Understanding Relationships Between Medical Students and Their Parents

I have two children, aged seven and ten. They are cheeky and difficult to care for. I want them to be independent as soon as possible, but they are also a constant source of concern when I am not with them. As a parent, my worries increase daily; I observe parents around me who are eager to educate their children, and I wonder whether there is anything more I can do for mine as they grow up. How can I help them become independent sooner? Contrarily, as part of a medical school faculty, I think of not only the medical students with whom I am involved but also their parents. I am sure that parents who send their children to medical school have their own thoughts and feelings. An applicant must clear highly competitive entrance examinations for admission into medical school in Japan. As significant efforts are associated with students’ education from early childhood and the cost of medical school is high, parents whose children attend medical school naturally have strong feelings about this stage of their children’s lives. Passed/failed medical school examinations, career choices, and fluid changes due to the COVID-19 pandemic are additional sources of anxiety for them. In fact, the number of inquiries from parents of medical students have been increasing. I researched and confirmed the policies of every Japanese university regarding the COVID-19 pandemic and found that parental concerns were significant in all medical universities’ policymaking (Hayashi et al., 2022). In one specific case, the parents of medical students demanded accountability for the university’s policymaking, resulting in the sudden cancellation of face-to-face classes and clinical practice, and a stricter code of conduct. Even in the absence of such a pandemic, it is common for parents to ask medical faculties for their opinions on their children’s poor performance. Thus, to what extent should faculty members mentoring medical students be concerned about parents?


INTRODUCTION
I have two children, aged seven and ten. They are cheeky and difficult to care for. I want them to be independent as soon as possible, but they are also a constant source of concern when I am not with them. As a parent, my worries increase daily; I observe parents around me who are eager to educate their children, and I wonder whether there is anything more I can do for mine as they grow up. How can I help them become independent sooner? Contrarily, as part of a medical school faculty, I think of not only the medical students with whom I am involved but also their parents. I am sure that parents who send their children to medical school have their own thoughts and feelings.
An applicant must clear highly competitive entrance examinations for admission into medical school in Japan. As significant efforts are associated with students' education from early childhood and the cost of medical school is high, parents whose children attend medical school naturally have strong feelings about this stage of their children's lives.
Passed/failed medical school examinations, career choices, and fluid changes due to the COVID-19 pandemic are additional sources of anxiety for them. In fact, the number of inquiries from parents of medical students have been increasing. I researched and confirmed the policies of every Japanese university regarding the COVID-19 pandemic and found that parental concerns were significant in all medical universities' policymaking (Hayashi et al., 2022). In one specific case, the parents of medical students demanded accountability for the university's policymaking, resulting in the sudden cancellation of face-to-face classes and clinical practice, and a stricter code of conduct. Even in the absence of such a pandemic, it is common for parents to ask medical faculties for their opinions on their children's poor performance. Thus, to what extent should faculty members mentoring medical students be concerned about parents?

SUBSECTIONS RELEVANT FOR THE SUBJECT
Fujisaki, a Japanese medical educator, criticizes residents' inability to become independent from their parents even after graduating medical school, likely due to the declining birth-rate, increasing nuclear families, and spread of consumer culture (Fujisaki, 2017). This phenomenon is supported by the fact that consultations with parents against medical school policy reflect their strong feelings that go beyond the faculty members' imagination.
The idea of self-concept may help address this issue by focusing on the students. Self-concept-the kind of person we are and our self-image-is a classic characteristic of the adult learning theory proposed by Knowles (1980); as individuals' dependent nature gradually transforms into a self-directed nature, the self-concept matures. Further, adults may prefer learning at their own pace with a degree of independence from educators, since they eventually feel bored with learning strategies that are simply given to them (Knowles, 1975). While support and assistance may be needed, learners must be independent from their parents as well. It is important for learners to take initiative and self-evaluate learning achievements, especially from the self-directed learning perspective. However, the relationship between medical students and their parents is inseverable. As such, the framework of professional identity formation is useful in considering parental involvement (Cruess et al., 2019). This theory suggests that learners have preexisting personal identities, and the environmental factors they have grown up in (especially family and friends) have significant impacts. Therefore, we cannot ignore parental relationships' influence when students are encouraged to socialize in medical school. Each medical student undergoes the socialization process and grows into a professional; however, when faculties think about medical students' growth, they must consider parents as well. Therefore, to what extent should medical school faculty tolerate parental involvement in the lives of medical students?
It is useful to clarify how relationships between learners and their parents impact the mentoring process between learners and faculty. If students are dependent on their parents when problems, such as poor grades arise, the students will likely seek parental advice. Therefore, during the mentoring process, faculty members should ensure that students are aware of the parental influence and ensure that any decisions students make are based on their own opinion. It may not be necessary to force learners to separate from their parents, but it may be necessary to verbalize to students that their own ideas are important; it is not always good for medical students to be completely independent of their parents.

DISCUSSION
This study explored the relationships between medical students and their parents, in Japan. Using various learning and professional identity-formation theories, students' need to balance their desire for independence and their desire for sources of support have been discussed. It also highlights the role of medical school faculties in navigating the studentparent relationship, especially in terms of mentoring students. Discussion of these issues may help us understand if and how parents view medical schools as service providers. Understanding the relationships between medical students and their parents may change how faculty members interact with parents and students. As a strategy to cope with this situation, I believe that collaboration between faculties and administrative assistants could be useful in solving the problem to create a system that accepts ideas from various perspectives.
I finally highlight the medical faculties need to understand the relationship between medical students and their parents beyond the COVID-19 pandemic in Japan. However, there must be diversity in this approach depending on the country's sociocultural background. In the Japanese system, students enter medical school immediately after high school graduation-a factor in considering the parental relationship. Moreover, the Japanese culture emphasizes mutual relationships, including medical students' relationships with their parents. Exploring social factors and comparing regions or countries may be good avenues for future research.

AUTHOR CONTRIBUTIONS
The author confirms being the sole contributor of this work and has approved it for publication.