Introduction
Career guidance in medical school education plays a critical role in enabling students to maximize their potential on personal, social, and national levels [1]. However, the scope and impact of career guidance provided to medical students are very limited, and it is not systematically addressed within the regular medical school curriculum [2]. The career paths of medical students are not simply determined at the time of admission but can continuously change and adjust based on various academic experiences, personal characteristics, and environmental factors. While medical students may decide on their specialty and enroll accordingly, they can harbor vague and sometimes incorrect perceptions of the medical profession as a career, making it rare for initial career preferences to become final choices. Most students begin contemplating their career paths after advancing to medical school or during clinical rotations, with preferences potentially changing during their education and decisions often made without certainty. Reality dictates that changing chosen career paths during residency training or after advancing to graduate studies is challenging. Career choice significantly impacts job satisfaction, personal well-being, and can positively affect the quality of healthcare services [3-6]. Therefore, a support system and appropriate educational approaches to support students’ career decisions throughout the entire curriculum must be established [7].
Education in the medical humanities offers medical students the opportunity to reflect on their values, roles, and identities as professionals [8,9]. This process of selfreflection enables students to explore and make informed career decisions by understanding the roles and responsibilities of their profession more deeply, thereby laying the foundation for meaningful career choices. The Catholic University of Korea’s School of Medicine provides opportunities for students in their fourth year of medical studies to explore areas of interest related to their careers through learning experiences in research, service, and clinical practice as the last step of the medical humanities education curriculum. In this context, a Capstone Program was designed to allow students to synthesize and internalize their entire educational journey, reflecting on their identity as physicians and from a medical humanities perspective.
The term “capstone” refers to the stone placed at the apex of a building or stone structure, symbolizing the culmination of a construction project (Fig. 1). In education, it represents the final stage of a course or curriculum where students are given the opportunity to synthesize knowledge and maximize their abilities without traditional assessments, such as exams, allowing both learners and educators to comprehensively evaluate the achievement of learning outcomes [10-12].
This study aimed to implement and evaluate the outcomes, perceptions, and satisfaction of the Capstone Program developed at the Catholic University of Korea, which integrates career exploration and medical humanities. The objective was to verify the educational effectiveness of linking career choice with reflection from a medical humanities perspective.
Methods
1. The Capstone Program as the finale of the medical humanities curriculum
The Capstone Program at College of Medicine, the Catholic University of Korea, includes a process for career exploration through project execution, conferences, and reflection on learning experiences during the 4-year medical humanities education curriculum (Fig. 2). This program is designed to actively engage students in activities directly related to career development. Initially, students select a career or area of interest along with a specific research topic during the second semester of their third year of medical school, either individually or in teams. This choice lays the groundwork for students to explore and plan their future career paths. Once a topic is selected, students are paired with an advising professor who oversees their focused research activities. The culmination of this process is the presentation of their findings, either orally or as a poster, at the Capstone Conference (Fig. 3). This conference serves as a critical platform for students to receive feedback and engage in discussions related to career development.
The learning outcomes of the Capstone Program are as follows: (1) Students are given the opportunity to select a topic, conduct in-depth research on it, and present their findings professionally. (2) Students integrate their research experiences with the principles of medical humanities through reflection. (3) Students share their research outcomes at the Capstone Conference, which not only enhances their understanding of various medical fields but also promotes informal discussions with peers and professionals about career development.
2. Collection
This study was conducted by collecting data related to the Capstone Program implemented for fourth-year pre-medical students from 2017 to 2019. The research data includes the following: First, the results of projects carried out by students as part of their career exploration, where they independently explored areas of interest and selected topics over the course of 1 year from their third to fourth year in medical school. Second, individual reports in which students reflected on the Capstone Program from a medical humanities perspective. Third, the results of a survey on students’ perceptions of and satisfaction with the Capstone Program. The survey contains 25 questions, each item is measured on a 5-point Likert scale from 1 (strongly dissatisfied) to 5 (strongly satisfied).
This study was approved by the Institutional Review Board (IRB) of Songeui Medical Campus, the Catholic University of Korea (IRB approval no., MC23EISI0079). The need for consent was waived by the IRB. The authors confirm that all methods were performed in accordance with the relevant guidelines and regulations.
3. Data analysis
First, this study categorized the students’ research topics and outcomes of the Capstone Program by field to identify trends in the areas of interest and career choices and quantitatively analyzed students’ perceptions related to career exploration.
Second, it qualitatively analyzed reflections on the Capstone Program in 2017 from a medical humanities perspective, including what the program meant to the students, how it aided their development as physicians, and what changes it brought in their perspectives on medicine, medical practice, and the core themes of medicine (doctors, patients, hospitals, and society).
Third, the perceptions and satisfaction of the students toward the Capstone Program were quantitatively analyzed. For the quantitative analysis, PASW SPSS ver. 18.0 (SPSS Inc., Chicago, USA) was used to calculate descriptive statistics, such as frequency and measures of central tendency, like means.
Inductive analysis was employed to identify themes in the qualitative analysis. Texts were read by two independent researchers (W.S.K. and D.M.Y.) without the intent of classification to familiarize themselves with the content of individual reports submitted by students after the conclusion of the capstone conference. Subsequently, themes were identified and independently classified by the two researchers from the content of the reports. The results of each researcher were reviewed to verify similar meanings, and themes were added, deleted, or modified to reach a consensus. The themes were then reviewed and discussed in relation to the data to reach an agreement. Quotations were extracted from the reports to illustrate each theme.
Results
1. Results of the Capstone Projects
The results of the Capstone Projects conducted from 2017 to 2019 were analyzed to identify the areas of career interest preferred by the students during their career exploration process (Table 1).
Teams participating in basic medicine research accounted for 35.48% of the total in 2017, showing the highest proportion. However, this decreased to 11.76% in 2018 and slightly increased to 23.33% in 2019. The average proportion was 23.53%. The number of teams choosing clinical medicine remained relatively stable over the 3 years, with an average proportion of 21.09%. The average proportion choosing global healthcare was 24.03%, with the highest proportion of 29.41%, which occurred in 2018. Integrated healthcare systems and innovation had the highest average proportion at 31.35%, which was 25.81% in 2017, with a significant increase to 38.24% in 2018.
2. Qualitative analysis of reflections on the Capstone Program from a medical humanities perspective
The qualitative analysis of individual student in 2017 reports reflecting on the Capstone Program from a medical humanities perspective revealed three themes: “sense of calling,” “competence,” and “leadership.”
1) Sense of calling
Regarding the sense of calling theme, the majority of the students mentioned that having a deep sense of responsibility and dedication to prioritizing the lives and health of patients is crucial for physicians. They noted that the Capstone Program provided them with an opportunity to reflect beyond merely utilizing medical knowledge and skills. It encouraged them to consider the fundamental motivation and mental attitude of physicians striving to alleviate patient suffering and provide the best possible care. Students expressed that physicians with a sense of calling viewed their profession not just as a job but as a vital mission to positively impact the lives and well-being of others. Some students commented:
“A good doctor should be qualified with skill and a spirit of sacrifice.”
“Poor and uneducated people suffer much more from diabetes, so public health care is necessary.” “Realizing the abundance of vulnerable individuals around us, I recognized the critical need for public education, not just awareness.”
“Throughout my medical studies, moments of fatigue sometimes clouded my initial resolve to heal patients holistically. The Capstone Program rejuvenated my original motivations and aspirations as a future doctor.”
One student, who conducted research on the “domestic burn treatment system,” expressed a connection between a sense of calling and career exploration as follows:
“Observing the burn surgeons, who diligently perform their duties with a profound sense of mission and responsibility, respecting life in this specialized field, helped me realize what true vocational calling means. This experience provided me with an opportunity to reflect on my own career path.”
2) Competence
Regarding the theme of competence, most students wrote that it is essential to possess the fundamental capabilities to prioritize patients’ health and safety and provide the best care based on the trust of patients and society. Additionally, they emphasized the need for a patient-centered attitude, scientific knowledge, and the best medical evidence to make accurate and appropriate medical judgments. They also stated that a continuous effort to improve the quality of healthcare is needed. Examples of the comments include:
“Capability as a doctor not only means medical skills but also the recognition of patients.”
“The Capstone Program made me question whether competence is solely about medical knowledge and treating obscure diseases. I realized that a doctor’s true skill also includes understanding and improving the unseen social challenges faced by the public.”
“Through this capstone, I realized that as societal trends and medical advancements evolve, the demands on medicine change. This highlighted the need for continuous research and reflection to proactively adapt to medical progress and shifts in the healthcare environment.”
Additionally, a student who conducted research on the “career choices of female doctors” commented:
“I was able to concretize the vague images of my future by learning from the experiences of senior female doctors. This provided an opportunity to plan my career in more detail, rather than relying on vague imaginings.”
3) Leadership
Regarding the theme of leadership, many students expressed that empathetic communication skills are essential for establishing trust and effective collaborative relationships for diagnosis or treatment decisions within the patient-doctor relationship. They stated that physicians should aim to improve not only individual patient health but also the well-being and health of society at large. They also mentioned that doctors should actively participate in various activities related to global health, showing interest in international healthcare advancements. For example, some commented:
“Reflecting on medical leadership, I realized it extends beyond building strong relationships with peers and patients to proactively addressing and improving societal issues, including the awareness of social vulnerabilities.”
“This Capstone Program inspired me to aim for a leadership role in global medicine, prioritizing not only advanced medical knowledge and research but also advocating for patient rights and welfare.”
“I learned that doctors play a crucial leadership role in community health and policy implementation, requiring an understanding of various stakeholders’ roles and political savvy.”
“The experience underscored the importance of being a doctor who values understanding different professions and prioritizes community welfare, focusing on the collective good in medical practice.”
One student expressed thoughts on the connection between career exploration and leadership as follows:
“Through this program, I had the opportunity to understand the lives and work environments of various stakeholders in medical device development, such as engineers and managers, by experiencing their daily routines. Additionally, even in a temporary position at a medical device company, I was able to observe firsthand the characteristics of an ideal organization, its members, and its leaders. I will keep this experience in mind as a blueprint for effectively leading any future group.”
3. Perceptions and student satisfaction of the Capstone Program
Perceptions and student satisfaction with the Capstone Program are as follows in Table 2. The preparation process for the capstone was reported to help cultivate empathy, care, and teamwork, which are important in the medical field (mean=4.19). Through this process, students evaluated that they were able to develop their research capabilities, including creative thinking, critical judgment, logical reasoning, and understanding of scientific research methodologies (mean=4.13).
The Capstone Program provided students with the opportunity to reflect on their medical knowledge and capabilities (mean=4.04), and this process fostered an attitude toward and capability for self-directed learning to further develop their knowledge and skills (mean=4.04). Additionally, the students reported that the capstone, as part of the overall medical humanities education curriculum, helped in developing a humanistic competency to view humans and healthcare from a broader perspective (mean=4.09) and that this curriculum contributed significantly to growing into physicians equipped with a sense of calling, competence, and leadership (mean=4.07).
In terms of career exploration, a majority of students responded that participating in the Capstone Project would assist them in choosing their career paths (mean=4.18), and guidance and advice from Capstone Project advisors were helpful in contemplating, exploring, and preparing for their career paths (mean=4.08). Additionally, the “Meetings with Seniors” session (mean=4.32), where alumni who have pursued various careers shared their experiences about life and work, received high satisfaction ratings. In the open-ended responses, several comments related to career exploration were noted: “It was surprising, new, and interesting to discover that my peers are exploring such different fields,” “The honest stories from alumni in various careers provided an opportunity to reflect on my own career and were helpful,” and “The program provided opportunities to develop various qualities necessary for being a doctor, and it allowed me to seriously consider my career as well as gain insights from a humanities perspective.”
The overall satisfaction with the Capstone Conference was high, with an average score of 4.12. Specifically, students were satisfied with the ability to convey the results of their peers’ projects (mean=4.36), and the content and quality of their peers’ presentations were deemed appropriate for achieving the learning outcomes of the program (mean=4.16).
However, responses indicated that the capstone schedule (mean=3.84) and the preparation process were burdensome (mean=3.66). While oral presentations received the highest satisfaction score at 4.33, poster presentations, which involved moving around in a large space under the guidance of an advising professor to listen and ask questions, showed lower satisfaction at 4.18.
Discussion
The Capstone Program demonstrated that students explored various career options through the process of researching a topic in their area of interest. Notably, students chose research topics in diverse fields such as basic medicine, clinical medicine, global healthcare, and integrated healthcare systems and innovation. This indicates that students are interested not only in traditional medical fields but also in new medical technologies and global health issues.
The qualitative analysis of individual reports, reflecting on the Capstone Program from a medical humanities perspective, showed that the program provided students with an opportunity for deep reflection on medical professionalism, including the qualities of character, a sense of calling, and social responsibility required of a physician.
The survey results of students’ perceptions of the Capstone Program indicated that the career exploration and research experience gained during this process had a positive impact. Specifically, conference sessions like “Meeting with Seniors,” in which the students directly heard the experiences of seniors, proved to be of practical help and inspiration to the students. The students evaluated that the presentations of peer research results provided useful information for exploring various career paths, showing that these experiences play a crucial role in contemplating and preparing for their careers.
The preparation process for the Capstone Program had a positive impact on cultivating empathy, care, and teamwork, which are vital in the medical field. Students assessed that through this process, they could develop their research capabilities, including creative thinking, critical judgment, logical reasoning, and understanding of scientific research methodologies. This suggests that the Capstone Program plays a significant role in medical education, going beyond mere knowledge acquisition to equip future medical professionals with essential competencies and character.
Students evaluated that the Capstone Program provided them with opportunities to reflect on their medical knowledge and capabilities and that the entire medical humanities education curriculum, including the Capstone Program, helped to enhance their humanistic competency to view humans and healthcare from a broader perspective. Such processes significantly contributed to developing a sense of calling, competence, and leadership in becoming a physician, indicating that learning experiences reflected from a medical humanities perspective lay a foundation for internalizing various competencies and values needed in the medical field.
The results of the satisfaction survey for the Capstone Conference suggest that this process provided an important platform for students to explore their career paths. Feedback indicating that students gained confidence through sharing their research results and receiving feedback during the presentation sessions showed that the program would positively impact future career decisions and personal development.
In medical school education, career guidance plays a crucial role in enabling students to fully realize their potential personally, socially, and nationally. However, the reality is that the scope and impact of career guidance offered to medical students are limited and not adequately addressed within the standard curriculum [1-3].
Career education in medical training is mostly conducted in the form of career seminars, job fairs, career counseling programs, and career development lectures [13-17]. The process of choosing a career should not only involve selecting a major but also contemplating and recognizing the importance of various competencies required for a professional. Therefore, career guidance education must include opportunities to recognize the spirit and attitude required of a physician.
Education in medical humanities plays a vital role in cultivating the professionalism, expert consciousness, ethical awareness, and self-reflection abilities necessary for physicians. Thus, linking medical humanities education with career education could be more effective in achieving each goal.
The College of Medicine, The Catholic University of Korea planned and operated a program named “Capstone” to link medical humanities education with career education, allowing students to explore and present their career paths within the medical humanities curriculum. This process provided students with opportunities to reflect on professionalism.
As a result of its operation, students went beyond exploring careers. Through comprehensive reflection from a professional perspective, they deeply considered not only the competencies required for a professional but also the importance of cultivating the spirit and attitude of a physician.
While meeting role models during career interviews, job fairs, and special lectures on career development can offer a chance to ponder professionalism or seek advice, few attempts to link medical humanities education with career guidance education within the regular curriculum have been made. This approach of operating career guidance education in conjunction with medical humanities education proved effective in achieving the ultimate goals of career education.
This research was conducted among students participating in the Capstone Program at a specific medical school. Consequently, there are limitations to generalizing the findings, necessitating further research to evaluate applicability in other medical schools or regions. The study primarily relied on cross-sectional data, lacking longitudinal research to track how students’ career choices and reflections on professional identity evolve over time. This limitation restricts understanding of how perceptions and attitudes may change. The study is based on data collected through surveys and interviews, limiting the control over external variables that might influence students’ career choices and reflections on professionalism. Thus, it’s difficult to explain clear causal relationships between the study findings and observed phenomena. Despite these limitations, this research lays an important foundation for exploring the positive impact of integrating career guidance with medical humanities education on the development of students’ professional identity in medical education. Future research is needed to overcome these limitations and further investigate this area.
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