enhance the effect of professional ideological education.

medical freshman

willingness to practice medicine

influencing factors

investigation

There has long been a perception that the medical profession in China carries the halo of "high salary", "high social status", "respectable", " healing the wounded and rescuing the dying", and "convenient for family members to seek medical treatment", which attracts a large number of high school students to apply for the clinical medicine major. However, medical students' original assumptions aren't aligned with heavy curriculum pressure after they enter the school. Additionally, occupational pressure and employment characteristics, etc. are important factors in determining whether medical students are willing to practice medicine^[1], and these factors are often not understood by medical students when applying for medical schools. Recent reports have shown that due to various factors such as disputes between doctors and patients, too high degree required for employment, high occupational pressure, the impact of resident physician normalized training policy, low incomes, and the nature of work in some departments, such as pediatrics and emergency rooms, the willingness of Chinese medical students to practice medicine has a declining trend^{[2, 3]}. In particular, hospital violence has played a significant role in medical students' reluctance to practice medicine^[4], and there is even a joke on the Internet that states, "To persuade people to study medicine, you will be struck by lightning and split in two."

However, at present, the medical major is still a popular major in college entrance examinations. Although the admission scores of key universities for medical majors are declining, and outstanding students in college entrance examinations are less inclined to study medicine^[5], the admission scores of local medical colleges remain high. Local medical colleges undertake the task of cultivating grassroots medical and health professionals, and most of the students from these schools will work in grassroots healthcare facilities at or below the county level after graduation. Even if they have a graduate degree, their first academic qualifications limit their competitiveness with clinical medicine students from key medical universities. When these gaps are significantly different from their admission expectations, they are likely to further affect their professional identity and future professional development^[6] and even affect their willingness to practice medicine, resulting in their choice of non-medical positions. Therefore, to cultivate outstanding medical and health talents and realize the Healthy China Strategy, it is vital to recognize the factors influencing medical students' choices of local medical colleges and actively guide, adjust, and improve these corresponding factors in the process of medical education. Considering the above reasons, to provide a reference for future teaching reform, the research group conducted a questionnaire survey in October 2021 among 2,338 freshmen majoring in clinical medicine at three local medical colleges to gain insight into the factors that influence medical students to apply to medical school.

2.1 Study Design, Sample, and Participants

Using cluster sampling, all freshmen majoring in clinical medicine at Gannan Medical College, Qiqihar Medical College, and Hunan University of Medicine were selected to participate in a questionnaire survey through courses such as mental health education in October 2021. A total of 2441 questionnaires were sent out, 2430 were recovered with a recovery rate of 99.55%, and 2338 were valid with a validity rate of 95.78%. Responders ranged in age from 16 to 22 years old with an average age of (18.26 ± 0.78). Among them, there are 1,207 boys and 1,131 girls; 1,048 freshmen come from urban areas and 1,290 from rural areas; There are 655 respondents who are the only one child in a family and 1683 respondents who have more than one child in a family; 291 respondents have medical staff in parents. All subjects are clinical medical students, excluding nursing, forensic medicine, rehabilitation therapy, and other medical-related majors not engaged in clinical diagnosis and treatment in the future. Because clinical medicine is a popular major in the three medical colleges, all admitted students are first in line to apply to the clinical medicine major, rather than adjusting or supplementary admissions. In addition, all respondents have completed the entrance education and have an understanding of what clinical medicine major will learn in the next five years and future career prospects, but have not yet begun the medical courses.

2.2 Questionnaire

2.2.1 A questionnaire that was self-compiled regarding the willingness to practice medicine

Based on previous research results, the questionnaire was compiled which was evaluated from the perspective of wanting to study medicine and being able to study medicine, including two questions as follows, “① When applying for the college, did you choose clinical medicine as your first choice? ② Do you want to study medicine from your heart and not choose to apply for other majors in other schools because of academic performance limitations and other factors?” The respondents were asked to answer "yes" or "no", In this study, medical freshmen who answered "yes" to both questions were defined as those who really "wanted to study medicine" when they applied for the college, and had a strong intention to study medicine, that is, they had the intention to study medicine; Other medical freshmen were defined as "only able to study medicine" due to academic performance limitations, inability to apply for their favorite major and school and other factors, that is, their willingness to study medicine was relatively weak.

2.2.2 Self-made questionnaire on influencing factors of applying for a medical major

Many factors affect high school students to apply for medical colleges. Relevant studies show that family conditions, personal ambition, personal interest, recognition of the social status of doctors, worship of the spirit of life-saving, understanding of the doctor-patient relationship and doctor-patient contradiction, parents' advice, and other factors^{[2, 6, 7, 8]} may affect their willingness to work as a doctor. At present, it has also been found that the epidemic of COVID-19 has made some middle school students willing to engage in medicine^[9]. Drawing on relevant research results and collecting the initial intention of applying for medical colleges according to a small range of interviews with clinical medical freshmen before the survey, a questionnaire was developed to investigate the motivation and influencing factors, such as personal experience, of medical students to choose clinical medicine. The scale consists of 22 items and the survey content includes the understanding and attitude of doctors' social status, economic income, and working pressure; the influence of relatives on an individual's willingness to practice medicine; understanding of the domestic doctor-patient relationship and relevant laws and regulations; others, such as whether the individual is interested in literature, family economic situation, etc. Respondents were asked to answer "yes" or "no". See Table 2 for details.

2.3 Statistical analysis

SPSS22.0 was used to analyze the data. χ2 test was used to compare the differences of medical students' willingness in different groups, and multiple logistic regression analysis was used to explore the influencing factors of medical freshmen's willingness to practice medicine. P < 0.05 was considered statistically significant.

3.1 The willingness of medical freshmen to study medicine

Among the 2338 medical freshmen, 1357 (58.04%) had the intention to learn medicine, and 981 (41.96%) had no strong intention to learn medicine. Among them, high school students from urban areas or whose father or mother is medical staff are more likely to study medicine. See Table 1 for details.

Table 1

Comparison of the basic situation and differences of the willingness of medical freshmen with different demographic characteristics to study medicine
Factors	Groups	The willingness to study medicine	Detection rate	χ²	P
gender	boy(n = 1207)	692	57.33%	0.515	0.437
gender	girl(n = 1131)	665	85.80%	0.515	0.437
place of birth	urban(n = 1048)	638	60.88%	6.276	0.012
place of birth	rural(n = 1290)	719	55.74%	6.276	0.012
Single child in a family	yes(n = 655)	380	58.02%	0.001	0.987
	no(n = 1683)	977	58.05%
medical staff in parents	yes(n = 291)	194	66.67%	10.154	0.001
	no(n = 2047)	1163	56.81%

3.2 Analysis of influencing factors of medical freshmen 'willingness to study medicine

According to this survey, high school students, who think that doctors have high income and have a higher status in society, pursue healing the wounded and rescuing the dying, relatively understand the resident physician normalized training policy, know the media reports on doctor-patient disputes, like reasoning and other logical thinking strong things, think that the medical investment and laws and regulations are reasonable, deny that there are many medical disputes, keep optimistic about the domestic medical industry, think that be a doctor can be respected, think it is easy to find a job in medicine, and want to study medicine due to the impact of COVID-19, are more likely to study medicine. In addition, students, whose families did not clearly indicate that they expected their children to study medicine, and their friends and teachers did not clearly suggest that high school students should major in medicine, were more inclined to study medicine. See Table 2 for details.

Table 2

χ2 test of the distribution of medical freshmen' intention to study medicine with different influencing factors
Factors	Groups	Number (n = 2338)	Hoarding phenomenon [Number (composition /%)]	χ²	P
1 I think doctors are well paid	yes	1948	1216(62.42)	92.075	༜0.001
1 I think doctors are well paid	no	390	141(36.15)	92.075	༜0.001
2 I think doctors have a good status in society	yes	1956	1163(59.46)	9.871	0.002
	no	382	194(50.79)
3 I have relatives, other than my parents, who are engaged in medical work	yes	1593	910(57.12)	1.723	0.189
	no	745	447(60.00)
4 I envy the job that can heal the wounded and rescue the dying	yes	2072	1268(61.97)	74.478	༜0.001
	no	266	89(33.46)
5 My family had a serious illness	yes	1257	744(59.19)	1.470	0.225
	no	1081	613(56.71)
6 I well understand the normalized training policy for medical graduates	yes	544	365(67.10)	23.867	༜0.001
	no	1794	992(55.30)
7 I am very disappointed about the current doctor-patient relationship in our country	yes	741	414(55.87)	2.099	0.147
	no	1597	943(59.05)
8 I have seen many cases of medical injuries and disputes between doctors and patients in the media	yes	1842	1092(59.28)	5.503	0.019
	no	496	265(53.43)
9 Ever since I was a kid, I've loved close reasoning	yes	1769	1063(60.09)	12.536	༜0.001
	no	569	294(51.67)
10 I think China's medical investment and relevant laws are reasonable	yes	1705	1019(59.77)	7.689	0.006
	no	633	338(53.40)
11 My family hope that I can apply for the medical major from the perspective of convenient medical treatment for my family and stable career	yes	1807	1023(56.61)	6.661	0.010
	no	531	334(62.90)
12 The medical profession will be very stable in the future, and there is no need to worry about unemployment	yes	1608	951(59.14)	2.562	0.109
	no	730	406(55.61)
13 I like literature and poetry very much	yes	1030	618(60.00)	2.901	0.089
	no	1308	739(56.50)
14 I think being a doctor is a high-risk profession because of the doctor-patient relationship, medical expenses, and other reasons	yes	821	458(55.19)	2.643	0.104
	no	1517	899(59.26)
15 I think there are a lot of medical disputes nowadays	yes	1013	564(55.68)	4.105	0.043
	no	1325	793(59.85)
16 I think many of the current doctor-patient disputes are due to the professional quality of doctors	yes	457	267(58.42)	0.034	0.874
	no	1881	1090(57.95)
17 I am very optimistic about the future of the domestic medical industry in China	yes	1980	1181(59.65)	13.685	༜0.001
	no	358	176(49.16)
18 I think a doctor can own the respect of the people around him	yes	2075	1228(59.18)	9.838	0.002
	no	263	129(49.05)
19 My family's financial situation is not good	yes	453	264(58.28)	0.013	0.916
	no	1885	1093(57.98)
20 I think there is a shortage of doctors in China, so the medical profession will be very good for employment	yes	1904	1131(59.40)	7.792	0.005
	no	434	226(52.07)
21 Many teachers, friends, and relatives thought a medical major was good and advised me to study medicine	yes	1008	492(48.81)	62.007	༜0.001
	no	1330	865(65.04)
22 Affected by the COVID-19 pandemic, I hope to study medicine	yes	984	637(64.74)	31.270	༜0.001
	no	1354	720(53.18)

The willingness to study medicine was taken as the dependent variable (1 = yes, 0 = no), the factors with statistical significance in the χ2 test that may affect the willingness to study medicine were taken as predictive variables, and the multiple logistic analysis of the influencing factors of the willingness to study medicine was conducted. The results showed that there were six factors affecting the willingness to study medicine. See Table 3 for details.

Table 3

Multiple logistic regression analysis of 2338 medical freshmen' willingness to study medicine and influencing factors
Factors	B	SE	Waldχ²	P	OR	95% CI
constant term	-1.150	0.199	33.481	༜0.001
Whether there is a medical staff in parents(no)
yes	0.489	0.147	11.089	0.001	1.630	1.223–2.173
1(no)
yes	1.057	0.124	72.229	༜0.001	2.878	2.255–3.672
4(no)
yes	0.847	0.149	32.493	༜0.001	2.333	1.743–3.122
6(no)
yes	0.358	0.112	10.261	0.001	1.430	1.149–1.780
21(no)
yes	-0.734	0.101	52.969	༜0.001	0.480	0.394–0.585
22(no)
yes	0.445	0.094	22.278	༜0.001	1.561	1.297–1.878
Note: () for reference, figures in factors are item numbers in Table 2

4.1 Medical Freshmen in local medical colleges have a higher willingness to study medicine

The result of this survey showed that nearly 60% of freshmen applied for medical majors due to their desire to study medicine, rather than insufficient scores or inability to apply for their favorite major or college. The result is similar to the research conclusion of Min Hongjie, et al. "55.1% of high school students intend to pursue medicine"^[9]. In other words, although there was a phenomenon that some outstanding students did not want to study medicine^[5], for local medical colleges and universities, medical freshmen are not like the media reports that they "do not want to be a doctor" or "hope to change careers", and they really want to study medicine to apply for medical colleges. That is to say, compared with engineering, agriculture, teaching, and other majors in provincial universities, in most people's minds, medicine is a relatively good major, but also a major with more development in the future. In China, there is a widespread view among the general public that doctors belong to a profession with "high income" and "high status". However, they are not familiar with the high work pressure, long training cycle, low income of medical and health posts, and even the current national normalized training policy for resident doctors of clinical medicine graduates and the educational requirements of employers. This leads to the current high willingness of Chinese medical students to learn medicine when they enter the university, but their willingness to learn medicine gradually decreases with the understanding of the learning pressure, employment requirements, career development, and related policies of clinical medicine during the school period^[10]. Therefore, an important reason that affects the willingness of Chinese medical students to practice medicine is that they do not know much about clinical medicine and apply for medical colleges with enthusiasm, but after they get to know relevant policies, they have antipathy towards clinical medicine and even misunderstanding. This suggests that the characteristics of clinical medicine and the nature of the doctor profession should be popularized in China in the future so that the general public can truly understand the profession, so as to attract candidates who are truly willing to work in medicine and enhance their willingness to work in medicine in the future.

Meanwhile, this study found that freshmen from urban areas were more willing to study medicine due to the more abundant medical resources in urban areas and more exposure to comments about the "income" and "social status" of medical staff. In addition, this study found that freshmen who have medical staff in parents were more willing to study medicine than those without parents of medical staff. It is different from the conclusion of Ye Cong, et al. 's investigation on the high school children of clinical medical staff in a 3A grade hospital that "only 10% children are interested in practicing medicine"^[11], and the conclusion of Cao Man, et al.' s investigation on medical staff in public hospitals that "the proportion of doctors expecting their children to study medicine is very low and the proportion of doctors who do not encourage their children to study medicine is very high"^[12], which may be due to the difference in sampling. The survey objects of this study are freshmen admitted to medical schools rather than high school students who have not yet decided to apply for medical school. Although influenced by their parents' idea of not recommending to study medicine, these freshmen grew up in a family of medical workers and may have a deeper understanding of the career, development, professional planning, and medical environment of doctors. After weighing the advantages and disadvantages, they are also likely to apply for medical schools. This group tends to have a higher level of professional identification with health care. It is suggested that we should not generally believe that "after understanding the characteristics of the medical profession, students will not study medicine". After admission, it is also of a certain value to help students realize the characteristics of the medical profession, relevant policies, and medical environment, objectively understand the advantages and disadvantages of the medical profession, and truly understand the medical profession, which will enhance the willingness of medical students to work in medicine after graduation.

4.2 The willingness of medical freshmen to study medicine is affected by many factors

The results of multiple logistic regression analysis showed that, in addition to whether there is a medical staff in their parents, the following five factors predicted the medical freshmen's willingness to be a doctor: they thought that doctors had a high income, envied doctors for saving lives, knew more about the standardized training policy, had no friends or relatives to recommend them to study medicine and decided to study medicine because of the COVID-19 epidemic. High school students who believe that doctors earn a high salary naturally have a stronger desire to practice medicine and are more inclined to choose a medical major after the college entrance examination. The medical freshmen with the lofty ideal of healing the wounded and rescuing the dying are more determined to work as a doctor in the future. Freshmen who have a better understanding of China's domestic normalized training policies have realized that the road to medicine is not easy, so the choice of clinical medicine may be out of their own interests; However, the more the friends, relatives, and teachers around them think that clinical medicine is a good major, the more likely it will arouse the aversion of some students who are not willing to study medicine, which will reduce their willingness to apply for medical colleges. The praise and praise for medical staff in China during the COVID-19 pandemic may encourage some high school students to learn more about the medical profession and increase their willingness to study medicine. However, the high pressure of the doctor profession, the sharp contradiction between doctors and patients, the uneven distribution of medical resources, and the lack of investment are not the influencing factors for medical freshmen to apply for medical colleges. This means that the factors influencing the willingness of students to practice medicine are more personal understanding of medical care, such as treatment, spiritual pursuit, social status, and the understanding of doctors by their relatives and friends around them, rather than the objective realistic factors such as doctor-patient conflicts, occupational pressure, uneven medical resources, and higher requirements of employment on education and graduation colleges in China. Once they find that the ideal doctor is not in line with reality, it will inevitably discourage them from practicing medicine. The important implication of this study is that it should not be considered that the current sharp contradiction between doctors and patients, insufficient medical investment, and the increase in the learning cycle of medical students caused by the normalized training of resident doctors lead to the decrease of medical freshmen's willingness to practice medicine, nor can it simply be considered that improving the medical environment and perfecting laws and regulations can improve the willingness of medical freshmen to practice medicine. This determines that the promotion of medical freshmen, and even medical students' willingness to practice medicine, needs to carry out teaching methods such as "early clinical practice and early practice" after entering the school, so as to truly let them understand the characteristics of the medical profession and guide them according to the spiritual values of the profession, instead of focusing only on the theoretical values such as the important significance and value of medicine, so as to avoid the inconsistency between the clinical practice of medical freshmen and their expectations, which affects the willingness to practice medicine.

The study draws two conclusions. (1) 58.04% of medical freshmen have the intention to practice medicine, and the intention of medical freshmen is higher. (2) High school students are more inclined to apply for a medical major, whose father or mother is medical staff, who subjectively believe that medical staff has a high income, are willing to heal the wounded and rescue the dying, understand the normalized training policy for resident doctors, have no relatives, friends or teachers suggest applying for the medical major before the college entrance examination, and are affected by the COVID-19 epidemic.

Although this study draws some conclusions on the current situation and influencing factors of the medical willingness of medical freshmen, there are still many deficiencies. Firstly, the Hawthorne effect may exist in this study. Secondly, this study did not involve the influence of medical professional learning, especially practice teaching, on medical students' willingness to work in medicine. Thirdly, the objects of the survey were only medical freshmen from local medical colleges in China, not medical students from "211", "985", key medical universities, and other universities. Finally, the research tool is too simple, there may be other influencing factors not included, and there is room for further expansion. Therefore, we plan to carry out the following studies in the future: (1) Expand the sample size and popularize the research conclusions; (2) Long-term follow-up survey on the change in medical students' willingness to practice medicine; (3) If possible, prepare the medical students' willingness to practice medicine scale.

Ethics approval and consent to participate: The study was performed in accordance with the Declaration of Helsinki and approved by Biomedical Research Ethics Committee of Gannan Medical University（Protocol code: Ref number 2022361/28 January 2022). Informed consent to participate in the study was obtained from all student participants.

Consent for publication: No applicable

Availability of data and materials: The datasets used and/or analysed during the current study are available from the first author on reasonable request.

Competing interests: The authors declare that they have no competing interests

Funding: 2021 Talent Training Project Supported by Central Government Reform and Development Fund for Local Universities: Research on Standardization of Ethical Review of Drug Clinical Trials；Key Project of Education Reform of Harbin Medical University (XZ201902)

Authors’ contributions: Yanan Zheng and Die Hu contributed to the drafting. Mei Yin contributed to the critical review of the manuscript. All authors read and approved the final manuscript.

Acknowledgements: We would like to thank all students who participated in this study.

Author information:

First Author Introduction:

1)Yanan Zheng (1983.9-), male, born in Qiqihar, Heilongjiang province, ph. D. candidate, associate professor, research direction: humanistic medicine, clinical psychology, Email: [email protected];

2)Die Hu (2000.1-), female, born in Changzhou, Jiangsu province, postgraduate, research direction: humanistic medicine, Email: [email protected].

Corresponding author: Mei Yin, doctoral supervisor, Email: [email protected]

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No competing interests reported.

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Why should we learn medicine?——A questionnaire survey based on 2338 medical freshmen in 3 local medical colleges

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Version 1

Abstract

1 Introduction

2. Materials And Methods

2.1 Study Design, Sample, and Participants

2.2 Questionnaire

2.2.1 A questionnaire that was self-compiled regarding the willingness to practice medicine

2.2.2 Self-made questionnaire on influencing factors of applying for a medical major

2.3 Statistical analysis

3 Results

3.1 The willingness of medical freshmen to study medicine

3.2 Analysis of influencing factors of medical freshmen 'willingness to study medicine

4 Discussion

4.1 Medical Freshmen in local medical colleges have a higher willingness to study medicine

4.2 The willingness of medical freshmen to study medicine is affected by many factors

5 Conclusion

6 Research Deficiencies And Prospects

Declarations

References

Additional Declarations

Status:

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