The impact of the COVID-19 pandemic on enrollment in undergraduate health-related studies in Spain – BMC Medical Education

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The present study investigated the impact of the COVID-19 pandemic on the choice of health-related undergraduate studies in Spain, and one of its main findings was that the pandemic affected career choice and motivations in a significant proportion of students. This was more evident among students affected by COVID-19, since whether they themselves or a close relative suffered the disease; the pandemic reinforced their interest in pursuing a health-related bachelor’s degree. Differences between genders and degrees were also observed for some determining factors.

Regarding the general motivating factors to pursue these types of studies, the most selected ones in our sample were the willingness to help others, vocation and interest in the content. Healthcare students usually pursue their future profession due to intrinsic factors such as personal motivations (e.g., interest in the sciences) and humanitarian factors (e.g., serve the community, help and care for others), sociodemographic factors (e.g. gender, socioeconomic status), extrinsic factors (e.g., employability, financial security, expectations of salary, diversity of job opportunities) and interpersonal factors (e.g., family, friends, prestige, social influence and recognition [34, 37]. According to a previous study, these mediators were altered during the COVID-19 pandemic, not only in the enrolled undergraduate students [14] but also in future students considering studying a health-related degree, because the main interests were focused on the desire to help others, reinforce citizenship values, and improve the country’s situation. The specific factors that can mediate the impact of the pandemic on undergraduate students may be classified in sociodemographic (e.g., age, gender), contextual and socioeconomic (income, urban area), health-related (e.g., mental health, overall health status) and pandemic-related (e.g., exposure to negative information, experiences during the pandemic) terms.

Most previous studies on the impact of COVID-19 on university students have focused on the effects on mental health due to the restrictions associated with the pandemic [42]. This phenomenon could have enhanced reflection on future plans of potential students wishing to study health-related higher education. Deng et al. [10] found that COVID-19 affected career choice both positively and negatively. In our study, we observed a positive impact of the pandemic on a proportion of students ranging from 16 to 42% depending on the determining factor. The latter frequency was found for the variable related to the increased willingness to pursue the degree and is higher than in other studies published.

A cross-sectional study conducted in China identified that, of 1,837 medical students, 11.7% were more willing and 6.9% less willing to become doctors after the COVID-19 outbreak. When it specifically came to majoring in respiratory medicine and infectious diseases, the percentages rose to almost 12% and 10%, respectively. Another cross-sectional study conducted in more than 1,000 students in China identified a 12% increase in the choice of nursing as a future career after the onset of the COVID-19 pandemic [26]. Other surveys conducted in the US found approximately 11–20% of dental and medical students believing that the pandemic would affect their future plans [14], including choice of residency and specialty [4, 13].

Previous studies have linked this interest to students’ motivations, since the pandemic had reinforced their interest in becoming a physician by validating their perception of the vital role that medical doctors play in society [24]. Medical students from the University of Geneva (Switzerland) highlighted the importance of the healthcare profession to society and confirmed their career choice during the pandemic [20]. Nursing students from the United States reported that the pandemic had influenced their interest in nursing, although the desire to help others was prior to the pandemic [27]. In a similar vein, we found that the pandemic influenced students’ desire to study the degree in order to help others (33.4%), to increase citizenship values (28.4%), and to contribute to improving the situation of the country (27.5%).

In our study, these social values related to professional practice (e.g., helping others, citizenship values, contribution to the country, belonging to the community) were found to be significantly more influential among women than men. On the other hand, men reported being more motivated by good salary prospects and job prestige. In the same vein, a previous study conducted in Catalonia (Spain) also found male physiotherapy students to be more interested in employability and income prospects [37]. Beyond the COVID-19 pandemic scenario, in a previous study female nursing students scored higher in values focused on social or affective relationships, while male nursing students scored higher in stereotypical masculine values such as dominance and success [43].

However, our results did not coincide with some other previous studies beyond the COVID-19 pandemic context. In our research, helping others was preponderant. Gennissen et al. [44] found different professional orientations or motivations in medical students; the main finding was that self-development throughout life was highly valued. Dzhaneryan & Gvozdeva [45] pointed out that female psychology students stated that the desire to build a career related to working for themselves was self-achievement. Other studies [46, 47] highlighted the entrepreneurial career ambitions in psychology students, who hoped to establish successful businesses and create employment opportunities for other people –with self-development in first place too.

When comparing degrees, we found a stronger influence of the pandemic on an increased desire to help others in nursing and medicine students. In relation to altruism, a qualitative study conducted in Japan found most nursing students stating that the pandemic reinforced their sense of belonging and decision-making processes. Several participants reported that, as committed citizens, they had the mission to increase the quality of the public health system and to serve their country during the disaster, making a personal sacrifice in seeking general rather than personal interests [22]. In the same vein, a survey conducted in France identified a high commitment of medical students to helping to manage the pandemic, reinforcing in most cases their motivation to become health professionals, even at a significant psychological cost [48]. Another study conducted with Chinese nursing students identified a high level of professional identity during the COVID-19 crisis, as well as a positive influence on the public image of the nursing profession [25].

The enhanced social perception of the importance of the healthcare workforce may have influenced future students, who may have seen this phenomenon as an opportunity for future professional development. In this sense, media coverage and governmental efforts to recognize the work of healthcare workers have played an important role in making health-related professions more visible during the pandemic [25]. The image of health-related disciplines has been highlighted to the general population, especially in the case of frontline healthcare workers, even invoking the language of ‘heroism’ to praise them [2]. It can be hypothesized that these factors could have caused a higher interest for undertaking a health-related undergraduate degree in previously undecided students or reinforced the desire to study a health-related degree in others. In the same vein, a longitudinal study conducted in China found that the COVID-19 outbreak strengthened students’ beliefs and choices to become good doctors in two-thirds of medical students, compared to only 13% reporting a negative impact on their career choices [49].

In the inferential analysis by degrees, we also observed that more students of nursing, psychology and medicine reported that the pandemic reinforced their interest in choosing the degree. In the same vein, a longitudinal study identified medicine and nursing as the degrees with the highest increased demand after the pandemic outbreak in Spain [50]. Interestingly, podiatry was the degree with a significantly higher influence of the pandemic on salary prospects and with more new students wishing to study it. In this line, a qualitative study conducted in the UK found that podiatry students were interested in the profession for its flexibility and good job prospects, including opportunities for career progression, salary and success [51].

In several factors, we found a significantly higher influence of the pandemic on the choice of a health-related bachelor’s degree among students more personally affected by COVID-19. Students that were more affected by the disease, i.e., who contracted the disease severely themselves or who had relatives that did, reinforced more their desire to study the degree, reconsidered more the professional path and recent decision to pursue the degree. Previous studies on students’ emotional distress during the COVID-19 pandemic have showed that most health risks to self or loved ones due to COVID-19 were not uniquely associated with emotional distress. Shanahan et al. [52] pointed out that pre-pandemic distress, secondary consequences of the pandemic (e.g. lifestyle and economic disruptions), and pre-pandemic social stressors were more consistently associated with young adults’ emotional distress than COVID-19-related health risk exposures.

Coping mechanisms used by university students during the pandemic have been explored in previous studies, finding that a proactive developing stress management habits and personal resilience helped through the challenges of studying in the University and also enduring the stress of the pandemic [53, 54].

Future studies can focus on this aspect. Future studies may link motivation to professional values, and they can also be longitudinal, analyzing the transformative effects of a university education, beyond the influence of the pandemic on the main subjects of study. They may also describe the influence of macrosocial events, e.g., a macroeconomic crisis, on students’ university trajectories.

As one of the limitations of the study, the data collection instrument has not been fully validated, and only a preliminary exploratory analysis has been performed, in which the reliability of the questionnaire was calculated. We also performed a factor analysis, the first results of which are within the accepted margins for basic studies. Future studies can validate this kind of questionnaire and also perform a multivariate analysis on each motivational variable.

One of the strengths of the study is its sample, which includes university students from all over Spain. Despite using an online survey, we carefully analyzed all the questionnaires, especially those from social media recruitments, and we excluded unreliable questionnaires and degrees with a high sampling error to ensure data quality. However, like any study on the COVID-19 pandemic, the context must be taken into account, and its results cannot be generalized to the world population. The larger proportion of women in the sample can be seen as a limitation; however, this does replicate the proportion of women and men studying health sciences in Spain.

In conclusion, willingness to help others, vocation and interest in the content were the factors that most determined the choice of a health-related bachelor’s degree in this sample of Spanish students. Differences by gender show that women were more prone to choose a health-related bachelor’s degree to help others and due to vocation, whereas men were more motivated by good salary prospects and job prestige. Regarding the impact of the pandemic, factors for choosing a health-related bachelor were strengthened in a proportion of students ranging from 11 to 42%. The most influential factors were the strengthening of the willingness to choose the degree, the desire to help others, the increase of citizenship values and the contribution to improving the situation of the country. Women were significantly more influenced by the pandemic in wanting to study the career, in reinforcing the interest in choosing the degree, helping others, citizenship values, contributing to the country, belonging to the community, reconsidering the professional path and employment prospects. Podiatry and psychology were the degrees that attracted more previously undecided students. More students of nursing, psychology and medicine reported that the pandemic reinforced their interest in choosing the degree. The influence of the pandemic on an increased desire to help others was significantly higher in nursing and medicine, whereas the feeling of belonging to community was stronger in nursing students. Podiatry was the degree with the highest proportion of students reporting an influence of the pandemic on choosing the degree due to good salary prospects. Students personally affected by the disease reported being more influenced in reconsidering their professional path, in reinforcing their willingness to pursue the health-related degree and in recently deciding to pursue it.

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