Do media stories about medical workers’ arduousness scare medical students? Insights from a cross-sectional study

Abstract

Background

Under the combined influence of the aftermath of the epidemic and aging, the shortage of health workforce has become increasingly serious across the globe, posing constraints to the achievement of Universal Health Coverage. Improving the professional identity of medical students can ensure a steady supply of potential medical workers, which can mitigate the shortage of medical workers. This study focuses on sad news about medical workers’ arduousness, a dominant news type in public crises, and examines how it affects medical students’ professional identity, which is regarded to be important in the development of medical education and public health.

Methods

This study employed a paper-and-pencil survey and recruited 1441 medical students in a Chinese university. Structural equation modeling (SEM) analysis with SmartPLS 3.0 was used to analyze the data.

Results

The results reveal that media stories have multi-layered impacts on medical students’ professional identity. Their exposure of sad news about medical workers’ arduousness not only has direct impacts on professional identity, but also exerts indirect impacts via the provision of online emotional support.

Conclusion

This study has both theoretical and practical implications. In theory, the findings highlight the importance of media stories in the construction of professional identity and propose a theoretical framework for explaining the impacts of sad news exposure. In practice, this study contributes to the improvement of medical education, hospital management and public health governance in the digital age.

Introduction

Medical workers play a central role in protecting public health and achieving the goal of Universal Health Coverage [1]. The COVID-19 pandemic also highlights the importance of medical workers in building the resilience of the health system. However, the health workforce shortfall has posed stress for the health systems. The global shortage of health workforce is estimated to be over 10 million in 2030 [1], and this trend will become more serious as the global aging society intensifies. Notably, there is an increasing dropout of medical workers as a result of long-term mental health problems and work pressure due to COVID-19 [2]. The shortage not only leads to the lack of public access to essential health services, but also causes the overwhelming workload and stress of medical workers [2]. As future medical practitioners, medical students’ professional identity can ensure a steady supply of potential medical workers.

Professional identity is an individual’s professional self-concept based on their beliefs, values, motives and experiences [3]. Professional identity not only affects individuals’ career choice [4], but also affects their job satisfaction and turnover intention [5, 6]. Professional identity is important for medical education as it can affect the development of medical workforce [4]. Particularly, medical students’ professional identity is regarded as the prerequisite for them to become qualified medical workers. Medical students’ professional identity is reflected by their attitudes, values, motives and beliefs toward their future profession. Compared with professional medical workers, medical students are young, vulnerable, digital natives, and their professional identity are easily influenced by external environment. As medical workers are in frontlines to protect public health, they are focused by media. Accompanied with the COVID-19 pandemic, media stories about medical workers’ sufferings and sacrifice become prevalent on the Internet. Recently, there is growing evidence suggesting that online media act as an important avenue to influence students’ knowledge and attitudes with regard to the medical profession, but the theoretical mechanism is unclear. Thus, it is important to investigate how media stories about medical workers’ arduousness affects medical students’ professional identity.

The existing studies tend to examine how medical students’ motivations, and studying or working environment influence the development of their professional identity [7]. Discussions on the effect of media stories are lacking. Additionally, previous research usually treats professional identity as an integrated concept [8, 9]. Considering that professional identity can be reflected in psychological as well as behavioral aspects, this study adopts belonging and commitment to represent it, aiming to provide a nuanced understanding of this concept. Belonging and commitment represent different aspects of professional identity. Belonging is the feeling of being a member of a group, describing individuals’ psychological ownership toward a group [10]. Commitment is the desire to commit to the profession and maintain membership in the profession [11], reflecting individuals’ behavioral continuity in a profession [12].

In order to illustrate the effect of media stories about medical workers’ arduousness on professional identity as well as the underlying mechanisms, 1441 medical students in four majors (basic medicine, clinical medicine, nursing and public health) from a medical school in China were recruited to participate in a survey. Theoretically, this study develops an in-depth understanding regarding how media environment affects the development of medical students’ professional identity. Practically, this study provides actionable guidelines for educators and government staffs to take advantage of media content to promote medical students’ professional identity.

Context of the study

During a public crisis, there are media stories about the sufferings and sacrifices of medical workers, making sadness the most widely experienced negative emotion. As a type of negative emotion, sadness arises from situations that are beyond one’s control or facing irreparable losses [13]. When news with sadness is related to users, it can exert a great impact on them [14]. Hence, the sad news about medical workers may affect medical students’ attitude toward the medical profession. This study conceptualizes sad news as the news with sad emotion, reporting the hard-working conditions, unavoidable infections and sacrifices of medical workers in a public crisis. Owing to the pervasiveness of sad news on media platforms and its potential impacts on professional identity during a public crisis, it is important to investigate how sad news exposure shapes medical students’ professional identity. As sad news conveys the emotion of sadness, this study takes the functionalist perspective of emotion to explain the effects of sad news.

The functionalist perspective of emotion

The functionalist perspective is proposed to examine how emotions are associated with the regulation of actions and action tendencies, and it holds that emotions are conceptualized as flexible, contextually bound, and goal directed [15]. By emphasizing the relational attribute of emotion, the functionalist perspective posits that it is better to understand the effects of emotion by considering the relationship between contextual events and individuals [15]. As sad news involves work situations of medical staffs in a public crisis, it is reasonable to examine the effects of sad news by simultaneously considering the characteristics of medical students and their relationship with the public crisis. Hence, the effects of sad news exposure can be understood by the functionalist perspective of emotion.

According to the functionalist perspective, sad news conveys social signals that help medical students develop their attitude toward the medical profession. First, by presenting sufferings and sacrifice of medical workers, sad news can engender a contagious emotion among the public [15, 16]. Such news signals the public’s emotional recognition of medical workers. Second, by entitling affective meaning to medical workers, sad news can strengthen medical students’ perception about the significance of medical profession [17]. Third, sad news can generate emotions of pride, which can have enduring effects when medical workers’ acts get approval from the public [18]. Therefore, sad news about medical workers during the public crisis can provide emotional support to medical students by conveying social signals about the public’s care and admiration of medical workers.

Emotional support refers to the empathy, care and trust from others [19]. During a public crisis, online media provide an important channel in delivering social support. The relationship between medical workers and students enables students to empathize with the emotions and experiences of medical workers in the news [18]. Once the acts of medical workers meet the social expectations and gain respect, medical students may also feel socially recognized and gain emotional support. Moreover, the exposure of sad news can also entitle a social role for medical students, bringing them the feeling of peer companion and affirmation [18].

In addition, emotional support has been regarded as a critical predictor of psychological and behavioral outcomes. Prior studies have found that emotional support can reduce conflicts between roles [20, 21] as well as role strain [22]. It can also help individuals adapt to the transformation of identity to promote identity synthesis [23]. Moreover, a recent work has proved that social support is a common protective factor to reduce the risk of mental health problems of medical workers [24]. In this way, medical students’ perceived online emotional support from the media may help them target their identity and construct their professional identity. Combining the above arguments, this study treats perceived online emotional support as a mediator and attempts to examine how sad news exposure can engender medical students’ perceived online emotional support, which further affects their professional identity.

The effects of sad news exposure

Sad news exposure is defined as the frequency regarding how people are exposed to online news that are sad [25]. Sad news and the associated negative emotions can increase the perceptual salience of an event [26]. Medical students as a group that closely associated with medical personnel are more likely to pay attention to news about medical workers, based on which they adjust their cognition of the profession. In this process, medical students may find commonalities with medical personnel in news related to medical workers, build connection between themselves and medical workers, and thus increase their sense of belonging to the medical profession. Besides, sad news such as the sufferings and sacrifice may improve medical students’ sense of social responsibility, and inspire them to make contributions to alleviate the public crisis, which also entitle medical students to commit to their future career [27, 28]. Thus, the following hypotheses are proposed:

H1a

Sad news exposure positively correlates with medical students’ sense of belonging to medical profession.

H1b

Sad news exposure positively correlates with medical students’ commitment to medical profession.

Sad news about medical workers in a public crisis can elicit the individuals’ emotional response such as anxiety, sadness and fear, which may further affect their perception of the social environment. Since the outbreak of the pandemic, online news regarding the dedication of medical workers usually reflects the public’s positive attitude toward the medical groups. Despite the sadness of the news, it expresses public’s acceptance, intimacy, caring, liking and respect and provides an favorable online social interaction environment. Along with this rationale, online emotional support can be perceived from sad news [29]. The following hypothesis is thus proposed:

H2

Sad news exposure positively correlates with medical students’ perceived online emotional support.

The effects of online emotional support

The theory of identity development highlights that identity can develop within important social relationships [30,31,32]. From this perspective, identity is not solely about individuals’ ability to synthesize important identity domains, but also related to interpersonal relationships [23]. Hence, online emotional support gained from interpersonal relationships can engender impact on professional identity.

Indeed, when others have a positive view of medical profession, medical students are more likely to identify themselves and healthcare group as a whole [33, 34]. Thus, when medical students get emotional support from media content, they may have a high level of sense of belonging [35]. Additionally, research has also confirmed that emotional support is associated with increased group commitment, and the more emotional support members were exposed to, the lower the risk of dropout [34]. Online emotional support can also reduce the effects of stress in identity exploration process by providing individuals with the sense of acceptance and self-worth [36]. In this way, medical students can relieve their stress in the construction of professional identity by obtaining online emotional support so as to improve their professional identity. Thus, the following hypotheses are proposed:

H3a

Medical students’ perceived online emotional support negatively correlates with their sense of belonging to medical profession.

H3b

Medical students’ perceived online emotional support negatively correlates with their commitment to medical profession.

The theoretical model

This study investigates how sad news on the media relates to medical students’ professional identity. Specifically, the mediation effect of online emotional support is examined. The research model is depicted in Fig. 1.

Fig. 1

The proposed research model

Method

Sampling

This study used a survey method to collect the data from a Chinese university. Before the data collection, several rounds of editing were conducted on the questionnaire. A pilot study was performed to test the validity of the questionnaire. According to the feedback and the results, minor modifications were made. The formal survey was conducted during March and May 2022. The convenience sampling technique is used to ensure the response rate. With the help of teachers in a medical school in China, students from four majors (namely basic medicine, clinical medicine, nursing and public health) participated in the survey. We selected these four majors owing to their important roles in the frontlines of public crises. The selection of four majors can also increase the diversity of our samples. To avoid the effects of social desirability, the anonymity of the questionnaire was ensured and the participation was voluntary. We also promised to provide incentives for valid responses. Finally, a total of 1554 responses were obtained. After eliminating invalid questionnaires (i.e., questionnaires with too many duplicated extreme answers, questionnaires with a quick response time), a total of 1441 valid samples were retained. The effective rate of the sample was 92.7%. Among them, 837 (58.1%) subjects were female, and 604 (41.9%) were male, the ratio of balance was maintained. As for age, 70.8% of the sample aged 20 to 25 which is consistent with the characteristics of students. In grade, 70.3% of the students are undergraduates, 19.8% are postgraduates, and 9.9% are doctoral students. Table 1 summarizes the demographic information of the subjects.

Table 1 Demographic information of subjects. (n = 1441)

Measurements

In order to ensure the validity of the instrument, measures for variables were mainly adapted from well validated scales and modified according to the Chinese context and medical student’s characteristics. As data were collected in China, the back-translation method was used to adapt the original English scale to Chinese context. Specifically, the questions were originally framed in English, translated into Chinese, and back-translated into English to ensure consistency [37].

Sense of belonging to medical profession

Belonging is a psychological concept that reflects the relation between a person and others in a certain group [38]. The measures for sense of belonging were derived from Lin et al. (2014) [39]. Considering the characteristics of medical students, we adapted prior measures to reflect medical students’ attitude toward their relationships with medical workers. Participants were asked to describe what extent they agree with the following statements indicating their social affiliation and emotional connection with the medical group: (a) I feel as if I belong to the medical workers, (b) I feel as if I am socially connected to the medical workers, (c) I feel as if I will be part of medical workers. All these items were measured by a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree).

Commitment to medical profession

Commitment is the intensity of individuals’ relation with their profession, reflecting their willingness to exert effort to the profession and the desire to stay in it. We measured commitment to medical profession with items adapted from Meyer et al. (1993) [12]. As medical students are not real medical professionals, their professional identity is reflected by their attitude toward their majors. Hence, participants were asked to rate how much they agree with these statements: (a) I will be proud to be a medical worker in the future, (b) I don’t regret choosing my current major, (c) It would be costly for me to change my major now, (d) There are no pressures to keep me from changing my major, (e) Social responsibility makes me choose to stay in this major. All these items were measured by a 7-point Likert scale (1 = strongly disagree, 7 = strongly agree).

Perceived online emotional support

Three items from Nick et al. (2018) [40] were adopted to assess online emotional support through a 7-point Likert scale (1 = never, 7 = very often). Participants were asked to assess the frequency they have encountered the following situations on the internet in the recent years: (a) people often pay attention to medical workers through the Internet, (b) people often give positive comments to medical workers on the Internet, (c) people often express their support for medical workers’ work on the Internet, (d) people often express their recognition for medical workers’ words and deeds on the Internet, (e) people’s expressions of support in the internet have often made medical workers proud of their careers.

Sad news exposure

The measurement of sad news exposure was adapted from those for measuring information exposure in Tan et al. (2015) [41]. In addition, the content of sad news was self-developed according to the news environment on the media during the public health event of COVID-19. As this study examines the professional identity of medical students, we collected news about medical workers’ arduousness from online media in China during the pandemic and chose the commonly reported ones. After several rounds of discussions, we selected two sad news. It should be noted that sad news is usually subjective to a certain extent, and it depends on recipients’ life experience, personality, perceived social supports and emotional hardiness [42]. Hence, we conducted a pilot study and interviewed the participants to get their feedback about the measures for sad news exposure. They regarded the listed news as sad and admitted that they often encountered such types of sad news on the media during the pandemic. Specifically, to measure sad news exposure, the participants were asked that “how often did you get exposed to the following types of information related to the medical workers in online media?” in the title of the instrument. And then they were shown information about sad news in the instrument. The two pieces of sad news include (a) in the process of fighting COVID-19, the conditions of medical workers were difficult, (b) in the process of fighting COVID-19, the medical workers suffered infections and sacrifices. The measurements were gathered using a 7-Likert scale, in which 1 indicated “never” and 7 indicated “often”.

Results

Measurement model test

To validate the measurement model, the reliability, convergent validity, and discriminant validity were assessed. Confirmatory factor analysis (CFA) was performed to assess reliability and convergent validity. As shown in Table 2, all items loaded high on their respective constructs (> 0.73) and the composite reliability (CR) for each construct was greater than 0.89 except the third item of commitment. As the loading of this item approximated 0.70, we kept it for the sake of content validity. The values of Average variance extracted (AVE) for all constructs were higher than the threshold of 0.50 [43]. Hence, the convergent validity was acceptable. The discriminant validity was assessed by comparing the inter-construct correlation coefficients with the square roots of AVE [43]. Table 3 reveals that all inter-construct correlation coefficients were less than the square roots of AVE. In addition, all values of the Heterotrait-Monotrait ratio of correlations (HTMT) were less than the threshold of 0.85 in Table 4, indicating an acceptable discriminant validity. We also checked multi-collinearity among the variables, the variance inflation factor (VIF) values of all constructs are lower than 10, indicating that multi-collinearity is not a confounding problem in this study [44].

Table 2 Variable reliability, AVE and factor loadings

Table 3 Correlation matrix with the square roots of the AVE in the diagonal

Table 4 Heterotrait-monotrait ratio of correlations values

Common method bias

This study also tested common method bias (CMB). Harman’s one-factor test was performed on variables in our theoretical model. An exploratory factor analysis was conducted on all the variables, including sad news exposure, online emotional support belonging and commitment [45]. The highest variance percentage explained by one factor was less than 50% [46], indicating that CMB was not likely to be a threat of this study. Second, the highest correlation among constructs was 0.671 (Table 3). Because CMB may result in much higher correlations (r > 0.90), it is reasonable to hold that CMB is not a major concern in this study.

Hypotheses testing

We used SmartPLS 3.0 to test the structural model and the results were illustrated in Fig. 2. The R²value of perceived online emotional support, sense of belonging and commitment to medical profession are 0.156, 0.236, 0.283 respectively. Overall, the model demonstrates a good fit to the data, as evidenced by the following statistics: χ² = 565.254, degrees of freedom (df) = 98, p < 0.001, χ²/df = 5.768, comparative fit index (CFI) = 0.979, root mean square error of approximation (RMSEA) = 0.058, standardized root mean square residual (SRMR) = 0.024. The fit indices for the model follow the thresholds recommend by Bentler (1990) and Hu and Bentler (1999) [47, 48]. Notably, despite the χ²/df exceeding 5, the value of 5.768 is deemed acceptable due to the large sample size, which includes 1441 valid responses.

Fig. 2

Data analysis results

The results showed that sad news exposure exerted positive and significant effects on sense of belonging to medical profession (β = 0.085, p < 0.01), commitment to medical profession (β = 0.070, p < 0.01) and perceived online emotional support (β = 0.395, p < 0.001). Hence, H1a, H1b and H2 were all supported. This study also examined the effects of perceived online emotional support on sense of belonging and commitment to medical profession. The results revealed that perceived online emotional support had positive and significant impacts on sense of belonging (β = 0.447, p < 0.001) and commitment to medical profession (β = 0.501, p < 0.001), providing support to H3a and H3b.

This study further examined the mediation effect of perceived online emotional support. We calculated the variance accounted for (VAF) value according to the direct effect, indirect effect and total effect of variables. VAF > 80% indicates full mediation, 20%< VAF < 80% shows partial mediation, and VAF < 20% indicates no mediation [49]. The results showed that perceived online emotional support had partial mediation effect on the relationship between sad news exposure and sense of belonging to medical profession (20%< VAF = 67.56%<80%) and on the relationship between sad news exposure and commitment to medical profession (20%< VAF = 73.88%<80%). Table 5 presents the results of the mediation test.

Table 5 Results of the mediation analysis

Discussion

Discussion of results

This study examines whether media stories can affect medical students’ professional identity via online emotional support. We have several interesting findings. First, sad news exposure exerts positive effect on medical students’ perceived online emotional support. The results are consistent with what we have expected. Although sad news is usually assumed to result in undesirable outcomes [50], it can also bring about desirable outcomes. Sad news about medical workers’ arduousness during the public crisis allows medical students to experience empathy and social care from the public, which are important sources of emotional support. Hence, sad news exposure positively relates to medical students’ perceived online emotional support.

Second, the results show that sad news exposure is positively related to medical students’ sense of belonging and commitment to their profession. Chinese people live in a collectivism culture, and they attach great value to the devotion of medical workers. Despite the sadness conveyed by sad news, it also inspires medical workers to develop a sense of responsibility. Hence, medical students’ sense of belonging and commitment to their profession will be high after being exposed to sad news.

Third, there exist positive relationships between perceived online emotional support and medical students’ sense of belonging and commitment to their profession. The findings are consistent with the argument that professional identity is constructed in a social context where social relationship plays an important role. We further find that perceived online emotional support mediates the relationship between sad news exposure and professional identity. As online emotional support from sad news can help reduce psychological distress and increase identity schema [51, 52], it is reasonable to find the mediation effect of online emotional support between sad news exposure and professional identity.

Theoretical and practical implications

Several theoretical implications of this study should be highlighted. First, this study examined how media stories associated with medical students’ professional identity. Prior studies mainly focused on the impacts of medical students’ personal factors (e.g. self-esteem, self-efficacy) [53, 54] and medical education (e.g. courses, clinical practice) [55, 56] on the development of their professional identity, ignoring the critical role of media environment. This study uncovers the mechanism underlying the relationship between media content exposure and professional identity, making a complement to the extant literature on professional identity.

Second, this study contributes to the literature by providing a nuanced understanding of the concept of professional identity. Specifically, this study utilizes belonging and commitment to represent professional identity. The former represents the psychological inclination toward the profession, and the latter represents the behavioral inclination toward the profession. By simultaneously examining the two dimensions, this study develops a good understanding of professional identity.

Third, this study not only investigates the direct impact of media stories on professional identity, but also examines the underlying mechanism between the two constructs with a focus on online emotional support. Notably, this study validates that sad news can inspire sympathy and bring online emotional support and increase professional identity. The findings provide a valid theoretical framework to understand the complex impacts of sad news.

This study also has practical implications. First, our findings reveal that sad news can also lead to desirable outcomes, which provides references for public communication skills. During public crises, medical workers usually make sacrifice for the sake of the public, the journalism of attachment [57] are inevitable. In such circumstance, proper news framing can generate positive effects. Particularly, sad news can contain information about the emotional empathy and caring of the public toward medical workers in order to transmit emotional support and foster professional identity.

Second, this study shed light on the education of medical students. Medical professional identity serves as a way to shape the social solidarity of medical professional groups. Our findings reveal that in addition to theoretical learning and clinical practice, information and narrative can also be used to foster medical students’ professional identity. Particularly, educators can take advantage of online information, such as sad news, to foster students’ responsibility and sense of honour to be medical workers.

Limitations and future research directions

There are several limitations that provide noteworthy ideas for future research. First, the measurements for sad news are derived from the situation in the COVID-19 pandemic. Although sad news combines news facts with individual emotions to promote the formation of a positive “we” union [58], There are various types of news about the medical workers during public crises and future research can take other types of news into consideration and try to clarify the impacts of different news. Second, this study employed an offline cross-sectional survey to collect data. Although this method can examine the relationships between constructs, it is weak in testing causal relationships. Future research can use other empirical methods, such as experiments and interviews, to collect data in order to validate the causal relationship between sad news exposure and professional identity. Third, the subjects were students from a medical school in China. Medical students’ professional identity may differ across universities, cities, cultures or countries. Future research can collect data from different universities, cities, cultures or countries to increase the representativeness of the samples. Furthermore, this study focuses on medical students’ responses to sad news. Future research can collect data from real medical professionals to examine their reactions to different types of sad news.

Conclusion

The development of technology has made the medium society into reality, the use of media has become the basic way of existence, and human civilization has entered the stage of media survival [59]. Facing with the massive content on the media, medical students’ media content exposure and associated perception toward the profession directly affect the stability of the medical professional team and public safety. In this study, 1,441 medical students were recruited to investigate how the exposure of media stories about medical workers’ arduousness affected their sense of belonging and commitment to medical profession. Our results showed that the exposure of such media stories not only exerted direct impacts on medical students’ sense of belonging and commitment to medical profession, but also had indirect impacts via the provision of emotional support. This study extends existing discussions on medical students’ professional identity by examining the effects of media story. Our findings can provide new approaches and strategies for medical education and hospital management in digital times, and also contribute to the broad interdisciplinary research that involves infodemic and One Health.