Based on the interviews, we found that participants experienced a variety of ‘ambivalent professional identities’, with four main themes identified: fear of becoming a professional, gap between ideal and reality, inadequate professional image, and underdeveloped self-confidence. Participants expected ‘desired identity support’, which was categorised into four main themes: highly confidential individualised mentoring; visualised professional image; learner-centred empathetic attitude; and opportunities for casual mentoring and meetings (Fig. 1).
Ambivalent professional identity
The concept of ambivalent professional identity encompasses the themes that emerged as a result of deep investigation into how medical students who underwent remediation in the first few years perceived the experience and how their identities fluctuated based on what they perceived as problems before and after remediation. Participants felt resistance toward the medical profession and conflict due to the gap between their prior ideals and the reality that they experienced after entering medical university. In addition, they had underdeveloped self-esteem and felt unable to disclose to their colleagues and parents that they were not motivated to continue their studies because they believed that this discussion would not resolve it. In addition to the university environment, life and family factors were also influential.
Fear of becoming a professional
Some participants felt that they had chosen to study medicine because of the expectations of those around them, despite their own tenuous sense of purpose. After entering medical university, they felt trapped in the medical community and had a sense of urgency about the possibility of acculturating:
I didn’t really want to go to medical university, but I didn’t know what else I wanted to do, and my parents wanted me to be a physician; so I compromised on that and enrolled into medical university...Medical university is a very small community and a unique environment. I feel uncomfortable living in this community for the rest of my life, and I am worried that I will go native.
Furthermore, participants were not only aware of differences in university and family environments but also recognised their social stratification through information exchange and interaction with classmates. Additionally, some felt a complex about social inequality:
I felt really jealous of my classmates who grew up in a privileged family environment with high social status because I'm from a rural area...Many of them know the world of medical professionals because of their parents’ influence, so I’m sure their information and ways of dealing with problems will be different from mine.
Gap between ideal and reality
Participants experiences a sense of emptiness, because they felt that they were incapable of becoming a physician. They were also burdened with a heavy workload and unable to complete all tasks. They tried too hard to conform to the environment:
I realised that even if I study, I won’t learn anything if I don’t have a sense of involvement...I had a hard time before I entered the medical university, but after I entered the medical university, the amount of study was more than I had imagined, and the hard time accelerated because my own efforts didn’t lead to good grades.
Participants were aware of their unfulfilled desire for recognition, as well as the inadequate recognition they received, because their efforts were not fully appreciated by their parents or the medical university faculty members:
When I was accepted to medical university for the first time, my parents asked me whether I really wanted to go there, and I was discouraged that they didn’t recognise the hard work and effort I had put in. Even after I started going to medical university, I felt that the return on my efforts to learn was too small.
Inadequate professional image
Some participants were unable to tell their peers and parents that they had not necessarily entered medical university with a firm desire to become a physician. In addition, they were unable to candidly tell their parents that they were not motivated to continue their studies, because they believed that nothing would be resolved through discussion:
While many of my classmates entered medical university because they wanted to become a physician, I couldn’t tell them the fact that I didn’t...I couldn’t honestly tell my parents about my lack of motivation after entering medical university, and I hid the fact that I wasn’t able to go to university from them.
Participants were unable to fully envision their future as physicians after entering medical university. The reason for remediation was not only the lack of credits and attendance, but also the fact that the remedial students in the first few years could not see their future as a physician, which led to strong resistance to the act of attending classes. They compared their learning environment to that at non-medical universities and were aware of feelings of insufficient free time:
I felt relieved when my seniors in the club told me that I would be able to advance even if I didn’t study a lot...I wanted to live like a real student, just like any other faculty, because I am a student.
Undeveloped self-confidence
Participants were overly anxious after entering medical university because they had a limited sense of self-worth. In addition, low resilience caused them to distance themselves from their classmates and delay their progress in the curriculum, even though they understood the requirements:
I knew what I needed to do then, but I couldn’t do it...I felt I wasn’t worth the high tuition at the medical university.
After I entered medical university, my motivation became lower and lower, and I coldly watched my classmates studying...I sometimes went drinking and gambling with my friends, thinking it was the summer vacation of my life.
Although the university offered numerous learning opportunities, the participants indicated that they did not seek out these available opportunities. They believed it was their fault if they did not take advantage of these opportunities and struggled to bridge the gap between feelings and actions. They attempted to resolve these issues by avoiding relationships with classmates and counselling opportunities. Although they felt isolated, they tried to improve their situation on their own:
I told myself that I have some understanding of myself in my own mind and decided not to discuss it with others.
Desired identity support
Participants sought support for their ambivalent identities and wanted to ensure that their safety was protected and that support was individualised. In addition to formal counselling, they felt that opportunities for interaction, among medical students of different years and with young physicians, as well as immediate advice through social networks, were important for professional identity support. They felt that the job description should be visualised from the student’s perspective before the clerkship.
Highly confidential individualised mentoring
Participants were concerned that discussing barriers could lead to the dissemination of personal information and affect their evaluation, and strongly favoured assurances of confidentiality as a condition of support. While they were sceptical of generalised approaches, such as formal mentoring offered to students by faculty, they were very hopeful that individualised approaches tailored to the learning styles of individual students would be offered:
I was worried that the information that I didn’t want to go to medical university would be leaked to the faculty members and that it might affect my grades...I was called by a faculty member to check on my progress when my grades were slipping, but I felt that she was still searching for a way to talk to the students without knowing how to talk to them...I would like the faculty to start by talking to the students in a more familiar way.
Some participants required help and expected teachers to provide them with specific goals and solutions tailored to their learning environments. They also felt that immediate advice and feedback via social media would be useful:
Rather than spending a lot of time explaining things, I’d like them to see why we are struggling...There are only a limited number of opportunities to talk about whether the way of study is really the right way, but I realise that the students themselves need help.
It would be helpful to get an immediate answer via social networking or chat when I need help with something.
Visualised professional image
Participants were concerned about the negative impact and uncertainty that the remedial experience itself would have on their future job prospects. Regarding motivation, they indicated that they had no role models nearby. They believed that career planning support would help them improve their motivation:
I have a vague feeling of anxiety about how I should think about my career...I don’t have anyone close to me, but if I had someone like a role model, I might be able to feel more positive about it.
Female medical students in particular were concerned about the possibility of having a ‘career gap’ in the future due to life events such as marriage and childbirth. They continued to worry about becoming a physician after medical university. They also felt it was important to seek faculty advice if required:
Even if I become a physician, there is a possibility that I will have a gap in my career due to childcare after marriage, and when I think about whether I will be able to go back to work, I feel uneasy. I want the faculties to point out directions when I have problems.
Learner-centred empathic attitude
Participants wanted to feel safe enough to disclose their concerns about the medical profession to the faculty. They also expected a holistic approach and a tolerant response based on detailed information about their life and family environment, along with their academic performance, to avoid misunderstandings about their personality:
Please don’t call me a problem learner...It is quite difficult for me to reveal my deepest feelings of lack of motivation to become a physician to the faculty, but I try to be as specific as possible because I don’t want my personality to be misunderstood.
Participants did not necessarily expect clear instructions or generous support from the university or faculty. They did, however, expect to be supervised at a reasonable distance and be provided adequate time, owing to their supervisors’ trust in their autonomy.
I don’t think my grades will improve because of the university’s generous support, so I didn’t think I needed any particular generous support...I just want them to wait a little bit until I’m ready to do it on my own, and I feel grateful if they are not too close and not too far away.
Opportunities for casual mentoring and meetings
Participants emphasised the importance of a comfortable environment and a sense of familiarity in accepting personal support. They believed that interaction and advice from older students close to their level would be helpful. They also believed that interaction among remedial students would help alleviate psychological distress and hoped that the university would provide such opportunities:
Friends and seniors are easier to talk to, more convincing, and I can complain without hesitation...I think talking to other remedial students makes me feel a little more comfortable because I realise we are all experiencing similar pain. It’s hard to be alone.
In addition, participants wanted to enjoy the efforts of faculty members and other students and felt that encouragement from third parties and classmates would be helpful:
I don’t study for the mentors, but it’s still nice when they tell me how hard I’m working...When I was in a situation where I didn’t know how to study, my classmates made a study schedule and supported me, which was very encouraging.