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.

Effects of the Education and Training Programme for Excellent Physicians in China on medical students' academic performance: a cross-sectional study.

OBJECTIVES: To evaluate the effect of the Education and Training Programme for Excellent Physicians in China on medical students' academic performance. DESIGN: This study is a secondary analysis of data from a cross-sectional survey of China Medical Student Survey (CMSS, 2021) and administrative data of the first-stage Medical Licensing Examination-the Standardised Competence Test for Clinical Medicine Undergraduates (the Test, 2021). CMSS used a stratified sampling process, with all undergraduate clinical medicine students participating voluntarily. SETTING: This programme is implemented at the class level within reformed medical schools, targeting undergraduate students in 5-year clinical medicine in China. The reformed medical schools run pilot classes and traditional classes simultaneously. The analytic sample was a total of 12 243 observations from pilot and traditional classes in 34 medical schools which implemented the reform across 19 provinces in China. METHODS: This study applied the propensity score matching method to estimate the effect of the reform by comparing the scores of the Test between pilot and traditional classes within the same medical schools. We further explored the potential mechanisms driving the effect from two facets of the Test: medical knowledge modules and cognitive levels. RESULTS: Pilot classes outperformed traditional classes by 0.104 SD on the Test (95% CI 0.037 to 0.171). Improvements were seen in basic medicine and clinical medicine modules (0.109 and 0.101 SD, respectively) and cognitive levels of memorisation and application (0.116 and 0.111 SD, respectively). CONCLUSION: These results suggest that the reform had a significant positive impact on medical students' academic performance. Based on the components of this reform and the potential mechanism analysis of the two facets, this study indicates that curriculum reform in integrated learning and teaching methods reform in the adoption of problem-based learning may have been the possible drivers of this positive impact.

Student engagement and learning outcomes: an empirical study applying a four-dimensional framework.

INTRODUCTION: This study applies Reeve's four-dimensional student engagement framework to a medical education context to elucidate the relationship between behavioral, emotional, cognitive, and agentic engagement and learning outcomes. Meanwhile, we categorize learning outcomes in knowledge and skills, and added taxonomies to the cognitive education objectives for the knowledge part, including memorization, comprehension, and application. METHODS: We used the China Medical Student Survey to investigate student engagement, and combined it with the Clinical Medicine Proficiency Test for Medical Schools results as a standardized measurement of learning outcomes. We performed multivariate regression analyses to delve into the effectiveness of different types of student engagement. Moreover, we evaluated the moderating roles of gender and the National College Entrance Examination (NCEE) within the relationships between student engagement and learning outcomes. RESULTS: We observed that emotional engagement is most effective in promoting learning outcomes in basic medical knowledge and basic clinical skills. Emotional engagement and cognitive engagement could effectively contribute to learning outcomes in all three aspects of basic medical knowledge. In contrast, behavioral and agentic engagement showed negative effects on learning outcomes. Besides, we found that the results of the NCEE played a positive moderating role. CONCLUSION: This study provides robust evidence for the effectiveness of emotional engagement and cognitive engagement in promoting learning outcomes. Whereas behavioral and agentic engagement may not be good predictors of learning outcomes in macro-level general competence tests. We suggest a combined effort by students and institutions to promote student engagement and bridge the distance between general competency tests and daily learning activities.

Syntheses, phase behavior, supramolecular chirality, and field-effect carrier mobility of asymmetrically end-capped mesogenic oligothiophenes.

A novel series of asymmetrically end-capped mesogenic oligothiophenes, with various oligothiophene core lengths, alkoxy tail lengths, and molecular polarities through introducing alkylsulfanyl or alkylsulfonyl functionalities as the terminal group, have been synthesized by palladium-catalyzed Suzuki cross-coupling and Kumada cross-coupling reactions as key steps. For the single end-capped oligothiophenes, C(m)O-Ar-OT(4)-H in which m=10, 12, 14, 16, and 18, all of these oligomers exhibited a broad temperature range of highly ordered smectic E and enantiotropic nematic phases, apart from the one with the longest octadecyloxy tail. For the double end-capped series C(10)O-Ar-OT(n)-R, R=Ph-SC(6) or Ph-SO(2)C(6) in which n=1, 2, 3, and 4, oligomers with more than one thiophene ring exhibited smectic A and smectic C phases, various crystal polymorphs and/or unusual low-temperature condensed phases. In the nonpolar, alkylsulfanylphenyl-substituted oligothiophene series, both the crystal/solid melting point and mesogenic clear point increased significantly with an increasing oligothiophene conjugation length. In the polar, alkylsulfonylphenyl-substituted oligothiophene series, all the oligomers showed increased melting points, but decreased mesogenic temperature intervals than those of their corresponding alkylsulfanyl counterparts. Remarkably, two different helical structures showing distinct striated textures or striped patterns were observed with a pitch of several to tens of micrometers under a polarized optical microscope upon cooling from their preceding fluidic smectic phases. The unusual twisted smectic layer structures in the thin solid films exhibiting distinct supramolecular chirality of both handednesses, revealed by circular dichroism measurements, were further confirmed by XRD analyses characterized by a sharp layer reflection together with its higher orders and diffuse wide-angle scatterings. In addition, initial studies showed that the highly ordered smectic phase of the single end-capped oligothiophenes can be utilized to improve field-effect charge mobility. C(10)O-Ar-OT(4)-H showed a hole mobility of 0.07 cm(2) V(-1) s(-1) when deposited on octyltrichlorosilane-treated substrates at 140 degrees C and the on/off current ratios reached 5 x 10(5); on the other hand, its mobility was only 8 x 10(-3) cm(2) V(-1) s(-1) on the same substrate when deposited at room temperature.