Effects of COVID-19 on career and specialty choices among Chinese medical students

Figures & data

Table 1. Characteristics of participants according to indicators of changes in willingness to be a doctor after the COVID-19 pandemic

Variables	Total (n = 1,837; 100.0%)	Changes in willingness to be a doctor
		Increased willingness (n = 194; 10.6%)	No change (n = 1,517; 82.5%)	Decreased willingness (n = 126; 6.9%)	P
Median (IQR) age	21.0(20.0–25.0)	22.0(20.0–24.0)	21.0(20.0–25.0)	23.5(20.8–27.0)	<0.001
The median (IQR) willingness to be a doctor before the COVID-19 pandemic	9.0(7.0–10.0)	7.0(5.0–8.0)	9.0(8.0–10.0)	8.0(7.0–9.0)	<0.001
Sex					0.753
Men	610(33.2%)	65(33.5%)	507(33.4%)	38(30.2%)
Women	1,227(66.8%)	129(66.5%)	1,010(66.6%)	88(69.8%)
Ethnicity					0.351
Han Chinese	1,508(82.1%)	154(79.4%)	1,246(82.1%)	108(85.7%)
Other	329(17.9%)	40(20.6%)	271(17.9%)	18(14.3%)
Education level					0.270
Undergraduate	1,521(82.8%)	159(82.0%)	1,264(83.3%)	98(77.8%)
Graduate	316(17.2%)	35(18.0%)	253(16.7%)	28(22.2%)
Annual household income (¥)					0.014
≤100 thousand	1,386(75.4%)	159(82.0%)	1,143(75.3%)	84(66.7%)
100–300 thousand	356(19.4%)	32(16.5%)	292(19.2%)	32(25.4%)
>300 thousand	95(5.2%)	3(1.5%)	82(5.4%)	10(7.9%)
Habit of regular exercising					0.935
No	1,158(63.0%)	124(63.9%)	956(63.0%)	78(61.9%)
Yes	679(37.0%)	70(36.1%)	561(37.0%)	48(38.1%)
Exposure to the most affected pandemic area					0.030
No	1,800(98.0%)	188(96.9%)	1,492(98.4%)	120(95.2%)
Yes	37(2.0%)	6(3.1%)	25(1.6%)	6(4.8%)
Preferential attention toward pandemic information					0.002
Negative	81(4.4%)	13(6.7%)	58(3.8%)	10(7.9%)
Neutral	690(37.6%)	79(40.7%)	551(36.3%)	60(47.6%)
Positive	1,066(58.0%)	102(52.6%)	908(59.9%)	56(44.4%)
Did you receive negative feedback from your families and friends who joined the frontline work?					0.015
No	1,821(99.1%)	193(99.5%)	1,506(99.3%)	122(96.8%)
Yes	16(0.9%)	1(0.5%)	11(0.7%)	4(3.2%)
Was anyone close to you suspected or confirmed to be infected?					0.680
No	1,774(96.6%)	187(96.4%)	1,467(96.7%)	120(95.2%)
Yes	63(3.4%)	7(3.6%)	50(3.3%)	6(4.8%)
Did you follow your own inclinations when choosing to major in medicine?					<0.001
No	299(16.3%)	54(27.8%)	210(13.8%)	35(27.8%)
Yes	1,538(83.7%)	140(72.2%)	1,307(86.2%)	91(72.2%)
Are you interested in medicine?					<0.001
No	163(8.9%)	36(18.6%)	113(7.4%)	14(11.1%)
Yes	1,674(91.1%)	158(81.4%)	1,404(92.6%)	112(88.9%)
Were you influenced by your elders (parents or other relatives) when selecting medicine as your major?					0.112
No	1,034(56.3%)	122(62.9%)	846(55.8%)	66(52.4%)
Yes	803(43.7%)	72(37.1%)	671(44.2%)	60(47.6%)
Changes in professional satisfaction after the COVID-19 pandemic					<0.001
Less satisfied	128(7.0%)	22(11.3%)	74(4.9%)	32(25.4%)
No change	1,446(78.7%)	103(53.1%)	1,265(83.4%)	78(61.9%)
More satisfied	263(14.3%)	69(35.6%)	178(11.7%)	16(12.7%)
Scores of PHQ-9	3.0(0.0–8.0)	4.0(1.0–8.0)	3.0(0.0–8.0)	6.5(1.0–9.0)	<0.001
Symptoms of depression					<0.001
No	1,046(56.9%)	100(51.5%)	895(59.0%)	51(40.5%)
Mild	579(31.5%)	67(34.5%)	466(30.7%)	46(36.5%)
Moderate	124(6.8%)	15(7.7%)	95(6.3%)	14(11.1%)
Severe	88(4.8%)	12(6.2%)	61(4.0%)	15(11.9%)
Scores of GAD-7	3.0(0.0–7.0)	5.0(1.0–7.0)	3.0(0.0–7.0)	5.5(1.8–8.0)	<0.001
Symptoms of anxiety					<0.001
No	1,088(59.2%)	94(48.5%)	939(61.9%)	55(43.7%)
Mild	582(31.7%)	81(41.8%)	455(30.0%)	46(36.5%)
Moderate	132(7.2%)	15(7.7%)	98(6.5%)	19(15.1%)
Severe	35(1.9%)	4(2.1%)	25(1.6%)	6(4.8%)
Scores of ISI	4.0(1.0–8.0)	5.0(1.0–9.0)	4.0(1.0–7.0)	6.0(2.0–10.0)	<0.001
Symptoms of insomnia					0.018
No	1,367(74.4%)	137(70.6%)	1,152(75.9%)	78(61.9%)
Subclinical	366(19.9%)	43(22.2%)	287(18.9%)	36(28.6%)
Moderate	89(4.8%)	13(6.7%)	66(4.4%)	10(7.9%)
Severe	15(0.8%)	1(0.5%)	12(0.8%)	2(1.6%)

GAD-7, Generalized Anxiety Disorder Scale; IQR, Interquartile range; ISI, Insomnia Severity Index; PHQ-9, Patient Health Questionnaire-9 item

Table 2. Characteristic of participants according to indicators of changes in willingness to specialize in respiratory medicine and infectious diseases after the COVID-19 pandemic

Variables	Total (n = 1,837; 100.0%)	Changes in willingness to specialize in respiratory medicine and infectious diseases
		Increased willingness (n = 215; 11.7%)	No change (n = 1,448; 78.8%)	Decreased willingness (n = 174; 9.5%)	P
Median (IQR) age	21.0(20.0–25.0)	21.0(19.0–23.0)	21.0(20.0–25.0)	23.0(21.0–26.0)	<0.001
Sex					0.005
Men	610(33.2%)	92(42.8%)	459(31.7%)	59(33.9%)
Women	1,227(66.8%)	123(57.2%)	989(68.3%)	115(66.1%)
Ethnicity					0.010
Han Chinese	1,508(82.1%)	166(77.2%)	1,187(82.0%)	155(89.1%)
Other	329(17.9%)	49(22.8%)	261(18.0%)	19(10.9%)
Education level					<0.001
Undergraduate	1,521(82.8%)	198(92.1%)	1,197(82.7%)	126(72.4%)
Graduate	316(17.2%)	17(7.9%)	251(17.3%)	48(27.6%)
Annual household income (¥)					0.002
≤100 thousand	1,386(75.4%)	177(82.3%)	1,093(75.5%)	116(66.7%)
100–300 thousand	356(19.4%)	29(13.5%)	286(19.8%)	41(23.6%)
>300 thousand	95(5.2%)	9(4.2%)	69(4.8%)	17(9.8%)
Habit of regular exercising					<0.001
No	1,158(63.0%)	107(49.8%)	930(64.2%)	121(69.5%)
Yes	679(37.0%)	108(50.2%)	518(35.8%)	53(30.5%)
Exposure to the most affected pandemic area					0.586
No	1,800(98.0%)	212(98.6%)	1,419(98.0%)	169(97.1%)
Yes	37(2.0%)	3(1.4%)	29(2.0%)	5(2.9%)
Preferential attention toward pandemic information					<0.001
Negative	81(4.4%)	2(0.9%)	60(4.1%)	19(10.9%)
Neutral	690(37.6%)	56(26.0%)	552(38.1%)	82(47.1%)
Positive	1,066(58.0%)	157(73.0%)	836(57.7%)	73(42.0%)
Did you receive negative feedback from your families and friends who joined the frontline work?					<0.001
No	1,821(99.1%)	215(100.0%)	1,438(99.3%)	168(96.6%)
Yes	16(0.9%)	0(0.0%)	10(0.7%)	6(3.4%)
Was anyone close to you suspected or confirmed to be infected?					<0.001
No	1,774(96.6%)	208(96.7%)	1,409(97.3%)	157(90.2%)
Yes	63(3.4%)	7(3.3%)	39(2.7%)	17(9.8%)
Did you follow your own inclinations when choosing to major in medicine?					<0.001
No	299(16.3%)	18(8.4%)	230(15.9%)	51(29.3%)
Yes	1,538(83.7%)	197(91.6%)	1,218(84.1%)	123(70.7%)
Are you interested in medicine?					<0.001
No	163(8.9%)	4(1.9%)	132(9.1%)	27(15.5%)
Yes	1,674(91.1%)	211(98.1%)	1,316(90.9%)	147(84.5%)
Were you influenced by your elders (parents or other relatives) when selecting medicine as your major?					0.002
No	1,034(56.3%)	100(46.5%)	845(58.4%)	89(51.1%)
Yes	803(43.7%)	115(53.5%)	603(41.6%)	85(48.9%)
Changes in willingness to be a doctor after the COVID-19 pandemic					<0.001
Decreased willingness	126(6.9%)	13(6.0%)	71(4.9%)	42(24.1%)
No change	1,517(82.5%)	169(78.6%)	1,231(85.0%)	117(67.2%)
Increased willingness	194(10.6%)	33(15.3%)	146(10.1%)	15(8.6%)
Changes in professional satisfaction after the COVID-19 pandemic					<0.001
Less satisfied	128(7.0%)	17(7.9%)	82(5.7%)	29(16.7%)
No change	1,446(78.7%)	151(70.2%)	1,177(81.3%)	118(67.8%)
More satisfied	263(14.3%)	47(21.9%)	189(13.1%)	27(15.5%)
Scores of PHQ-9	3.0(0.0–8.0)	2.0(0.0–9.0)	3.0(0.0–8.0)	7.0(2.0–9.0)	<0.001
Symptoms of depression					<0.001
No	1,046(56.9%)	127(59.1%)	856(59.1%)	63(36.2%)
Mild	579(31.5%)	63(29.3%)	441(30.5%)	75(43.1%)
Moderate	124(6.8%)	17(7.9%)	88(6.1%)	19(10.9%)
Severe	88(4.8%)	8(3.7%)	63(4.4%)	17(9.8%)
Scores of GAD-7	3.0(0.0–7.0)	2.0(0.0–7.0)	3.0(0.0–7.0)	7.0(3.0–9.0)	<0.001
Symptoms of anxiety					<0.001
No	1,088(59.2%)	133(61.9%)	898(62.0%)	57(32.8%)
Mild	582(31.7%)	63(29.3%)	434(30.0%)	85(48.9%)
Moderate	132(7.2%)	17(7.9%)	91(6.3%)	24(13.8%)
Severe	35(1.9%)	2(0.9%)	25(1.7%)	8(4.6%)
Scores of ISI	4.0(1.0–8.0)	3.0(1.0–7.0)	4.0(1.0–7.0)	6.5(3.0–10.0)	<0.001
Symptoms of insomnia					<0.001
No	1,367(74.4%)	164(76.3%)	1,091(75.3%)	112(64.4%)
Subclinical	366(19.9%)	43(20.0%)	279(19.3%)	44(25.3%)
Moderate	89(4.8%)	7(3.3%)	70(4.8%)	12(6.9%)
Severe	15(0.8%)	1(0.5%)	8(0.6%)	6(3.4%)

GAD-7, Generalized Anxiety Disorder Scale; IQR, Interquartile range; ISI, Insomnia Severity Index; PHQ-9, Patient Health Questionnaire-9 item

Table 3. Predictors of changes in willingness to be a doctor in linear regression analysis

Independent variables	Unadjusted coefficient (95% CI)	Adjusted coefficient (95% CI)†
Covariates
Age	−0.011(−0.022 to 0.000)*	−0.015(−0.025 to −0.004)**
The willingness to be a doctor before the COVID-19 pandemic	−0.084(−0.103 to −0.065)***	−0.107(−0.127 to −0.087)***
The severity of depressive symptoms	−0.007(−0.015 to 0.001)	−0.011(−0.019 to −0.003)**
The severity of anxiety symptoms	−0.010(−0.020 to −0.001)*	-
The severity of insomnia symptoms	−0.004(−0.012 to 0.004)	-
Factors
Gender, ref. Men	−0.076(−0.162 to 0.009)	−0.099(−0.181 to −0.018)*
Ethnicity, ref. Chinese Han	−0.059(−0.164 to 0.046)	-
Education level, ref. Graduate students	0.086(−0.021 to 0.193)	-
Annual household income (¥)
≤100 thousand	ref.	ref.
100–300 thousand	−0.126(−0.228 to −0.024)*	−0.080(−0.179 to 0.018)
>300 thousand	−0.311(−0.493 to −0.128)**	−0.261(−0.437 to −0.085)**
Habit of regular exercising, ref. No	0.002(−0.082 to 0.085)	-
Exposure to the most affected pandemic area, ref. No	0.005(−0.282 to 0.292)	-
Preferential attention toward pandemic information
Negative	−0.271(−0.470 to −0.072)**	−0.317(−0.510 to −0.124)**
Neutral	−0.065(−0.149 to 0.019)	−0.114(−0.195 to −0.032)**
Positive	ref.	ref.
Receiving negative feedback from your families and friends who joined the frontline work, ref. No	−0.743(−1.176 to −0.310)**	−0.595(−1.012 to −0.178)**
Having relatives and friends with suspected or confirmed COVID-19, ref. No	−0.133(−0.355 to 0.089)	-
Following your own inclinations when choosing to major in medicine, ref. No	−0.081(−0.191 to 0.028)	-
Being interested in medicine, ref. No	−0.242(−0.384 to −0.101)**	-
Influenced by your elders (parents or other relatives) when selecting medicine as your major, ref. No	−0.054(−0.135 to 0.027)	-
Changes in professional satisfaction after the COVID-19 pandemic
Less satisfied	−0.275(−0.432 to −0.119)***	−0.348(−0.501 to −0.195)***
No change	ref.	ref.
More satisfied	0.409(0.295 to 0.522)***	0.364(0.253 to 0.475)***

†Adjusted for age, sex, ethnicity, educational level, income level, habits of exercise, geographic location, aspects of information attention, negative feedback exposure, infection status of COVID-19 among friends and relatives, the motivation in selecting medicine, changes of professional satisfaction, symptoms of depression, anxiety, and insomnia. *p < 0.05, **p < 0.01, ***p < 0.001

Table 4. Predictors of changes in willingness to specialize in respiratory medicine and infectious diseases in binary logistic regression analysis

Independent variables	Decreased willingness		Increased willingness
	Unadjusted OR (95% CI)	Adjusted OR (95% CI)†	Unadjusted OR (95% CI)	Adjusted OR (95% CI)†
Covariates
Age	1.078(1.037 to 1.120)***	-	0.948(0.908 to 0.989)*	-
The severity of depressive symptoms	1.095(1.065 to 1.125)***	-	0.997(0.962 to 1.033)	-
The severity of anxiety symptoms	1.138(1.102 to 1.176)***	1.099(1.061 to 1.139)***	0.997(0.968 to 1.027)	-
The severity of insomnia symptoms	1.095(1.065 to 1.125)***	-	0.994(0.965 to 1.024)	-
Factors
Gender, ref. Man	0.905(0.649 to 1.262)	-	0.620(0.463 to 0.831)*	0.640(0.471 to 0.869)**
Ethnicity, ref. Chinese Han	1.794(1.094 to 2.942)*	1.592(0.937 to 2.705)	0.745(0.527 to 1.053)	-
Education level, ref. Graduate students	0.550(0.384 to 0.788)**	-	2.442(1.461 to 4.082)***	2.180(1.290 to 3.683)**
Annual household income (¥)
≤100 thousand	ref.	-	ref.	-
100–300 thousand	1.351(0.925 to 1.974)	-	0.626(0.414 to 0.947)*	-
>300 thousand	2.321(1.321 to 4.081)**	-	0.805(0.395 to 1.642)	-
Habit of regular exercising, ref. No	0.786(0.560 to 1.105)	-	1.812(1.359 to 2.417)***	1.559(1.155 to 2.105)**
Exposure to the most affected pandemic area, ref. No	1.448(0.553 to 3.790)	-	0.692(0.209 to 2.293)	-
Preferential attention toward pandemic information
Negative	3.626(2.054 to 6.404)***	2.301(1.219 to 4.343)*	0.177(0.043 to 0.734)*	0.191(0.045 to 0.803)*
Neutral	1.701(1.219 to 2.374)**	1.405(0.983 to 2.007)	0.540(0.391 to 0.746)***	0.575(0.412 to 0.803)**
Positive	ref.	ref.	ref.	ref.
Receiving negative feedback from your families and friends who joined the frontline work, ref. No	5.136(1.843 to 14.309)**	-	-	-
Having relatives and friends with suspected or confirmed COVID-19, ref. No	3.912(2.162 to 7.078)***	3.368(1.751 to 6.478)***	2.067(1.250 to 3.417)**	-
Following your own inclinations when choosing to major in medicine, ref. No	0.455(0.319 to 0.650)***	0.570(0.387 to 0.840)**	1.598(1.126 to 2.267)**	-
Being interested in medicine, ref. No	0.546(0.349 to 0.854)**	-	5.291(1.936 to 14.459)**	5.795(2.087 to 16.089)***
Influenced by your elders (parents or other relatives) when selecting medicine as your major, ref. No	1.338(0.977 to 1.834)	-	1.612(1.209 to 2.149)**	1.543(1.145 to 2.080)**
Changes in willingness to be a doctor after the COVID-19 pandemic
Decreased willingness	6.224(4.065 to 9.530)***	4.370(2.747 to 6.953)***	1.334(0.723 to 2.461)	1.387(0.720 to 2.671)
No change	ref.	ref.	ref.	ref.
Increased willingness	1.081(0.615 to 1.900)	0.769(0.419 to 1.411)	1.646(1.092 to 2.482)*	1.738(1.110 to 2.720)*
Changes in professional satisfaction after the COVID-19 pandemic
Less satisfied	3.528(2.218 to 5.609)***	2.242(1.325 to 3.795)**	1.616(0.933 to 2.798)	1.464(0.817 to 2.623)
No change	ref.	ref.	-	ref.
More satisfied	1.425(0.913 to 2.225)	1.403(0.867 to 2.270)	1.938(1.350 to 2.783)***	1.870(1.271 to 2.750)**

†Adjusted for age, sex, ethnicity, educational level, income level, habits of exercise, geographic location, aspects of information attention, negative feedback exposure, infection status of COVID-19 among friends and relatives, the motivation in selecting medicine, changes of professional satisfaction and the willingness to be a doctor, symptoms of depression, anxiety, and insomnia. *p < 0.05, **p < 0.01, ***p < 0.001