The health care reform as a critical life event: Investigating medical student commitment to medical career goals in a time of health care reform.

摘要

The study investigated the degree to which medical students' health care reform perceptions, self-efficacy, role ambiguity, and year in medical school play a role in the degree to which they are committed to their medical degree and their most likely specialty choice. The study utilized the Health Care Reform Thoughts Survey (HCRTS; Goodin, 2010) to measure medical students' perceptions of the health care reform. Measurement modeling of the HCRTS instrument resulted in a 3 factor solution with a marginal fit, chi2(776) = 3,177.835, p < .001, CFI = .898, TLI = .893, RMSEA = .065, and SRMR = .052. The subscales of the instrument included Outlook (the extent of negativity toward the reform), Reaction (the degree to which medical students intend to modify their goals with respect to the reform), and Uncertainty (the perceived stability of the reform and its future). Students in Year 3 had significantly more Role Ambiguity than students in all other years. Specifically, they had a mean difference of 0.252 (p < .001) with Year 1, the control variable for Year. Reaction had a significant association with Role Ambiguity and Self-efficacy (beta = 0.241, p < .001 and beta = -0.247, p < .001, respectively). Both Role Ambiguity and Self-efficacy were found to be significantly associated with Specialty Commitment (beta = -0.160, p < .001 and beta = 0.128, p < .001, respectively). Finally, in the structural equation model, all predictors (Outlook, Reaction, Uncertainty, Year, Self-efficacy, and Role Ambiguity) were found to explain 29.1% of the variance in Specialty Commitment ( p < .001). Findings suggest that the HCRTS be a continued resource in measuring the health care perceptions of medical students and other populations in modified form. Implications of the research findings are that medical student commitment to their career goals is affected by their perceptions of the health reform. Medical education must consider the impact of the reform in order to support the needs of medical students and public medical needs within the changing health care landscape.