{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:18:56Z","timestamp":1783491536314,"version":"3.55.0"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Systemic disruptions, including public health emergencies, natural disasters, and large-scale interruptions to clinical training, can destabilize health professions education and reshape students\u2019 perceptions of their future careers. Career perception may function as a cognitive anchor that links disrupted learning environments with both psychological well-being and professional development, yet its structural role remains insufficiently understood. This study examined whether career perception operates as an upstream determinant of mental health, dropout intention, and professional competencies among medical and nursing students in a pandemic-era disrupted educational context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted using secondary data from 1,707 undergraduate medical and nursing students during the pandemic. Career perception was assessed via a single-item measure of perceived change during COVID-19. Validated instruments measured empathy, lifelong learning, mental health symptoms, life satisfaction, and dropout intention. Group differences were examined using one-way and two-way ANOVA. Pearson correlation analysis assessed bivariate associations. Bayesian network analysis with bootstrap resampling was applied to explore directed probabilistic dependencies among variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Students with more positive career perceptions demonstrated higher levels of empathy, lifelong learning orientation, and life satisfaction, and lower levels of anxiety, depression, and dropout intention (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Career perception was significantly associated with all major outcomes (|\n                      <jats:italic>r<\/jats:italic>\n                      |\u202f=\u202f0.12\u20130.41). Bayesian network analysis identified career perception as an upstream node with robust directed effects on dropout intention (arc strength\u202f=\u202f1.00) and lifelong learning (arc strength\u202f=\u202f0.89). Dropout intention emerged as a central mediator linking career perception to depression, anxiety, and satisfaction. Lifelong learning and satisfaction, in turn, directly influenced empathy. These structural relationships were highly stable across bootstrap samples.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In a disrupted health professions education context, career perception functioned as an upstream determinant shaping both mental health and professional competencies. The findings suggest that professional meaning-making and career reflection should be treated as core educational support during periods of systemic instability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1810306","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:58:08Z","timestamp":1783490288000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Career perception as an upstream determinant of mental health and professional competencies in health professions education during systemic disruption"],"prefix":"10.3389","volume":"13","author":[{"given":"Haoran","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Clinical Psychology, Wenzhou Seventh People\u2019s Hospital","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenxing","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology, Wenzhou Seventh People\u2019s Hospital","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaocui","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology, Wenzhou Seventh People\u2019s Hospital","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengzhou","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Emergency, Zhejiang Hospital","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology, Wenzhou Seventh People\u2019s Hospital","place":["Wenzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1097\/ACM.0000000000000729","article-title":"The becoming: students\u2019 reflections on the process of professional identity formation in medical education","volume":"90","author":"Sharpless","year":"2015","journal-title":"Acad Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1097\/ACM.0000000000005513","article-title":"Maintaining community during disruption: lessons from the accelerating change in medical education consortium","volume":"99","author":"Elliott","year":"2024","journal-title":"Acad Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1016\/S0140-6736(22)02092-X","article-title":"Challenges and opportunities for educating health professionals after the COVID-19 pandemic","volume":"400","author":"Frenk","year":"2022","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1792445","DOI":"10.3389\/fmed.2026.1792445","article-title":"Navigating rural medical training: mapping the landscape of resident physician wellbeing using critical realist inquiry","volume":"13","author":"Perez","year":"2026","journal-title":"Front Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e2119110","DOI":"10.1001\/jamanetworkopen.2021.19110","article-title":"Association of Characteristics of the learning environment and US medical student burnout, empathy, and career regret","volume":"4","author":"Dyrbye","year":"2021","journal-title":"JAMA Netw Open"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1186\/s12912-022-01016-8","article-title":"First-year nursing students\u2019 initial contact with the clinical learning environment: impacts on their empathy levels and perceptions of professional identity","volume":"21","author":"Wang","year":"2022","journal-title":"BMC Nurs"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"S96","DOI":"10.1097\/ACM.0000000000004904","article-title":"A critical review of professional identity formation interventions in medical education","volume":"97","author":"Mount","year":"2022","journal-title":"Acad Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"130","DOI":"10.5334\/pme.1308","article-title":"Quarantining from professional identity: how did COVID-19 impact professional identity formation in undergraduate medical education?","volume":"13","author":"Rehman","year":"2024","journal-title":"Perspect Med Educ"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1798088","DOI":"10.1080\/10872981.2020.1798088","article-title":"Effect of the COVID-19 pandemic on medical student career perceptions: a national survey study","volume":"25","author":"Byrnes","year":"2020","journal-title":"Med Educ Online"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s12909-020-02462-1","article-title":"Effects of the COVID-19 pandemic on medical students: a multicenter quantitative study","volume":"21","author":"Harries","year":"2021","journal-title":"BMC Med Educ"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"645340","DOI":"10.3389\/fpsyt.2021.645340","article-title":"Attitude of medical students about their role and social accountability in the COVID-19 pandemic","volume":"12","author":"Hong","year":"2021","journal-title":"Front Psych"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e0248627","DOI":"10.1371\/journal.pone.0248627","article-title":"Medical students\u2019 perceptions and motivations during the COVID-19 pandemic","volume":"16","author":"Tempski","year":"2021","journal-title":"PLoS One"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1007\/s40670-020-01165-y","article-title":"Online-learning due to COVID-19 improved mental health among medical students","volume":"31","author":"Bolatov","year":"2021","journal-title":"Med Sci Educ"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.5811\/westjem.2020.7.48684","article-title":"The impact of COVID-19 on healthcare worker wellness: a scoping review","volume":"21","author":"Shreffler","year":"2020","journal-title":"West J Emerg Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e10164","DOI":"10.7717\/peerj.10164","article-title":"Impact of COVID-19 outbreak on the mental health status of undergraduate medical students in a COVID-19 treating medical college: a prospective longitudinal study","volume":"8","author":"Saraswathi","year":"2020","journal-title":"PeerJ"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1919042","DOI":"10.1080\/10872981.2021.1919042","article-title":"Perception of medical education by learners and teachers during the COVID-19 pandemic: a cross-sectional survey of online teaching","volume":"26","author":"Motte-Signoret","year":"2021","journal-title":"Med Educ Online"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1186\/s12909-021-02811-8","article-title":"Medical students\u2019 perception towards E-learning during COVID 19 pandemic in a high burden developing country","volume":"21","author":"Gismalla","year":"2021","journal-title":"BMC Med Educ"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2131","DOI":"10.1001\/jama.2020.5227","article-title":"Medical student education in the time of COVID-19","volume":"323","author":"Rose","year":"2020","journal-title":"JAMA"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/s12909-023-04061-2","article-title":"Impact of online learning on sense of belonging among first year clinical health students during COVID-19: student and academic perspectives","volume":"23","author":"Tang","year":"2023","journal-title":"BMC Med Educ"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"2139657","DOI":"10.1080\/10872981.2022.2139657","article-title":"Beyond COVID-19: the impact of recent pandemics on medical students and their education: a scoping review","volume":"28","author":"Bughrara","year":"2023","journal-title":"Med Educ Online"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1136\/medethics-2020-106353","article-title":"Medical students and COVID-19: the need for pandemic preparedness","volume":"46","author":"O\u2019Byrne","year":"2020","journal-title":"J Med Ethics"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1186\/s40359-024-01838-y","article-title":"Global prevalence of anxiety and depression among medical students during the COVID-19 pandemic: a systematic review and meta-analysis","volume":"12","author":"Lin","year":"2024","journal-title":"BMC Psychol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1214320","DOI":"10.3389\/fmed.2023.1214320","article-title":"Burnout and motivation to study medicine among students during the COVID-19 pandemic","volume":"10","author":"Metakides","year":"2023","journal-title":"Front Med (Lausanne)"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.jad.2022.10.040","article-title":"The prevalence and risk factors of mental problems in medical students during COVID-19 pandemic: a systematic review and meta-analysis","volume":"321","author":"Peng","year":"2023","journal-title":"J Affect Disord"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.1038\/s41597-025-05508-5","article-title":"Professionalism, emotional wellbeing, and dropout intention in health professions students during the pandemic","volume":"12","author":"Castagnetto","year":"2025","journal-title":"Sci Data"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1159\/000381954","article-title":"Eleven years of data on the Jefferson scale of empathy-medical student version (JSE-S): proxy norm data and tentative cutoff scores","volume":"24","author":"Hojat","year":"2015","journal-title":"Med Princ Pract"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1097\/ACM.0b013e3181acf25f","article-title":"Measurement and correlates of physicians\u2019 lifelong learning","volume":"84","author":"Hojat","year":"2009","journal-title":"Acad Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1097\/01.MLR.0000093487.78664.3C","article-title":"The patient health Questionnaire-2: validity of a two-item depression screener","volume":"41","author":"Kroenke","year":"2003","journal-title":"Med Care"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"317","DOI":"10.7326\/0003-4819-146-5-200703060-00004","article-title":"Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection","volume":"146","author":"Kroenke","year":"2007","journal-title":"Ann Intern Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1207\/s15327752jpa4901_13","article-title":"The satisfaction with life scale","volume":"49","author":"Diener","year":"1985","journal-title":"J Pers Assess"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1186\/s12913-024-10684-y","article-title":"The effect of perceived professional benefits on health professionals\u2019 job engagement: the role of psychological availability and future perceived professional benefits","volume":"24","author":"Wan","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"855286","DOI":"10.3389\/fpsyg.2022.855286","article-title":"Empirical development and verification of career well-being scale for teachers in Taiwan: implications for workplace counseling","volume":"13","author":"Yu","year":"2022","journal-title":"Front Psychol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"e7492","DOI":"10.7759\/cureus.7492","article-title":"The impact of COVID-19 on medical education","volume":"12","author":"Ferrel","year":"2020","journal-title":"Cureus"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1023994","DOI":"10.3389\/fpsyg.2022.1023994","article-title":"The perspectives of social cognitive career theory approach in current times","volume":"13","author":"Wang","year":"2022","journal-title":"Front Psychol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1177\/10690727231187096","article-title":"Careers in disarray? COVID-19 and self-perceived employability","volume":"32","author":"Ren","year":"2023","journal-title":"J Career Assess"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"8551","DOI":"10.1038\/s41598-024-59238-6","article-title":"Examining the relationship between self-efficacy, career development, and subjective wellbeing in physical education students","volume":"14","author":"Yiming","year":"2024","journal-title":"Sci Rep"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"2143307","DOI":"10.1080\/10872981.2022.2143307","article-title":"COVID-19 related disruptions to medical education and perceived clinical capability of new resident physicians: a nationwide study of over 1200 first-year residents","volume":"28","author":"Guldner","year":"2023","journal-title":"Med Educ Online"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.jebo.2021.12.034","article-title":"Still want to be a doctor? Medical student dropout in the era of COVID-19","volume":"195","author":"Ye","year":"2022","journal-title":"J Econ Behav Organ"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e0291676","DOI":"10.1371\/journal.pone.0291676","article-title":"The essential impact of stress appraisals on work engagement","volume":"18","author":"Al Hajj","year":"2023","journal-title":"PLoS One"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"641","DOI":"10.3390\/bs14080641","article-title":"Medical professionalism and its association with dropout intention in Peruvian medical students during the COVID-19 pandemic","volume":"14","author":"Hancco-Monrroy","year":"2024","journal-title":"Behav Sci (Basel)"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1097\/ACM.0b013e318221e615","article-title":"Empathy decline and its reasons: a systematic review of studies with medical students and residents","volume":"86","author":"Neumann","year":"2011","journal-title":"Acad Med"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"12","DOI":"10.5116\/ijme.54c3.60cd","article-title":"Underlying construct of empathy, optimism, and burnout in medical students","volume":"6","author":"Hojat","year":"2015","journal-title":"Int J Med Educ"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e2027315","DOI":"10.1001\/jamanetworkopen.2020.27315","article-title":"US clinicians\u2019 experiences and perspectives on resource limitation and patient care during the COVID-19 pandemic","volume":"3","author":"Butler","year":"2020","journal-title":"JAMA Netw Open"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1402","DOI":"10.3390\/bs15101402","article-title":"Striving for career establishment: young adults\u2019 proactive development under career identity and passion dynamics","volume":"15","author":"Yang","year":"2025","journal-title":"Behav Sci"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1476426","DOI":"10.3389\/feduc.2024.1476426","article-title":"A potential exodus: what is behind dropping out intentions among university students?","volume":"9","author":"Herrera","year":"2025","journal-title":"Front Educ"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"3012","DOI":"10.3390\/ijerph19053012","article-title":"Role of empathy and lifelong learning abilities in physicians and nurses who work in direct contact with patients in adverse working conditions","volume":"19","author":"Delgado Bolton","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"432","DOI":"10.3389\/fpsyg.2020.00432","article-title":"Factors related to the differential development of inter-professional collaboration abilities in medicine and nursing students","volume":"11","author":"Berduzco-Torres","year":"2020","journal-title":"Front Psychol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1810306\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:58:09Z","timestamp":1783490289000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1810306\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":47,"alternative-id":["10.3389\/fmed.2026.1810306"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1810306","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]},"article-number":"1810306"}}