This study first explored the role of medical students' attention to COVID-19 on the sources of confidence in overcoming COVID-19 and the improvement of medical students' professional identity. We developed a mediation model to assess their direct and indirect relationships. We found that the sources of confidence in overcoming COVID-19 are positively associated with the improvement of medical students' professional identity. Medical students' attention to COVID-19 plays a partial medium role between them. These findings are essential additions to existing research on the theory and practice of professional identity among medical students.
Implications for theory
This study found that the sources of confidence in overcoming COVID-19 play an essential role in improving medical students’ professional identity. The emergency management of COVID-19 requires full participation, mobilizing the forces of individuals, families, communities, social organizations and other aspects, forming an environmental atmosphere for the public to fight against the epidemic. The expected positive emotional experience and mutual social trust make the public firmly believe that the risk of public health events will be overcome [21]. The government, medical workers, scientific researchers, and grass-roots organizations are the leading players involved in preventing and controlling the COVID-19 epidemic. Their achievements are the source of public confidence that the epidemic will be overcome. Studies show that 43.3%, 46.3%, 53.6%, and 42.7% of the public have confidence in scientific researchers, medical staff, government, and grass-roots to overcome COVID-19, respectively [29]. In particular, medical staff members work day and night on the medical front and have established a high sense of professional responsibility and morality for medical students, which is conducive to enhancing medical students' medical professional identity [30].
The results of the current study demonstrated that medical students' attention to COVID-19 plays a partially medium role in the sources of confidence in overcoming COVID-19 and the improvement of professional identity. Social media is the primary channel for the public to pay attention to preventing and controlling COVID-19. According to statistics, WeChat (82.4%) and Twitter (75.8%) were the main channels, followed by television (42.9%), websites (41.1%), and news clients (40.8%) [29]. The network media concentrated on reporting the effectiveness of joint prevention and control measures of various regions and departments have strengthened the confidence of medical students that the country and its people will eventually overcome the virus and further encouraged them to continue to pay attention to the development of national COVID-19. They are interested in a wealth of information about COVID-19, such as disease development, treatment methods, preventive measures, vaccine research, and medical team dispatch [4, 7, 8]. At the same time, medical students are expected to apply their knowledge to prevention and control work. A study found that approximately 83.85% of medical students were moved by the behavior exhibited by front-line medical staff, who devoted much of their time and energy to work [31]. About 85.7% of medical students are willing to take the initiative to participate in front-line work in the future [32]. It can be seen that medical students are full of confidence to overcome the COVID-19 epidemic, which is conducive to promoting their continued to pay attention to the progress of COVID-19 prevention and control and further improve their professional identity.
Despite the high social status of medical staff, the work nature of high-risk, high-pressure, and long working hours leads to some medical students’ low professional identity scores [17, 33]. In the progress of prevention and control of COVID-19, the strong support of social groups for medical work and the high frequency and intensity of positive reports by the news media have greatly improved the professional identity of medical students, which has deeply enhanced their sense of responsibility and mission [11]. Studies have shown that 59.0% of medical students are willing to participate in front-line epidemic prevention actions, and 87.7% of medical students have experienced a positive impact on their professional identity [33]. Other studies have shown that 42.9% of medical students have not been shaken in their professional beliefs during the COVID-19 epidemic, and 53.6% of medical students have strengthened their beliefs [34]. Therefore, the support of the government, society, and media to medical staff is essential to improve medical students’ professional identity.
Implications for practice
Improving medical students' professional identity is a critical target of professional identity education and an essential task of national development and social stability. According to our study results, we propose the following recommendations.
First, community practice can provide a theoretical basis for professional identity [35, 36]. During COVID-19, the anti-epidemic activities of medical staff were the most regular, large-scale community practices in the epidemic areas. Colleges should pay attention to the role of community practice courses in shaping professional identity. Medical students could establish their professional image through experiential learning in the Centers for Disease Control and Prevention (CDC), Community Health Centers, clinical hospitals, and other organizations [37]. In the interactive process of social practice, they can think, act and feel like medical staff, and gradually understand the essence of professional identity and the socialization process of identity formation [35]. Some scholars believe that the most influential factors influencing professional identity formation are role models and mentors, and experiential learning in clinical and nonclinical situations [38, 39]. In community practice, students consciously acquire knowledge through observation, imitation, and practice [33, 40, 41]. Role models and mentors can encourage medical students to reflect and summarize in practical learning to enhance their learning effect considerably [33]. These measures enable medical students to avoid overreliance on historical precedent, intuition, or perceived common sense and improve their underlying public health service skills. In addition, medical colleges need to set up special practical skills courses on how to deal with the doctor-patient relationship to improve medical students' medical confidence and thus enhance their willingness to practice medicine [42].
Second, social media is essential for improving the cognitive domain [43]. The attention of medical students to media reports reflects the critical role of social media in the construction of medical students' values and professional sense to a certain extent. Medical students pay close attention to the progress of public health events through social media. They discuss issues with peers online, give feedback and show their attitude, and are influenced by each other through the media [10]. Positive reports of COVID-19 can improve medical students' confidence in overcoming COVID-19. However, relevant information about COVID-19 is often exaggerated in the spread of social media. Even those not directly affected will form a particular position or attitude, causing forwarding, commenting, and other behaviors, further promoting the spread and diffusion of public opinion information on social media platforms. This situation can spread anxiety, panic, and other negative emotions, thus shaking confidence in overcoming crisis events [44]. At the same time, the adverse reports on doctor-patient disputes by the news media have made medical students’ levels of cognition and emotion toward medical work more one-sided [45]. From this, government departments should first take a clear stand on public opinion during the crisis, reasonably guide public opinion, and positively build public confidence in dealing with COVID-19. Then, they need to monitor and analyze the public opinion information of public health emergencies, guide medical students to understand the medical and practice environments objectively, and clarify the professional situation of medical staff. The media should report the significance of medical personnel in dealing with COVID-19, which is conducive to stabilizing the supply of human medical resources and improving the quality of medical services. Additionally, the idea of modern medical education is to guide medical students to make full use of network media in a positive way to improve their professional identify to promote the transformation of their self-awareness from university medical students to future healthcare professionals [46]. Consequently, the correct levels of guidance from the government and the media allow medical students to choose their jobs objectively and strengthen their professional beliefs when paying attention to COVID-19.
Finally, society and family support are essential factors for medical students to strengthen their professional consciousness. During COVID-19, the sources of confidence in overcoming COVID-19 from the government and society reflected the most vital social support. In addition to professional courses, employment guidance and training, society and family are important factors affecting medical students' professional identity. Many nurses think that patients do not respect nursing work and that nurses have a lower social status. When the professional status of medical personnel is low, dismissal may occur, especially for male nurses who suffer from gender stereotypes and lack social and family support [47, 48]. It is well known that nursing staff are an indispensable part of medical activities, especially since the role of male nurses is becoming increasingly prominent. These warn the national relevant departments, such as holding regulators, hospitals, and nursing educational institutions, to develop the professional identity of male nurses, emphasizing personalized training and guidance, such as lectures, competitions, or salons, to realize their social value fully. Participation in these activities can change their perception of the nursing profession and help maintain the stability of male caregivers [49, 50]. In addition, family conflict was negatively correlated with professional identity. Faced with the current heavy academic burden and high social requirements of medical students, families should create a healthy and relaxed environment. When the country in a significant public health crisis, families should actively support medical students to participate in primary healthcare workers and encourage them to promote their professional competence and vocational awareness.
Strengths, limitations, and future research
The study makes an essential contribution to the literature by evaluating the associations among the sources of confidence in overcoming COVID-19, the improvement of medical students' professional identity, and medical students' attention to COVID-19 through data reported by medical students from three medical universities in Hunan Province. The present study confirms our research hypothesis that medical students' attention to national crisis events moderates the relationship between the sources of confidence in overcoming COVID-19 and the improvement of medical students' professional identity. Additionally, these findings enrich the theory and practice of professional identity education-related research among medical students.
Our study has several limitations. First, our study is a cross-sectional study, which can only account for the associations between these three and cannot explain the causal relationships between them. Second, this study was based on the self-reported of students to assess the improvement of their professional identity, which may have led to a response bias. Third, medical students' professional attitudes result from many factors, and we explored only their attention to COVID-19 as an intermediary factor. In future research, longitudinal research is needed to confirm these contentions. The predictive effect of other personal factors, such as medical students' participation in epidemic prevention and control workers or social and family factors on medical students' professional identity, need to be further studied. Beyond that, their association and role in the context of other public health events requires further research.
