A study on the relationship between self-efficacy and career identity of rural-oriented tuition-waived medical students based on the mediating effect of vocational outcome expectations.

backgroundPrimary healthcare plays a crucial role in providing accessible, affordable, and comprehensive care to meet basic health needs. However, primary healthcare in China faces problems such as insufficient numbers of medical staff and low professional quality, which affect the quality of primary healthcare services. Since 2010, the Chinese government has initiated a rural-oriented tuition-waived medical education (RTME) programme, which has trained many excellent general practitioners for primary healthcare. However, rural-oriented tuition-waived medical students (RTMSs) have a weak sense of career identity and a low willingness to engage in primary healthcare at present, hindering the sustainable development of primary healthcare services. This study, based on social cognitive career theory, takes Zhejiang Province as an example to investigate the career identity levels of RTMSs and explores the demographic factors influencing these levels. It validates the internal relationships and mediation models among self-efficacy, vocational outcome expectations, and career identity. The study provides empirical evidence to enhance the willingness of RTMSs to serve in primary healthcare and to optimize talent training policies.

methodsA cross-sectional survey was conducted among 428 RTMSs in Zhejiang, China, between November 2023 and March 2024. Participants were selected using multistage stratified random sampling. Descriptive statistics were calculated, and differences between groups were estimated using Student's t-test and ANOVA. Pearson correlation analysis was performed to assess the degree of correlation between different dimensions of self-efficacy, career identity, and career outcome expectations. Based on the hypothesized model, structural equation modeling analysis was conducted to test the interrelationships between these research variables.

resultsThe average total score of the career identity survey questionnaire for Zhejiang RTMSs is 3.68 ± 0.56. There are significant differences in the career identity scores of RTMSs across groups based on grade level, whether parents are healthcare workers, the level of understanding of the orientation policy, and the degree of parental support (p < 0.05). Results from the structural equation model indicate that self-efficacy significantly predicts career identity (β = 0.284, p < 0.001), with vocational outcome expectations playing a partial mediating role between self-efficacy and career identity(Indirect effects account for 67.1%).

conclusionsCareer identity of RTMSs in Zhejiang is at medium level, with the lowest score observed in the "attitudinal identity" dimension, indicating that RTMSs' willingness to accept primary healthcare work needs improvement. Vocational outcome expectations partially mediate the relationship between self-efficacy and career identity, in line with the SCCT. Enhancing RTMSs' confidence through skills training and primary healthcare practice, along with optimizing policies that support vocational prospects, can strengthen positive outcome expectations.