The COVID-19 pandemic was a major event for people around the world. It brought about very profound social changes, because of both its economic impact and the various measures that were taken to manage the health crisis (quarantine, lockdown, curfew, closure of schools, shops and businesses). Students were particularly affected by it, in terms of its psychological consequences[1, 2] and economic impact[3], as well as the resulting changes in teaching methods. It also raised questions about career building and, by extension, work culture.
Based on concepts borrowed from the sociology of work, the notion of work culture is most often associated with a specific economic activity. It is assumed that the exercise of a professional activity sustainably and deeply influences individuals and contributes to their development[4]. For students, entering the practical phase of their course and engaging in more specialized training can be regarded as a form of secondary socialization, in that they internalize the functioning of new universes. At this stage, they are already able to define themselves partly in terms of belonging to a profession, that is, a fully-fledged social group which therefore has its own culture[5]. A work culture is essentially a culture that is passed down from generation to generation. However, it includes the notion of companionship, not least in medical education[6, 7]. A work culture can be learned either formally, through courses or internships that transmit knowledge and know-how, or by mimicking how exemplars speak and act[8–11]. These aspects of work culture facilitate relationships between those who possess them. They reinforce the feeling of belonging to the same group because those who have gone through this process construct the meaning of their experiences in a similar way and do not need to explain everything. The practice of a professional activity involves mastering a set of tools and techniques (processes), corresponding to distinctive skills shared by the group. It is therefore a way of positioning oneself in relation to other professionals. Finally, members of a profession have specific representations of their work culture, such as how it should be implemented, as well as its purpose and its place in the work organization. This type of professional socialization requires a specific language that is adapted to the profession’s technical requirements and allows its members to express their representations of it. A work culture is capable of identically coding certain experiences so that they then become common, and of eliciting specific behaviors.
These considerations are particularly valid in the medical profession, which has a culture with a strong identity component (corporation, order, specialty, competition-type rites of passage)[12–14] and whose skills are shared and tacitly recognized (knowledge of physical examination, investigative techniques, clinical reasoning, etc.) and which only they are authorized to perform. Regarding language, all physicians know how to speak to patients, and how to communicate about patients with their colleagues (e.g., nurses and social workers[15]).
In France, medical studies are organized in three cycles. The first cycle lasts 3 years: a common core curriculum in the first year, followed by a 2-year diploma course in medical sciences. In the third year, students begin their daily hospital or outpatient internships and participate in the clinical and administrative activity of the care units. The second cycle (diploma in advanced medical sciences) also lasts for 3 years. In the third cycle, which lasts 4–5 years, students train in their specialties (residency).
To minimize the impact of the pandemic on medical students, urgent changes had to be made to the organization of their education. In most countries, there was a rapid transition to online teaching, virtual simulations, and technology-enhanced coaching for healthcare providers[16], or else a structural reorganization[17]. However, little is known about the pandemic’s impact on students’ perceptions of the work culture.
In many countries, medical students were mobilized to support the healthcare system at the height of the pandemic. However, a survey of 4870 Indonesian medical students found that only 48.7% of respondents were willing to volunteer, and only 18.7% felt ready to practice, as they did not think they had sufficient knowledge and skills[18]. Furthermore, volunteering may influence the perception of professional roles and identification with the profession[19], so entering practice[20] may accelerate the construction of a professional identity[21]. A mixed-methods study among 900 Indian students showed that despite the COVID-19 pandemic, the majority of respondents (63.4%) retained a positive image of the profession, and over 91.4% of them confirmed their career choice[22].
Nevertheless, another study showed that students who engaged in an elective COVID-19 literature review course while their faculty was closed continued their literature searches after the return of face-to-face classes[23].
In France, students could perform various tasks on a voluntary basis, such as providing back-up in intensive care units or tracing patients under the COVISAN system, where one of the objectives was to support people who were screened and their contacts, both to ensure their care and to contain the disease. Other students were trained in nursing skills and could be assigned to departments under particular strain. Finally, students were confronted with end-of-life support and the fear of having to make ethical choices at the peak of the pandemic.
These experiences potentially constituted motivational reinforcers that influenced students’ acquisition of the medical profession’s work culture. A better understanding of the mechanisms that can influence this acquisition either positively or negatively could help to improve current teaching methods. Recent studies have mainly focused on the negative impact of the pandemic from a psychological point of view[24], and not on aspects that may have promoted a form of resilience.
To explore these concepts, we adopted the mixed qualitativequantitative vignettes method, which has long been used in the social, behavioral and health sciences. The objective of the present study was to measure the effect of students’ engagement in the healthcare system during the pandemic, and to explore whether it reinforced their professional identity.