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Korean J Med Educ > Volume 36(2); 2024 > Article
Yune, Park, Yoo, and Park: Differences in fear of failure and college adjustment by type of medical school entrance extrinsic motivation using a latent profile analysis

Abstract

Purpose

The decision to enroll in medical school is largely influenced by extrinsic motivation factors. It is necessary to explore the factors that affect pre-med students’ motivation to enter medical school and their college adjustment, and to develop measures to help them adjust.

Methods

A total of 407 pre-med students were surveyed regarding their motivation to enter medical school, fear of failure, and college adjustment. We analyzed the latent profiles of extrinsic motivation factors using latent profile analysis. One-way analysis of variance was conducted to examine the differences in fear of failure and adaptation to university life according to the latent groups.

Results

After analyzing the latent profiles of entrance motivation, three latent profiles were selected. They were divided into high, medium, and low extrinsic motivation groups. Three profiles scored the highest on job security, followed by good grades and social status. Sophomores were more likely to be high extrinsic motivators than freshmen were. Fear of failure was high in the group with high extrinsic motivation, and adaptation to college life was highest in the group with low extrinsic motivation.

Conclusion

Job security was the most important extrinsic motivator for entering medical school, and extrinsic entrance motivation influenced fear of failure and college adjustment. Given the high level of extrinsic motivation among medical students, it is meaningful to analyze the extrinsic motivation profile of entering medical students and how it affects failure motivation and college adjustment.

Introduction

In Korean society, many parents want their children to become medical professionals, and becoming a doctor ranks among the top career aspirations of elementary and secondary school students [1]. However, while students who enter medical school experience a sense of accomplishment, pride in becoming medical students, and relief that they have secured a stable career path, they may also feel doubtful about their choice, dissatisfied with their medical school life, or maladjusted [2]. Students who enter medical school blindly, following their parents’ or others’ wishes, with little thought about their career path and little internal motivation, may experience a sense of loss and maladjustment due to academic, relationship, and career decisions, creating difficulties during the premedical school [3].
Several factors influence the decision to become a doctor, such as the humanistic aspect of medicine, openness to new experiences, deep personal identification with the profession, a sense of professional fulfillment, and a desire to help people and recognize one’s usefulness [4]. The motivation to enter medical school is divided into two main factors: intrinsic motivation, which is the desire to become a doctor or fulfill intellectual curiosity about medicine; and extrinsic motivation, or outcome-oriented motivation, which is the desire to earn a high salary as a professional [5]. The 2016 survey of Korean students found that extrinsic motivation to enroll in medical school was high, with more than 50% of students being encouraged by their parents or others [6].
It has been established that students are more extrinsically motivated than intrinsically motivated when entering medical school. Extrinsic motivation has also been shown to be related to demographic factors, such as student gender and school year [7]. However, even though extrinsic motivation is a large part of medical student’s motivation to enroll in medical school, much of the research on this topic has not focused exclusively on extrinsic motivation. There is a need for a clearer understanding of the extrinsic motivations that bring students to medical school and how these motivations affect their medical school experience.
The motivation to enter medical school and adjustment to college life during the pre-medical school period are interrelated. College adjustment is the process by which students achieve high levels of self-satisfaction through active interaction with the college environment. This process influences academic success and life satisfaction in medical schools as well as the development of post-graduation careers and values [8]. Motivation also influences the fear of failure in academic situations. Fear of failure is defined as an emotional and motivational trait of avoiding failure in achievement situations [9]. The fear of failure is associated with performance and task avoidance in academic situations [10] and has been linked to learned helplessness [11] and shame [12]. Therefore, students with a high fear of failure are more likely to undergo negative psychological experiences in academic situations.
As described above, the transition to college marks a move to independent adulthood, when students become responsible for their actions, and successfully navigating this transition carries important personal and societal implications. However, despite medical students’ motivation to attend medical school being largely driven by extrinsic factors, there has been little empirical research on the characteristics of this extrinsic motivation at the time of enrollment and its impact on their overall college experience.
Therefore, it is necessary to explore the factors affecting medical students’ entrance motivation and their college adaptation, and to develop educational interventions that facilitate their adjustment. This study focuses on extrinsic motivation of medical students, classifies the types of motivation, and investigates the effects of extrinsic motivation on college adjustment and fear of failure. The results of this study can help develop educational programs that consider the motivations of premedical students.
The research questions of this study are as follows: (1) How are medical students’ types of motivation categorized? (2) What are the characteristics of medical students’ types of entrance motivation? (3) Are there differences in medical students’ perceived fear of failure based on the type of entrance motivation? (4) Are there differences in medical students’ perceived college adjustment based on the type of entering motivation?

Methods

1. Study participants

This study investigated the motivations for entering medical school, adaptation to college life, and fear of failure among first- and second-year medical students in pre-medical schools in Gyeonggi, Jeolla, and Busan from July to September 2022. The sample size was calculated using the G*Power ver. 3.1.9.7 program (Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany; http://www.gpower.hhu.de/), targeting more than 252 participants based on an effect size of 0.25, an α error probability of 0.05, a power (1-β error probability) of 0.95, and three groups. Ultimately, 407 subjects were selected, excluding non-respondents and those who answered insincerely.

2. Instruments

The scale developed by Kim and Park [13] was used to measure students’ motivation to enter medical school. This instrument consists of 30 items across seven subfactors: unmotivated, good grades, parental expectations, job security, social status, aptitude, and sense of calling. However, this study utilized only 16 items from four sub-factors of extrinsic motivation: good grades, parental expectations, job security, and social status. The reliability (Cronbach’s α) for each subfactor ranged from 0.823 to 0.898, with an overall reliability of 0.868. Additionally, the Fear of Failure Scale, developed by Conroy et al. [14] and adapted by Lim [15] for the Korean context, was utilized to assess the emotional response of students to failure. This scale comprises 25 items in five subfactors: fear of losing the attention of significant others, fear of being devalued, fear of experiencing shame and embarrassment, fear of having an uncertain future, and fear of upsetting significant others. College adjustment is measured using a scale developed by Baker and Siryk [16] and adapted by Lee [17], which includes academic, social, emotional, physical adjustment, and attachment to college. The subscale reliabilities range from 0.614 to 0.780, with an overall reliability of 0.854.

3. Data analysis

A latent profile analysis was conducted to identify latent profiles. The Akaike information criterion (AIC), Bayesian information criterion (BIC), and sample-size adjusted BIC (SABIC) were used to determine the number of latent profiles. A lower value of the information index indicates a better fit [18]. Entropy, a measure of the quality of the latent classification, ranges from 0 to 1. The closer the entropy value is to 1, the more accurate the latent classification assigned by the population. We conducted model comparison tests of the latent profiles using the LoMendell-Rubin adjusted likelihood-ratio test (LMRLRT) and the parametric bootstrapped likelihood ratio test (BLRT). Specifically, we tested the differences between a model with k latent profiles and a model with k-1 latent profiles, adopting the k latent profile model if the p-value was significant and the k-1 latent profile model if the p-value was not significant. We evaluated whether the classification of the selected latent profile was realistic and simple, and whether the group classification’s meaning was validly interpreted based on the theory. Mplus ver. 8.2 (Muthén & Muthén, Los Angeles, USA) was used for latent profile analysis, while IBM SPSS ver. 27.0 (IBM Corp., Armonk, USA) was used for basic statistical and group differences analysis.

4. Ethical considerations

This study was conducted with the approval of the Institutional Review Board of Gachon University Gil Medical Center to comply with research ethics (approval no., GBIRB2022-183). All data were collected anonymously to protect participant privacy, adhere to ethical guidelines, and respect the voluntary participation and rights of all participants.

Results

1. Latent profile types of entrance motivation

As latent profile analysis necessitates consideration of individual differences within variables, we conducted a correlation analysis among each subfactor. These correlations between the variables used in the latent profile analysis were found to be statistically significant (p<0.001), ranging from 0.418 to 0.619 (Table 1). As indicated in Table 2, latent profile analysis was performed with four variables: good grades, parental expectations, job security, and social status. This was done to ascertain the number of latent profiles characterizing medical students’ motivations to enter medical school. The AIC, BIC, and SABIC indices decreased as the number of clusters increased from 2 to 4. The entropy value, indicative of the quality of the classification, was highest for group 3, followed by groups 2 and 4. The LMRLRT and BLRT, measures of model fit for the latent profiles, were not statistically significant between 3 and 4 profiles. The classification rate did not fall below 5% for any configuration up to five latent profiles. Based on these findings, three latent profiles were ultimately selected.

2.Characteristics of entrance motivation types

1) Entrance motivation types

Based on the profile analysis of three groups, the low extrinsic motivation group displayed lower-than-average scores in grades, parental expectations, job security, and social status. Conversely, the high extrinsic motivation group recorded the highest scores across these subfactors. The medium extrinsic motivation group showed scores that were lower than average but similar to those of the high group (Fig. 1). The distribution of these groups, as detailed in Table 3, was 17.69% for the low, 44.96% for the high, and 37.35% for the medium groups, respectively.

2) Characteristics of entrance motivation types

We examined the presence of differences in extrinsic motivators for entering medical school based on grade, gender, retaking status, type of entrance motivation, and high school region. According to Table 3, significant differences were found only by grade. Specifically, second-year students displayed fewer low extrinsic motivators and more high extrinsic motivators compared to first-year students (p<0.05).

3.Differences in fear of failure by entrance motivation types

When analyzing the differences in fear of failure across entrance motivation types, significant variations were observed among all subfactors and total scores, as detailed in Table 4. The fear of losing the attention of significant others was significantly higher in the high extrinsic motivators group compared to the low and medium groups (p<0.001). Similarly, the fear of being devalued was more pronounced among high and medium extrinsic motivators than those with low extrinsic motivation (p<0.001). Additionally, the high motivation group experienced more intense fear of shame and embarrassment than both the medium and low groups (p<0.001). Moreover, fears of an uncertain future (p<0.001) and of upsetting significant others (p<0.01) were also greater in the high and medium groups compared to the low group. Overall, scores for failure motivation were highest among the high and medium motivation groups (p<0.001).

4. Differences in college adjustment by type of entrance motivation

The results of the analysis of variance assessing differences in college adjustment by entrance motivation type are presented in Table 5. Significant differences were observed in emotional adjustment (F=3.05, p<0.05), attachment to college (F=5.06, p<0.01), and overall college adjustment (F=3.92, p<0.05). Notably, the low extrinsic motivation group consistently scored higher than the high extrinsic motivation group across these dimensions: emotional adjustment, attachment to college, and overall college adjustment.

Discussion

This study explores the extrinsic motivation of medical students for enrolling in medical school, analyzes various types of entrance motivation profiles, and examines the differences in college adjustment and fear of failure based on entrance motivation type.
First, three latent profile types of extrinsic motivation for entering medical school were identified: high, medium, and low. Across these profiles, all groups rated job security as the most significant factor, followed by good grades and social status. These findings align with previous studies in Korea using the same motivational tool, which also highlighted job security as the predominant motivator among medical students [13]. Similarly, other research indicates that economic stability and family expectations are key extrinsic motivators [19]. Thus, job security consistently emerges as the principal extrinsic motivation for students entering medical school, underscored by academic performance and social status.
According to self-determination theory (SDT), studying medicine to please parents or for the prospect of a high salary represents a controlling motivation. This type of motivation—driven by rewards, threats of punishment, or internal pressures like guilt or shame—can negatively affect students’ learning behaviors and performance [20]. SDT suggests that students can transition between dynamic, autonomous motivation and controlled motivation. It posits that intrinsic motivation is activated when three basic psychological needs are met: autonomy (the will to act), competence (the ability to achieve goals), and belongingness [20]. It is, therefore, crucial to identify the motivations of students entering medical school and to implement educational interventions that foster healthy motivations.
Second, the distribution of the three extrinsic motivation groups varied significantly by academic year. Second-year students were notably more likely to belong to the high extrinsic motivation group compared to first-year students, with no other demographic differences observed. This finding is consistent with previous studies indicating that intrinsic motivation is higher among students in the preclinical phase, yet tends to decline over a 3-year period [21]. Furthermore, a study on healthcare administration majors found that first-year students exhibited higher intrinsic motivation, whereas second-year students demonstrated higher extrinsic motivation [22].
Our study’s results revealed no significant variations in motivation across demographic groups other than academic year. Earlier research has also suggested that factors such as gender, grade, retaking, admission type, and high school location do not significantly influence extrinsic or intrinsic motivation [7]. Nevertheless, the inconsistent findings regarding gender differences in motivation may be attributed to cultural expectations about the medical profession [23]. These observations underscore the need for further research to explore how various demographic factors, including gender, influence the motivation to enter medical school.
Third, the fear of failure was more pronounced in the high and medium extrinsic motivation groups compared to the low-extrinsic motivation group. Failure, a distressing and challenging experience, triggers fear that can adversely affect behavior and performance [24]. Previous research has highlighted differences in academic burnout and failure tolerance between groups with autonomous and controlled motivations, revealing that those with controlled motivations experience higher burnout and reduced tolerance for failure. Specifically, passive learners, as opposed to active ones, are more susceptible to burnout, less likely to rebound after setbacks, and show lower academic engagement [25]. Extrinsic motivation, especially controlled motivation, strongly correlates with fear of failure, and this fear is linked to diminished adaptive learning strategies and increased test anxiety [26]. Therefore, understanding the motivations driving students’ fear of failure is crucial for designing educational interventions that foster greater self-motivation.
Fourth, regarding differences in college adjustment based on entrance motivation type, the low motivation group outperformed the high motivation group in emotional adjustment, attachment to college, and overall college adjustment. Previous research indicates that intrinsic motivation consistently supports college adjustment [27]. Conversely, recent studies have found that students who recognize the benefits of extrinsic motivation, such as employment prospects and admissibility, along with maintaining both intrinsic and extrinsic motivations, tend to have lower dropout rates, greater satisfaction with their majors, and better overall college adjustment [28]. It remains unclear whether high levels of intrinsic motivation directly influence decisions to enter medical school and subsequent college adjustment, or if the academic climate of a university primarily fosters students’ intrinsic motivation [7]. Thus, further extensive research on the motivations of medical students is necessary.
The focus of this study was solely on external motivation, making it challenging to fully delineate all types and levels of motivation among medical students. Nevertheless, considering the high levels of extrinsic motivation observed among incoming medical students, it is valuable to investigate their extrinsic motivation profiles and their effects on coping with failure and adjusting to university life. Therefore, these findings underscore the importance of understanding the motivations of first-year medical students and developing educational interventions that foster greater internal self-motivation.

Acknowledgments

We express our sincere gratitude to the medical students who participated in this study.

Notes

Funding
This work was supported by a 2-Year Research Grant of Pusan National University.
Conflicts of interest
So Jung Yune, Hyo Hyun Yoo, andKwi Hwa Park serve as an Editorial Board members of the Korean Journal of Medical Education but have no role in the decision to publish this article. Except for that, no potential conflict of interest relevant to this article was reported.
Author contributions
SJY and KHP conceived and designed the study. SJY, IBP, KHP, and HYY drafted the initial version of the manuscript and analyzed the data. All authors discussed and approved the final manuscript.

Fig. 1.
Three Types of Motivations for Entering Medical School
kjme-2024-296f1.jpg
Table 1.
Correlations among the Subfactors of Entrance Motivation
Factor Good grades Parental expectations Job security Social status
Good grades -
Parental expectations 0.523*** -
Job security 0.611*** 0.452*** -
Social status 0.510*** 0.418*** 0.619*** -
Mean±SD 13.66±4.14 10.13±4.43 15.49±3.97 13.29±4.43

SD: Standard deviation.

*** p<0.001.

Table 2.
Information Criteria and Model Fit Indices for Two to Four Latent Profile Analyses
Factor No. of profiles
2 3 4
Information criterion
 AIC 8,903.008 8,779.459 8,716.974
 BIC 8,955.122 8,851.618 8,809.176
 aBIC 8,913.871 8,794.501 8,736.194
Entropy 0.831 0.737 0.907
Latent class size (%)
 1 28.99 17.69 8.35
 2 71.01 44.96 18.43
 3 37.35 42.51
 4 30.71
LMRLRT 0.0000 0.0350 0.0566
BLRT 0.0000 0.0000 0.0000

AIC: Akaike information criterion, BIC: Bayesian information criterion, aBIC: Adjusted BIC, LMRLRT: Lo-Mendell-Rubin adjusted likelihood-ratio test, BLRT: Bootstrapped likelihood ratio test.

Table 3.
Subfactor Scores and Characteristics by Entrance Motivation Types
Grade No. (%) Sub factors
Pre-medical school grade
Gender
Retaking
Admission type
High school location
Good grades Parental expectations Job security Social status 1st 2nd Male Female 1 ≥2 Occasional Regular Capital area Non-capital area
Low 72 (17.69) 8.20±3.50 6.22±2.72 9.13±3.09 8.00±3.34 56 (21.6) 16 (10.8) 48 (16.7) 24 (20.2) 27 (17.3) 45 (17.9) 47 (18.0) 25 (17.1) 22 (17.1) 50 (18.0)
Medium 183 (44.96) 13.06±2.68 8.71±3.29 15.45±2.25 12.54±3.46 115 (44.4) 68 (45.9) 131 (45.5) 52 (43.7) 71 (45.5) 112 (44.6) 121 (46.4) 62 (42.5) 55 (42.6) 128 (46.0)
High 152 (37.35) 16.81±2.22 13.55±3.63 18.38±1.97 16.56±2.72 88 (34.0) 64 (43.2) 109 (37.8) 43 (36.1) 58 (37.2) 94 (37.5) 93 (35.6) 59 (40.4) 52 (40.3) 100 (36.0)
Total 407 (100.00) 12.69±4.14 9.49±4.43 14.32±3.97 12.37±4.43 χ2=8.44, p=0.015 χ2=0.710, p=0.701 χ2=0.040, p=0.980 χ2=930, p=0.628 χ2=715, p=0.699

Data are presented as mean±standard deviation or number (%), unless otherwise stated.

Table 4.
Differences in Fear of Failure by the Entrance Motivation Types
Factor Mean±SD No. F p-value Scheffe
Fear of losing the attention of significant others 8.02 0.000 High > medium, low
 Low 10.38±3.90 72
 Medium 11.21±4.05 183
 High 12.52±4.11 152
Fear of being devalued 8.06 0.000 High, medium > low
 Low 8.81±3.46 72
 Medium 10.16±3.51 183
 High 10.80±3.42 152
Fear of experiencing shame and embarrassment 10.25 0.000 High > medium, low
 Low 16.25±6.13 72
 Medium 18.27±6.36 183
 High 20.22±6.32 152
Fear of having an uncertain future 8.96 0.000 High, medium > low
 Low 9.07±3.15 72
 Medium 10.52±3.34 183
 High 10.98±2.98 152
Fear of upsetting significant others 7.11 0.001 High, medium > low
 Low 9.01±3.63 72
 Medium 10.60±4.22 183
 High 11.16±3.87 152
Total 11.38 0.000 High, medium > low
 Low 53.51±17.41 72
 Medium 60.77±18.72 183
 High 65.67±17.20 152

SD: Standard deviation.

Table 5.
Differences in College Adjustment by the Entrance Motivation Types
Factor Mean±SD No. F p-value Scheffe
Academic adjustment 2.51 0.083
 Low 14.58±3.27 72
 Medium 13.87±2.9 183
 High 13.64±2.89 152
Social adjustment 2.22 0.110
 Low 13.91±2.98 72
 Medium 19.42±3.59 183
 High 18.4±3.72 152
Emotional adjustment 3.05 0.049 Low > high
 Low 20.04±3.79 72
 Medium 18.95±3.89 183
 High 18.69±3.95 152
Physical adjustment 1.20 0.301
 Low 13.65±3.02 72
 Medium 13.04±3.01 183
 High 13.09±2.86 152
Attachment to college 5.06 0.007 Low > medium, high
 Low 19.63±3.06 72
 Medium 18.48±3.22 183
 High 18.15±3.43 152
Total 3.92 0.021 Low > medium, high
 Low 87.32±13.11 72
 Medium 82.73±13.41 183
 High 82.49±12.26 152

SD: Standard deviation.

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