Exploring motivational and contextual factors influencing medical career choice: a theory-informed study

Abstract

Background:

Career choice in medicine represents a multidimensional decision influenced by motivational, emotional, and sociocultural dynamics. Understanding how these factors interact is essential for developing educational environments that nurture sustained professional commitment. Drawing on the Social Cognitive Career Theory (SCCT) and the Expectancy–Value Theory (EVT), this study explored how self-efficacy beliefs, outcome expectations, task values, and contextual supports shape medical career motivation among first-year medical students.

Methods:

A cross-sectional quantitative design was used, involving 297 first-year medical students at a public university in western Türkiye. Data were collected online and anonymously during the 2022–2023 academic year, using a researcher-developed and pilot-validated questionnaire comprising 33 items assessing motivational and contextual determinants of career choice. Questionnaire items were structured according to the constructs of SCCT and EVT. Descriptive and inferential statistical analyses (t-tests, ANOVA, p < 0.05; SPSS v25) were performed to examine associations between motivational dimensions and demographic variables.

Results:

Students’ strongest motivations were intrinsic and self-efficacy–based—particularly personal desire to study medicine, belief in being a good physician, and moral satisfaction—corresponding to SCCT’s self-efficacy and EVT’s intrinsic value dimensions. Job security and professional prestige also received high ratings, reflecting positive outcome expectations and utility value. In contrast, environmental barriers (e.g., workload, media influence, and perceived low income) had comparatively lower influence. Female students reported higher intrinsic and altruistic motivations, whereas male students emphasized financial stability and outcome expectations. Parental education and age were also associated with higher efficacy and expectancy beliefs, aligning with SCCT’s view of environmental support as a reinforcing factor.

Conclusion:

The findings suggest that intrinsic motivation and perceived competence outweigh external constraints in shaping early medical career intentions. Framing medical career choice through SCCT and EVT offers a comprehensive understanding of how emotional, motivational, and cultural factors intersect in professional identity formation. These insights can inform interventions that strengthen self-efficacy, moral engagement, and contextual support in medical education.

1 Introduction

Career choice is a complex and multidimensional decision for students, influenced by cultural, economic, familial, and individual characteristics, as well as prior medical exposure and competencies. These factors vary across countries due to cultural and socioeconomic differences (Shahab et al., 2011; Tiwari et al., 2016; Goel et al., 2018). Medicine has long been one of the most prestigious and preferred professions, positioning physicians as key health providers.

As of 2024, Türkiye ranks among the leading countries worldwide with 116 medical faculties actively providing undergraduate education (Sistemi, 2025). Every year, more than two million students sit for the national university entrance examination, and only those within the highest percentile are able to secure admission to a state medical faculty. In this context, choosing a profession based not only on exam performance but also on personal interests and abilities becomes particularly challenging. Understanding students’ motivations and reasons for selecting medicine is therefore critical for training competent and motivated physicians. This study aims to explore the factors influencing first-year medical students’ choice of medical school.

Although numerous studies have explored the motives behind medical career choice (Goel et al., 2018; Clack and Head, 1998; Girasek et al., 2011) most have focused on students from Western or high-income contexts. There is limited evidence from Türkiye, where medical education is highly competitive, culturally diverse, and shaped by socioeconomic pressures. Understanding how motivational and contextual factors interact in this setting may provide valuable insights for curriculum development, student guidance, and workforce planning in medical education. Therefore, this study examines the topic within the framework of two complementary and well-established career development theories; Social Cognitive Career Theory (SCCT) (Lent et al., 1994) and Expectancy–Value Theory (EVT) (Wigfield and Eccles, 2000), to provide a comprehensive and theory-informed understanding of why and how students choose medicine as a career. SCCT suggests that self-efficacy beliefs and outcome expectations, in interaction with interests and environmental supports, shape career choices (Lent et al., 1994). EVT emphasizes that achievement-related choices are determined by individuals’ expectations of success and the subjective task value they attribute to an option (utility, importance, interest, and cost) (Wigfield and Eccles, 2000). In the Turkish context, rational considerations such as job security and income can also be explained through human capital and rational choice perspectives.

Guided by these theoretical frameworks, this study examines how students’ emphasis on factors such as personal desire, belief in becoming a good physician, high moral satisfaction, employment security, and financial benefits can be theoretically justified.

2 Materials and methods

2.1 Study design

This study was designed as a quantitative, descriptive, cross-sectional study to explore the factors influencing first-year medical students’ decisions to enrol in medical school. The study was conducted at the Faculty of Medicine, Aydın Adnan Menderes University, located in western Türkiye, during the 2022–2023 academic years.

2.2 Participants

The target population included all 310 first-year medical students actively attending classes during the study period. No sampling was performed, as the study aimed to reach the entire cohort. A total of 297 students (95.8%) voluntarily participated in the study by completing the online questionnaire. Prior to participation, all students were verbally informed about the voluntary nature and purpose of the study, and informed consent was obtained electronically. Participants were assured of anonymity and confidentiality of their responses.

2.3 Data collection tools

Data were collected using a structured questionnaire developed by the researchers based on the conceptual frameworks of the SCCT and EVT. The questionnaire was first evaluated by four expert medical educators and pilot-tested among 20 s-year medical students to ensure clarity and relevance. After revisions, the internal consistency reliability was confirmed with a Cronbach’s α of 0.864, indicating good reliability.

The questionnaire consisted of two main parts: Socio-demographic variables (13 items); including sex, age, type of high school, parental education, and place of residence. In Türkiye, Science High Schools and Anatolian High Schools are both selective secondary institutions; the former emphasizes intensive STEM education, while the latter offers a balanced curriculum combining sciences and humanities to prepare students for higher education (Supplementary material 1).

Motivational and contextual factors (33 items); including 22 items assessing positive motivations (“factors influencing enrolment”) and 11 items addressing hesitation or deterrent factors (hesitation/deterrent items were completed only by students who reported experiencing any hesitation when choosing medicine). All items were rated on a 5-point Likert scale (1 = least important/did not influence at all, 5 = most important/strongly influenced) (Supplementary material 1).

2.4 Data analysis

Statistical analyses were performed using IBM SPSS Statistics 25.0 software package. Descriptive statistics [frequency, percentage, mean, and standard deviation (SD)] were calculated. Percentages were based on the total sample (N = 297). All questionnaire items were rated on a 5-point Likert scale (0 = not influential, 5 = very influential), and mean scores were calculated based on this response range. Group comparisons were conducted using the Chi-square test, independent samples t-test, and one-way ANOVA. The significance level was set at p < 0.05.

2.5 Construct validity (exploratory factor analysis–methods)

Exploratory factor analysis (EFA) was conducted using Principal Component Analysis with Varimax rotation to assess construct validity. Only the 22 items completed by all participants (N = 297) were included in the analysis, whereas the 11 hesitation-specific items were completed only by a subgroup of students (n = 90) and were therefore not included in the factor analysis because they were not administered to the full sample. Sampling adequacy was assessed using the Kaiser–Meyer–Olkin (KMO) statistic, and factorability was examined via Bartlett’s test of Sphericity.

3 Results

3.1 Participant characteristics

A total of 297 first-year medical students participated in the study, of whom 50.2% (n = 149) were female and 49.8% (n = 148) were male. The mean age was 19.12 ± 1.33 years (range: 18–27). Additional socio-demographic characteristics of the participants are presented in Table 1.

3.2 Motivational and contextual factors

Table 2 presents the mean scores of items assessing motivational factors in relation to SCCT and EVT dimensions. Within the SCCT perspective, items related to self-efficacy (e.g., personal desire, belief in being a good physician) and outcome expectations (e.g., moral satisfaction, job security and professional prestige) received the highest mean scores. In contrast, items reflecting environmental influences and cost-related barriers (e.g., family health problems, peer or media effects) had the lowest mean ratings (Table 2).

Within the EVT perspective, intrinsic value components such as altruism and moral satisfaction were the most influential, followed by utility and extrinsic values related to job stability and income. These findings indicate that students’ career motivations are primarily driven by intrinsic motivation, self-efficacy beliefs, and positive outcome expectations, rather than by external pressures or contextual determinants (Table 2).

Several barriers were also identified, the most prominent were inadequate income, challenging working conditions, and decreased societal respect for the profession. These findings reflect perceptions reported only by the subgroup of students who experienced hesitation when choosing medicine (n = 90). These factors correspond to the environmental barrier and cost constructs described in the SCCT and EVT frameworks (Table 3).

3.3 Construct validity results

Exploratory factor analysis demonstrated strong sampling adequacy (KMO = 0.852) and a significant Bartlett’s test of Sphericity, χ² (231) = 2830.14, p < 0.001. Five components with eigenvalues greater than 1 were extracted, explaining 61.6% of the total variance. The rotated factor loadings, presented in Supplementary material 2, showed a clear and interpretable structure. The five components corresponded conceptually to intrinsic–academic motivation, contextual–social influences, deterrent perceptions, workload and practice-related concerns, and prestige–financial expectations (Supplementary material 2).

Overall, the factor solution demonstrated strong construct validity and coherent alignment with SCCT and EVT.

3.4 Comparison of SCCT and EVT dimensions by demographic variables

When SCCT and EVT dimension scores were compared according to demographic variables, several significant differences emerged. Mother’s education: Students, whose mothers had higher education levels scored significantly higher in self-efficacy (p = 0.042) and expectancy (p = 0.038) than those whose mothers had lower education levels. Father’s education: Higher paternal education was associated with significantly higher Value scores (p = 0.029). Age group: students aged 20 years and above reported significantly higher Outcome expectations (p = 0.016) compared to those aged 19 years or younger.

These demographic effects align with SCCT assumptions that environmental and familial support systems reinforce self-efficacy and expectancy beliefs, while maturity and age-related experience enhance outcome expectations in career decision-making.

3.5 Gender differences

Statistically significant gender differences were observed in two motivational domains. Female students reported higher scores for personal factors such as desire to study medicine and moral satisfaction (4.70 ± 0.55 vs. 4.50 ± 0.65, p = 0.02), reflecting stronger self-efficacy and intrinsic value dimensions within the SCCT and EVT frameworks. In contrast, male students assigned greater importance to expectation of favourable income (4.60 ± 0.65 vs. 4.30 ± 0.70, p = 0.03), consistent with higher extrinsic task value and outcome expectations in EVT.

These findings suggest that female students are more driven by internal satisfaction and confidence in their abilities, whereas male students are more motivated by financial and instrumental rewards. Such gendered motivational orientations align with previous evidence that cultural and socioeconomic contexts shape the relative centrality of altruistic versus pragmatic motives in medical career choice.

3.6 Integration of findings with theoretical frameworks

Table 4 presents the alignment between the study findings and the components of the SCCT, which was used as a guiding framework. Self-efficacy-related items included students’ belief in becoming good physicians, their own desire, and perceived personal suitability for the profession. Outcome expectations, both positive and negative, encompassed job security, societal respect, income expectations, as well as concerns about low remuneration, poor working conditions, and workplace violence. Personal goals were reflected in high moral satisfaction, interest in scientific research, and willingness to help people. Environmental/contextual factors included gender differences, parental education, and the presence of healthcare workers in the family.

Table 4 illustrates the alignment between the key components of SCCT and the findings from the current study on factors influencing first-year medical students’ choice of medicine as a career.

4 Discussion

This study explored the motivational and contextual factors influencing medical students’ choice of medicine through the SCCT and EVT frameworks. According to SCCT, career interests and decisions are shaped by self-efficacy and outcome expectations within supportive or constraining environments (Lent et al., 1994). Similarly, EVT proposes that the subjective value attached to a career option and the expectation of success determine choice behavior (Eccles and Wigfield, 2002). These results align with prior international literature emphasizing the predictive power of intrinsic motivation and perceived competence in medical career choice (Wang et al., 2022; Chiu et al., 2023; Sobral, 2004).

4.1 Personal and intrinsic motivations

The most core motivational themes—personal desire to study medicine, belief in being a good physician, and moral satisfaction—reflect the intersection of self-efficacy (SCCT) and intrinsic value (EVT). Similar to Bansal and Pagidas (2025), who reported that intrinsic motivation and perceived competence predict sustained engagement and academic performance, this theoretical perspective suggests that intrinsic goals tend to play a more influential role than external rewards or constraints in shaping early medical career interests. In Türkiye, where admission to medical faculties is highly competitive, students’ strong entrance-exam performance may reinforce their sense of competence and autonomy, further strengthening self-efficacy and professional commitment.

As prior research has shown, SCCT provides a robust framework linking self-efficacy, outcome expectations and contextual supports to career choices (Lent et al., 1994; Chiu et al., 2023; Sheu et al., 2010). Consistent with this framework, the pattern observed in our study suggests that positive self-beliefs and meaningful task value may buffer the impact of perceived barriers during the early stages of career formation.

Recent studies from Europe similarly highlight the multidimensional nature of medical career motivation. Montenegrin students emphasized intrinsic values and professional ideals as key determinants of choosing medicine (Zvrko et al., 2024), while Portuguese findings showed that intrinsic motivation strengthens as students advance academically and develop a clearer professional identity (Matos Sousa et al., 2025). German and Polish studies further illustrated how contextual factors—such as working conditions, lifestyle expectations, and prestige—interact with stable intrinsic motivations in shaping career intentions (Leutritz et al., 2024; Sarnowska et al., 2025). Overall, these findings indicate that the motivational patterns observed in our study are consistent with emerging trends across European settings, where intrinsic aspirations and contextual influences jointly guide early medical career decisions.

4.2 Sociocultural and demographic determinants

Sociocultural background and family education are well-recognized contextual determinants within SCCT, as parental education, social capital and academic support shape students’ self-efficacy and career expectations. In many settings, students from academically advantaged families benefit from clearer guidance and stronger confidence in their abilities, whereas those from less educated backgrounds tend to rely more on external supports such as teachers, peers, or institutional mentoring systems (Odusanya et al., 2000). These dynamics highlight the importance of considering both familial and environmental resources when interpreting early career motivation in medical students. Developmental factors may also play a role, as maturing students often demonstrate more crystallized expectations and clearer career reasoning, consistent with broader developmental and motivational research.

Gender-related motivational tendencies reported in prior research suggest that broader social role expectations and value orientations may shape how male and female students engage with the medical profession (Heiligers, 2012; Vaglum and Ekeberg, 1999). Studies, including the recent work by Saxena et al. (2024), indicate that gendered patterns in learning strategies, altruistic values, and career priorities continue to influence professional identity development in medical education. These longstanding cross-cultural trends highlight the importance of considering gender as a sociocultural factor that interacts with intrinsic motivation, perceived rewards, and contextual expectations when interpreting early career intentions (Saxena et al., 2024). These differences may reflect gendered social roles and expectations around care and responsibility, as noted in broader SCCT applications (Wang et al., 2022). From a curriculum-development perspective, recognizing these patterns can help educators design interventions that balance humanistic and pragmatic motives and promote equitable participation.

4.3 Perceived barriers and emerging challenges

Research on early career choice frequently notes that pragmatic concerns; such as income, workload or societal recognition, tend to have limited centrality during the initial stages of medical identity formation. The relatively limited centrality of these barriers at entry may indicate that strong vocational ideals overshadow pragmatic concerns, a phenomenon described in literature on early medical identity formation. This finding suggests that while students recognize barriers, they are not significantly deterred by them at the entry stage. Comparable results have been reported in studies where early-stage medical students idealized the profession before encountering systemic pressures (Tiwari et al., 2016; Girasek et al., 2011). The minimal reported influence of the COVID-19 pandemic in our cohort aligns with recent evidence that the symbolic and moral value of medicine continues to outweigh pragmatic concerns. While some studies conducted during and after the pandemic documented increased hesitation among medical and premedical students due to perceived occupational risks, disrupted training, and emotional fatigue (Nishimura et al., 2024; Doan et al., 2023), others have emphasized that the pandemic also strengthened students’ moral identification with the profession (Joseph et al., 2024).

4.4 Implications for medical education

Understanding motivational and contextual dynamics through SCCT and EVT provides actionable insights for curriculum development. Educational interventions that enhance self-efficacy, foster reflective and moral growth, and strengthen professional identity can help sustain intrinsic motivation throughout medical training. Structured mentorship, early clinical exposure, and positive role modeling may serve as protective factors against the motivational decline often observed in later academic years (Bansal and Pagidas, 2025). At the institutional level, addressing workload, safety and compensation-related concerns remains essential to align students’ idealistic aspirations with realistic career expectations and ensure long-term professional fulfillment.

4.5 Limitations and future directions

This single-centre, cross-sectional study limits generalizability, and the reliance on self-reported data may reflect perceptions rather than actual behaviors. Additionally, responses may have been influenced by social desirability bias, as students might have tended to report motivations that appear professionally or socially acceptable. Future multi-institutional and longitudinal studies should explore how motivational factors evolve throughout medical training. Complementary qualitative approaches could also provide deeper insight into how individual, familial, and societal influences interact within SCCT and EVT frameworks to shape sustained professional identity and career satisfaction.

4.6 Implications for practice

The findings highlight the need for structured early clinical exposure and meaningful contact with role models to strengthen students’ self-efficacy and clarify their expectations regarding the medical profession. Integrating professional identity formation activities—such as reflective writing, narrative medicine, and medical humanities sessions—into the early curriculum may further support students’ intrinsic motivation and sense of belonging. Additionally, programs that introduce the diverse career pathways within medicine, combined with structured career guidance, can help students develop more realistic and sustainable motivational profiles. Collectively, these educational strategies align with SCCT and EVT frameworks by enhancing students’ perceived competence, clarifying outcome expectations, and reinforcing the personal and professional values that shape long-term career satisfaction.

5 Conclusion

In conclusion, this theory-informed study contributes to a deeper understanding of how motivational and contextual determinants shape medical students’ career choices. Integrating Social Cognitive Career Theory and Expectancy–Value Theory provides a coherent conceptual framework for interpreting medical career motivation and for guiding educational strategies that foster sustained engagement and long-term professional commitment.

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