Ideality and reality collision: how perceived professional environment shapes Chinese medical undergraduates' subject...

Subject interest among medical students-an intrinsic motivation reflecting specialty preference-typically exhibits considerable variation. As curricular factors offer limited explanations for changes in college students' interests, existing studies have gradually shifted the research horizon from the curriculum environment to the overall professional environment. This study aimed to examine how undergraduate medical students' perceived professional environment affects subject interest, with professional identity formation analyzed as a mediating factor.

In this study, we classified medical students' professional environments into three domains: medical school environment, regulatory environment, and social environment. Using a sample of 1,648 clinical medicine students from 14 universities across 6 Chinese provinces, we assessed: (1) the effects of perceived environmental factors on subject interest, and (2) the mediating role of professional identity formation.

All perceived professional environments significantly predict subject interest, and students' professional identities mediate the relationship between the perceived professional environment and subject interest. Although perceived medical school and the social environment positively predict students' professional identity, the perceived regulatory environment negatively predicts professional identity. Heterogeneity analysis indicated that male students and those with lower grades, higher annual score ranks and clinical experience performed better in terms of subject interest. The effect of the perceived social environment on professional identity formation was significant only for graduates. The effect of the perceived medical school environment on subject interest was significant only for freshmen.

Findings reveal that a supportive professional environment is an effective model for increasing medical students' professional identity formation and subject interest. Further research is needed to explain other factors that may influence the causal relationship between the career environment and professional interest.