This study surveyed 1067 medical postgraduates across China to explore whether students’ academic satisfaction with scientific research could be affected by those characteristics, including sociodemographic characteristics (age, marital status, medical school year of training, major specialty, master’s or doctoral degree and degree category of academic or professional), objective factors (research direction, from “double world-class” university or not, university location, research working time per day, research learning manner, number of published papers and participating projects), and subjective factors such as sense of time urgency, anxiety and depression. It was found that the majority of postgraduates come from “double world-class” universities. The median age of the participants was 25.5 years old, with nearly half of the respondents (75.9%) being master candidates. The academic satisfaction score was lowest among medical professional masters and highest among doctor postgraduates, followed by academic masters. Research working time per day, number of participating projects and research learning manner could affect academic self-satisfaction. However, neither university type or location nor research direction appeared to be related to overall low satisfaction. Higher levels of depression and anxiety were associated with postgraduates’ low satisfaction with scientific research, whereas the sense of time urgency was not affected.
1. Academic satisfaction of scientific research among postgraduates and objective associated factors
The outcome analysis suggested that postgraduates experienced moderate levels of self-satisfaction. The professional masters performed the lowest level of satisfaction, possibly because they needed to balance the time properly between clinical standardized training and academic projects within three years under the "four certificates in one" training mode39. Most professional masters research in the clinical science direction, while academic masters engage in basic science (Figure 1). Generally, clinical research requires the full collection and analysis of data from clinical patients, while basic science research requires researchers to spend much time in the lab with sufficient research funds as well as professional guidance for experiments. However, both usually need experimental platform. However, it does not show a significant distinction between research category and satisfaction. Doctor candidates who have the highest satisfaction may be due to their rich experience and skills in scientific research, which help them complete science projects and finish papers. In fact, most postgraduates without academic projects are in low medical school years, and they are less experienced.
Moreover, as noted in our study, the number of participating projects and mentors’ guidance are critical to postgraduates’ satisfaction with scientific research. Our analysis demonstrates that medical postgraduates participating in science projects showed higher satisfaction and spent more time on daily research activity than those without projects (Fig. 3). The number of projects is a protective factor for low academic satisfaction. However, in our study, more than one-fifth of master postgraduates had not taken part in any project, especially professional master candidates (Supplementary Tables S1, S2). Thus, medical postgraduates should be encouraged to join in sciences practice as soon as possible, which helps them accumulate rich operation experience. In the initial process of a project, the overriding aim is to inspire their interest and enthusiasm for scientific research. In terms of daily science hours, a number of master’s students (34%), especially professional students, spend 1~3 hours and show a lower level of academic satisfaction. It is interesting that properly increasing the daily time length for scientific research, such as 4~6 hours or 10-12 hours, contributes to improving the degree of self-satisfaction, while working times that are too short or too long have no contribution (Fig. 4). This is probably because time length in scientific research, as an indirect reflection of devotion to the research, is a necessary base for scientific achievement, while too longer working wears researchers and impairs the efficiency of research. Meanwhile, postgraduates who work longer per day are likely to obtain more papers (Fig. 3).
As one study indicated, almost 98% of participants identified lack of mentoring as the first (42%) or second (56%) most important factor hindering career progress in academic medicine40. Additionally, another study found that medical master postgraduates with mentors’ guidance report more publications, but they focused on academic medicine faculty members rather than postgraduates41,42. However, our analysis shows that there is nonsignificant association between the number of published papers and guidance from mentors among all participants. Specifically, a significant association between papers and guidance is indicated among doctor candidates but not among master candidates (Supplementary Table S1-3). Moreover, approximately one-fifth of master respondents (20.6%) were learning on their own, while most of them felt lower research satisfaction than those guided by formalized mentors, senior postgraduates, peers or colleagues. It is a major challenge for postgraduates to complete scientific research independently because they might be headed in the wrong direction and be more likely to experience psychological dilemmas, as we discussed before. It is hard for them to achieve progress on scientific research projects. Although students are supposed to cultivate their ability to self-learn, from the perspective of our participants, scientific research lacking mentoring may increase academic stress and decrease the opportunity to achieve academic advancement and research fund disparities.
Therefore, postgraduates’ educational institutions should promote the relationships between mentors and students. The mentors not only help postgraduates to direct academic questions or research assignments properly but also motivate the mentees to accomplish their research and obtain achievements in a high standard. As another study said, the effective mentor knows the mentees well enough to envision possibilities by recognizing the potential of the mentees so that they encourage the students to reach their highest potentials40. Establish reward policies for prized mentors who have “clout,” knowledge and are willing to provide both professional and personal support to mentees. Sufficient guidance from mentors would offer medical postgraduates more opportunity to gain progress in their scientific research and help to maintain their mental health. This, in turn, would contribute to improving the level of academic satisfaction and working out high-quality papers.
2. The state quo of mental unhealthy and it relates to lower self-satisfaction
When investigating postgraduates’ academic satisfaction, we find that 76.0% of postgraduates have depression or depressive symptoms (16.6% serious) and 79.4% have anxiety (20.1% serious). As our study showed, depression and anxiety were associated with low satisfaction among postgraduates. Along with the severity of depression and anxiety, it is more likely to result in low satisfaction. Anxiety and depression are two unhealthy mental states. First, mental health has a further adverse impact on the physical and mental health of graduate students. For example, anxiety will significantly increase the risk of time urgency (Fig. 3). Some studies have reported that students suffering from depression tend to be despondent and lack interest or energy in activities. They usually have feelings of guilt or worthlessness and thoughts of suicide. In addition, these psychological symptoms suggest that postgraduates may be suffering from a huge gap between reality and expectation. Long-term anxiety or depression makes it more difficult for postgraduates to achieve the expected academic goals, which would wear down their confidence toward academia, finally resulting in low academic self-satisfaction of scientific research. Meanwhile, students’ intrinsic characteristics, such as time urgency, had a significant association with depression and anxiety (Fig. 3). Although no significant association was found in our study between time urgency and self-satisfaction, people with A-type personality tend to pursue perfection and have high requirements for themselves. They are usually difficult to be satisfied, which increases the probability of anxiety or depression symptoms43,44.
Our survey suggests that there is a high prevalence of mental unhealth among medical postgraduates. However, one study found that only 36% of students with mental disorders see a mental health professional to address mental concerns5. This is because postgraduates might feel ashamed to consult psychological problems, and several academies do not have supporting measures to solve postgraduates' psychological problems. Thus, on the one hand, medical academies and affiliated hospitals should help students build a right attitude toward their mental health and encourage them to use counseling services without worrying about what others thought. In addition, when students feel stressful about their research, they are supposed to look to peers and colleagues for informal mentoring and assistance in navigating academic research. Colleague mentors can be found both in one's own department and at other academic centers. On the other hand, it is necessary for hospitals to develop and perfect mental and emotional support systems for their students, including support from teaching department tutors, developing counseling services and a third-party occupational health approach. This collaborative mentoring would offer an effective approach for students to balance their mental health. Meanwhile, a close network of families, friends, and community connections is highly valued in Chinese society, which is important for adolescents and young adults to resist and effectively cope with the stressful events related to mental health45. Moreover, individuals, especially those with type A characters, should avoid self-imposed pressures, such as setting the bar too high to reach and self-doubt. Some of them may be undergoing intense competition against other prospective masters to apply for doctor education. In this case, they are supposed to improve their scientific research ability as well as mental toughness (MT)46. Regardless, making progress in scientific research requires effort and persistence rather than stress-related academic dishonesty47.
3. A novel model to predict lower self-satisfaction based on associated factors and direct individualized interventions
According to our survey, academic satisfaction with scientific research could be affected by many factors, including tutor guidance, the number of participating projects, anxiety and depression. Therefore, based on the results of multivariable logistic regression, we assigned a value to the contribution of those factors to satisfaction. When each score is summed, we can use the total grade to predict the level of academic satisfaction of medical postgraduates. In other words, we established a prediction model of the alignment diagram, which is also known as the nomogram. This novel prediction model for academic satisfaction of medical postgraduates is based on multiple related factors. Thus, it can screen according to the predicted value of scientific research satisfaction of medical research and help to direct early intervention to postgraduates with low satisfaction.