Still want to be a doctor? Medical student dropout in the era of COVID-19

An Integrative Scoping Review of Behavioral Economics Applications in Higher Education: Opportunities for Academic Pharmacy

OBJECTIVES

This integrative scoping review explores the applications of behavioral economics within higher education, particularly, through the lens of nudging (a concept that leverages insights from economics and psychology to guide individuals' decisions subtly). The primary objective is to provide a broad overview of interventions that use behavioral economics principles and, secondarily, discuss their potential to improve pharmacy education and create a foundation for future research in this area.

FINDINGS

The review analyzed 89 studies that applied behavioral economics principles in higher education settings. Reminders and prompts were the most frequently used principles, with generally positive outcomes, especially in enrollment management. Framing, incentives, and salience also demonstrated effectiveness, depending on the context. Social norms and simplification showed mixed results, whereas priming, loss aversion, feedback, comparison, and commitment had varying degrees of success in influencing behavior.

SUMMARY

Behavioral economics principles offer valuable insights and tools for enhancing various aspects of education. The review highlights the potential for using these principles to improve student engagement, enrollment processes, and health and well-being initiatives. However, it emphasizes the importance of context-specific design and careful implementation when applying these interventions. Future research opportunities exist to further explore the applications of behavioral economics in pharmacy education and beyond.

The trajectory and transition pattern of intention to practice medicine among medical students in China

There has been a growing concern about the career intentions (whether medical students have the intention to practice medicine) due to the increasingly serious problem of medical students attrition. Career intentions have the potential to promote medical students' career commitment and encourage them to stay in the medical profession. Moreover, a series of dynamic career intentions during medical education can be served as an early guide to the medical students' future career choices (whether medical students finally choose to practice medicine). However, few studies focus on the dynamics of career intentions among medical students. In this study, we utilized data from a large-scale national survey of medical students conducted in China from 2020 to 2022 to curve the trajectory of the intention to practice medicine among medical students during their undergraduate medical education by using multilevel growth model. Furthermore, we applied latent Markov model to estimate the transition matrix of the intention across each academic year during the undergraduate medical education. Our findings revealed a trajectory curve with a peak during the second year in the intention to practice medicine. In addition, we identified three latent states of career intention including "strong intention", "wavering" and "weak intention", and further found two distinct transition patterns between individuals with strong career intentions and those without strong career intentions. The transition patterns play a crucial role in understanding the changes in the trajectory of medical students' intentions and determining the optimal timing for interventions to prevent medical student attrition. Our study offers a comprehensive understanding for the dynamics of the career intention among medical students, which has practical implications for medical educators and institutions to address the issues of medical student attrition.

Chronic stress and turnover intention of resident physicians after experiencing COVID-19

BACKGROUND

Previous studies have explored the stress and turnover intention of healthcare workers, but as important backup talents in the healthcare system, resident physicians have received little attention from researchers, especially after experiencing COVID-19. Therefore, this study aims to evaluate the chronic stress and turnover intention of resident physicians after experiencing COVID-19.

METHODS

From June to August 2022, we conducted a questionnaire survey on resident physicians in the Children's Hospital of Hebei Province through the online platform (Wenjuanxing) to evaluate their chronic stress and turnover intention after experiencing COVID-19. For the collected data, we used frequency and percentage to make the statistical description, the Chi-square test to make a univariate analysis on the scores of chronic stress and turnover intention scale, and binary logistic regression analysis to explore the influencing factors of turnover intention.

RESULTS

Out of 143 respondents, we finally received 127 questionnaires, with a response rate of 88.81%. Among 127 respondents, 80.31% of resident physicians experienced varying degrees of chronic stress (mild: 36.22%, moderate: 35.43%, severe: 8.66%), and 74.80% of resident physicians showed varying degrees of turnover intention (mild: 23.62%, moderate: 37.79%, severe: 13.39%). Moreover, age (OR = 0.772, P = 0.042), identity (OR = 8.648, P = 0.021), and chronic stress levels (mild: OR = 6.938, P = 0.003; moderate: OR = 44.049, P < 0.003; severe: OR = 46.141, P = 0.004) can significantly affect turnover intention.

CONCLUSION

In this study, we reported a relatively high proportion of resident physicians with high chronic stress and high turnover intention after experiencing COVID-19. We suggest that the relevant departments should pay more attention to the resident physicians' group and formulate corresponding measures to solve the problems faced by the resident physicians and ensure the stability of the health human resources.

The effect of an information intervention on the career commitment of medical students: evidence from a randomized experiment

Introduction

The needs-based shortage of healthcare workers is severe worldwide and it would be exacerbated if many medical students switch to other careers after graduation. Maintaining and improving the career commitment of medical students, which could be a feasible, effective, and scalable way to reduce the attrition rate, is essential in medical education. We designed a randomized experiment to test whether an information intervention based on role modeling could enhance medical students' career commitment.

Methods

In the randomized experiment, the sample (N = 36,482) was divided into the treatment group (N = 18,070) and the control group (N = 18,412). The intervention information consisted of image-text messages on Zhong Nanshan, who is an inspiring role model for he went to the frontline of COVID-19 in the most critical circumstances and received praise and affirmation from the public. Α difference-in-differences model was employed to identify the effect of the information intervention. Heterogeneous treatment effects were identified using sub-sample analyses.

Results

The results showed that the information intervention statistically significantly reduced medical students' dropout intention by 2.7 percentage points (95% CI: -0.037 to -0.016, t = -4.95, p < 0.001), equivalent to 14.6% of the control group mean. This estimate indicates that the information intervention could significantly increase the career commitment of medical students. Finally, male and senior students were influenced more than their female and junior counterparts, which can be explained by their relatively high dropout intention.

Conclusion

Role model-based information intervention improves the career commitment of medical students. The underlying behavioral model is that, when students use a role model as their reference point, they consider dropout as a substantial welfare loss. Role modeling is an effective way to improve the career commitment of medical students, especially for males and senior students.

Attracting adolescents to become doctors and nurses: differential importance of personal and environmental factors in 61 economies

BACKGROUND

Doctors and nurses play a fundamental role in maintaining global health systems and achieving universal health care coverage. However, significant shortages persist, and little is known about the popularity of these careers among young people in various economies or the relative impact of personal inputs and contextual factors.

METHODS

Using data from the large-scale Programme of International Student Assessment (PISA) 2018, we showed the recent distribution of adolescents' medical (doctor) and nursing career expectations in 61 economies. With multilevel logistic and hierarchical linear regression, we examined the relative importance of economic indicators, health work conditions, and personal background factors in affecting adolescents' health career expectations.

RESULTS

Approximately 11% of adolescents expected to be doctors in each economy, while only 2% expected to be nurses. Adolescents were attracted to health professions mainly by system-level favourable conditions (accounting for 1/3 variance), including (a) government health expenditure beyond that expected gross domestic product (GDP); (b) a safe working environment for doctors in wealthy nations; and (c) high salaries for nurses in less-developed economies. In contrast, adolescents' background (gender, social status, and academic ability) was less influential, explaining only 10% of the differences.

CONCLUSIONS

In the technological and digital era, high-ability students are equally competitive for emerging careers other than doctors and nurses. In developing countries, a high salary package and societal respect are enough to attract adolescents to nursing careers. In contrast, for developed countries, extra expenditures beyond regular GDP allocation and a safe work environment are crucial in attracting adolescents to become doctors. Salary may effectively attract international-trained doctors and nurses, but the work environment will likely emerge as an essential factor in retaining migrants in their positions.

TRIAL REGISTRATION NUMBER

No human participants were involved in this study.

Prosocial modelling matters: the association between parent and faculty involvement in fighting COVID-19 with medical students' career commitment

BACKGROUND

Role models are essential in medical education, yet empirical research is relatively insufficient on the influence of prosocial modelling on medical students' career commitment. The prosocial behaviour of medical staff involved in the fight against the novel coronavirus disease 2019 (COVID-19) at the beginning of 2020 presents an opportunity to fill the research gap. We explored and compared the different associations of the two most important role models for medical students - parents and faculty- with medical students' career commitment.

METHODS

The cross-sectional study was conducted with 99,559 undergraduate students majoring in clinical medicine in mainland China. Questions were asked to collect information about participants in the battle against COVID-19, medical students' determination to practice medicine after graduation, as well as students' socio-demographic characteristics. Chi-square tests and hierarchical regressions were performed to examine the associations between parent and faculty involvement and students' career commitment.

RESULTS

The results showed statistically significant associations between prosocial modelling during the COVID-19 pandemic in China and students' intention to pursue medical careers. The association of faculty involvement (OR = 1.165, p < .001) with students' career commitment was greater than that of parents (OR = 0.970, p > .05). For faculty involvement, the association was stronger among male students (OR = 1.323, p < .001) and students who were already determined to be doctors (OR = 1.219, p < .001) before the pandemic.

CONCLUSIONS

Our study provides new evidence on the potential roles of parents and faculty in shaping medical students' career commitment. Encouraging faculty to act as positive role models could help medical students increase their intention to become doctors.KEY MESSAGESProsocial modelling could enhance students' intention to pursue medical careers.The association of prosocial behaviour of faculty is larger than that of parents on medical students.Those who have prior medical career commitment are much more likely to persist in the medical profession, and prosocial modelling of faculty is positively associated with their medical career commitment.

Assessment of dropout rates in the preclinical years and contributing factors: a study on one Thai medical school

BACKGROUND

The highest dropout rate for medical students is during the preclinical years of education. Several studies have reported possible contributing factors, however, studies regarding the dropout rate from medical education among Thai medical students and its associated factors are still lacking. This study aimed to identify the prevalence of dropout from medical education within the preclinical period and its associated factors among Thai medical students.

METHODS

We collected data from preclinical medical students who entered one medical school in Bangkok, Thailand, between 2017-2019. Demographic data, admission program, pre-admission mental health status assessed by the Thai Mental Health Indicator 66, mental health records from the faculty-based counseling services, and academic achievement were extracted. Data were reported in a descriptive fashion. We analyzed the association between dropout and these factors by robust Poisson regression.

RESULTS

In total, 914 students were recruited. Dropout was only 1.5%, which was lower than the previous studies. Regression analysis showed a significant association between dropout and mental health problems [Prevalence ratio (PR) 58.20, 95%CI 13.72- 246.95] but not admission program [PR 0.32, 95%CI 0.09 - 1.16] or failing examinations [PR 0.59, 95%CI 0.18 - 1.90]. However, other contributing factors such as financial status, family problems, medical illness, and students' motivation, were not evaluated in this study.

CONCLUSIONS

Mental health problems during medical education were associated with dropout after adjusting for other confounding variables. Further longitudinal studies are needed to identify the impacts of academic failure on dropout in higher clinical years.