{"paper_id":"b1747def-13e6-4c4b-ac7b-bc29d1098155","body_text":"The relationship between the sources of confidence in overcoming major public health events and the improvement of medical students' professional identity: mediation by medical students' attention to major public health events. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The relationship between the sources of confidence in overcoming major public health events and the improvement of medical students' professional identity: mediation by medical students' attention to major public health events. Na Zhu, Zhiyuan Zhang, Jun Xie, Yangli Ou, Jia Tan, Hong Gao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2136973/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Jan, 2023 Read the published version in BMC Medical Education → Version 1 posted 8 You are reading this latest preprint version Abstract Background The prevalence of COVID-19 highlights the shortage of medical human resources, and improving medical students' professional identity is a key condition to improve this situation. The sources of confidence in overcoming major public health events and medical students' attention to major public health events were key factors affecting their professional identity, but no study has yet investigated the mediating role of medical students' attention to major public health events in the relationship between them. This study aims to investigate the relationship among these three in medical university students in Hunan Province. Methods This was a cross-sectional survey of 2,960 medical students’ questionnaires collected from three universities in Hunan Province. An intermediary model was established to evaluate the role of medical students' attention to major public health events in the sources of confidence in overcoming major public health events and the improvement of medical students' professional identity. Results The sources of confidence in overcoming major public health events, medical students' attention to national crisis events, the improvement of medical students' professional identity were positively associated with each other ( β = 0.328 ~ 0.464, P < 0.001). The mediating effect accounted for 23.3% of the total effect and 30.4% of the direct effect. Medical students' attention to major public health events plays a partial mediating role in the relationship between the sources of confidence to overcome major public health events and the improvement of medical students' professional identity. Conclusions This study found that the sources of confidence in overcoming major public health events, medical students' attention to national crisis events have a signifcant predictive effect on the improvement of medical students' professional identity. Medical students' attention to major public health events mediated the relationship between the sources of confidence to overcome major public health events and the improvement of medical students' professional identity. The findings have emphasize the theoretical and practical significance of professional identity education for medical students. COVID—19 medical education social media confidence in overcoming crisis events professional identity Figures Figure 1 Figure 2 Introduction The high morbidity and mortality rates of COVID-19 have led to an acute shortage of medical human resources worldwide, which has placed a burden on healthcare systems [1–2]. Medical students are the reserve army of medical human resources. Improvement of their professional attitudes are a key factor maintaining the stability of medical personnel teams. Medical students are the active group of network media because of their high frequency of using internet media, they focus on the relevant reports of the state, government, society and the medical treatment in major crisis events, which are greatly affected their professional identity, and further changed their attitudes toward medicine [3]. In response to major public health events, the state and the people have demonstrated their respective institutional advantages and civilized awareness, which are the pivotal sources of confidence in the national fight against the epidemic and plays an important role in the cultivation of medical students' professional awareness and spirit. However, the possible influence of these mechanisms on the improvement of medical students' professional attitude is not clear among medical students. From this perspective, the present study focused on the the mediation effect of medical students' attention to major public health events between the sources of confidence in overcoming major public health events and the improvement of medical students' professional attitudes. In the mediation model, we hypothesize that the sources of confidence in overcoming major public health events positively affect the improvement of medical students' professional attitude through their attention to major public health events. We test the mediation hypothesis in a sample of medical students from three regions of Hunan Province. Model and hypothesis development We schematically highlight the overall mediation model for the study in Fig. 1 . We posit that the sources of confidence in overcoming major public health events positively influence the improvement of medical students' professional identity, (e.g., identity and employment intention in the medical profession, sense of trust in medical staff, recognition of medical knowledge, respect for the medical profession, health and awareness). Furthermore, we assume that this positive effect is mediated by medical students' attention to major public health events(e.g., concern about the progress of COVID-19, the front-line support of medical staff, prevention and control measures, epidemic prevention knowledge, donation activities in epidemic areas). During the prevention and control of COVID-19, government departments' attention to fighting the epidemic and the public’s cooperation in prevention and control work have brought medical students confidence in overcoming major public health events, promoting their constant attention to the progress of COVID-19, and subtly had a positive impact on their future professional identity. In the theory of emotion and adaptation, emotions arise from an individual’s appraisal of the situation. In the prevention and control of COVID-19, national leaders attached great importance to the epidemic, issued a series of policies, dispatched many medical teams to support the epidemic areas, and disseminated propaganda and education on epidemic prevention and control measures to gradually bring the epidemic under control. The effective measures taken by the government and society in the prevention and control of the epidemic are the sources of confidence for medical students that the whole country can overcome the epidemic. Attitudes are the evaluative judgments that integrate and summarize these cognitive affective reactions [4]. These evaluative abstractions vary in strength, which in turn has implications for persistence, resistance, and attitude-behavior consistency. During the epidemic, medical students' confidence in the fight against the epidemic potentially affects the stability of their professional conception. As the main force in the fight against the epidemic, medical staff have made great efforts and contributions [5], and won high trust and praise from the international and society, which greatly improved the medical students' professional identity. Studies have shown that the more government and society support medical personnel and their work, the stronger the medical students’ professional identity and employment intention [6]. Based on the above, we propose: Hypothesis 1 (H1): The sources of confidence in overcoming major public health events are positively associated with the improvement of medical students' professional identity. Medical students' attention to major public health events as a mediator First, we expect that the sources of confidence in overcoming major public health events would be positively associated with medical students' attention to major public health events. “Theory of Mind” (ToM) is the ability to represent and attribute mental states such as knowledge, beliefs, expectations, intentions, and emotions to oneself and others, and can be used to understand and predict one’s own and other’s behavior [7]. In the face of the sudden occurrence of major public health incidents, the state has taken resolute measures and carried out strict prevention and control actions throughout the country, to ensure the safety and health of the people. Medical workers and people from all walks have offered support and cooperation to the epidemic areas, and pushed for an orderly epidemic prevention and control work. In this environment, medical students recognized the consistency and efficiency of the state and various social groups in fighting against the epidemic, which is an important source of confidence to believed that the country and people will overcome the epidemic. Visual attention is guided not only by the physical salience of one's environment but also by the mental representation of its social relevance [8]. Major COVID-19-related public health events have attracted attention from all walks of life. Compared with other students, medical students have higher medical knowledge levels and pay more attention to information related to epidemic situations, such as future development of disease, treatment methods, prognosis, protective measures, and vaccine development progress. The achievements of the state, government and society in fighting against the epidemic have strengthened the confidence of medical students that the country and its people will eventually overcome the virus, and further encouraged them to continue to pay attention to the development of national major public health events. Therefore, the sources of confidence in overcoming major public health events can enhance medical students' attention to major public health events. They interact with each other. Second, we expect that medical students' attention to major public health events will be positively associated with the improvement of medical students' professional identity. Shared attention involves a person perceiving the world from the perspective of the collective, and hence constitutes an inherently cognitive state [9–10]. Perceptions of shared attention may play an important role in the emergence of shared attitudes and beliefs, or instances of shared reality [11–12]. The COVID-19 outbreak has spread rapidly across the country and attracted extensive attention from society. The network media concentrated on reporting the effectiveness of joint prevention and control measures of various regions and departments, highlighted the important role of medical workers in fighting the epidemic, created a good public opinion atmosphere for epidemic prevention and control, and guided the public to form a common attitude and belief. In the process of paying attention to epidemic news, medical students felt the urgent situation of the shortage of medical staff in the country, understood the professional spirits of medical staff, and fully realized the values of health technical personnel, which was conducive to enhancing their faith and identity in the medical profession. When medical students are aware of their great sense of responsibility in health care, they will pay attention to the prevention and control measures in major health events and strengthen the study of public health knowledge to enhance their clinical practice and social service ability. At the same time, this further urge them to strengthen the study of public health knowledge to improve their clinical practice and social service capabilities. Based on the above, we propose: Hypothesis (H2): The sources of confidence in overcoming major public health events is positively associated with medical students' attention to major public health events. Hypothesis (H3): Medical students' attention to major public health events are positively associated the improvement of medical students' professional identity. Materials And Methods Participants The participants in this study were medical students from three universities in Hunan Province, including freshmen, sophomores, juniors and seniors. From March 15 to April 19, 2020, we conducted a survey on medical students who provided informed consent through the “wenjuanxing” platform. The questionnaire include demographic information such as age, gender, nationality, university, residences, grade level, and majors. A total of 2,960 college students from several colleges participated voluntarily in the survey, and all of them provided informed consent before completing the questionnaire. According to the preliminary analysis, 2775 valid questionnaires were collected, and the effective rate was 93.8%. Each participant was paid a total of 7 yuan ( $ 1). Measurements Medical students' attention to major public health events Medical students' attention to national crises was evaluated using seven items: Item 1: “ I am concerned about the progress of COVID-19, such as the trends change of confirmed, suspected, dead and cured number cases”; Item 2: “I am concerned about the measures taken by the national government to prevent and control the spread of COVID-19”; Item 3: “I am concerned about the measures taken by my local government to prevent and control the spread of COVID-19 ”; Item 4:“I am concerned about the protection knowledge of COVID-19”; Item 5: “I shared the knowledge of COVID-19 with my friends and relatives during the epidemic period”; Item 6: “I am concerned about people's donation activities to the epidemic areas”; Item 7: “I am concerned about any news or information about the epidemic from the medical staff.” Every item was calculated using a 4-point scale. All subjects could choose the most appropriate item according to their own actual situation. The highest score of 4 was “I am concerned about it every day”, and the lowest score of 1 was “I did not pay attention to the news”. The total score of the questionnaire was calculated from the sum of all items. Higher scores indicate that students paid close attention to major public health events. The questionnaire was created by the research team according to their professional knowledge, combined with a literature review, expert consultation and existing research instruments [13–17]. It had higher reliability and validity among medical students. The improvement of medical students' professional identity The improvement of medical students' professional identity were assessed by five items. Item 1: “The understanding of global epidemic prevention and control through internet media has improved my awareness of health”; Item 2: “The understanding of global epidemic prevention and control through internet media has improved my cognition of scientific and academic rigour of medical knowledge”; Item 3: “The understanding of medical staffs epidemic prevention and control actions through internet media has increased my sense of trust in medical staff”; Item 4: “The understanding of medical staffs epidemic prevention and control actions through internet media has strengthened my respect for the medical profession”; Item 5: “ This public health event has enhanced my sense of identity and employment intention in the medical profession”. Every item was calculated using a 5-point scale ranging from 1 to 5. All subjects could choose the most appropriate item according to their own actual situation. The highest score of 5 was “full improvement” and the lowest score of 1 was “declined a lot.” The total score of the questionnaire was calculated from the sum of all items, and higher scores reflected that medical students’ professional attitudes promoted better. The questionnaire was created by the research team according to their professional knowledge, combined with a literature review, expert consultation and existing research instruments [18–23]. The results showed satisfactory reliability and validity of the instrument. The sources of confidence in overcoming major public health events The sources of confidence in overcoming major public health events were assessed by six items. Item 1: “Our country has taken resolute measures to prevent and control the epidemic, which makes me believe that major public health events can be overcome”; Item 2: “National leaders attach great importance to epidemic prevention and control, which makes me believe that major public health events can be overcome”; Item 3: “The medical staff has provided strong assistance to the epidemic area, which makes me believe that major public health events can be overcome”; Item 4: “All over the country, groups have carried out charity donation activities to the epidemic areas, which makes me believe that major public health events can be overcome”; Item 5: “The prevention and control measures taken by the local government have gradually brought the epidemic under control, which makes me believe that major public health events can be overcome”; Item 6: “The public has gradually understood the knowledge of epidemic prevention and control, which makes me believe that major public health events can be overcome”. Students responded “yes” (score 1 point) or “no” (score 0). The total score of the questionnaire was calculated from the sum of all items. All subjects could choose the most appropriate item according to their own actual situation. The questionnaire was completed by the research team according to their professional knowledge, combined with a literature review, expert consultation and existing research instruments [24–26]. The reliability and validity of the scale were fair ideal. Statistical Analysis Statistical Package for the Social Sciences software (SPSS, version 26.0) and Excel (Microsoft Corp, Redmond, WA, United States) were used for management and analysis. Descriptive statistics were used to analyze demographic data and all study variables. Spearman correlation analysis was used to analyze the correlation among the study variables. PROCESS Model 4 with 5000 bootstrap samples in SPSS was used to test the mediation model. The bias-corrected bootstrap method was used to estimate the highest statistical efficacy and the most accurate confidence interval [27]. The sources of confidence in overcoming major public health events were used as independent variables, medical students' attention to major public health events were used as a mediating variable, and the changes in medical students' professional attitudes were used as a dependent variable. The total, direct, and indirect effects were considered statistically significant at the 0.05 probability level if the results of the 95% bias-corrected confidence interval (CI) did not include zero [28]. Ethical approval The study was approved by the ethics committees of the University of South China. All participants provided informed consent. Results Characteristics of the study population A total of 2960 medical students were enrolled in the study. After excluding 185 invalid questionnaires, 2,775 valid questionnaires were ultimately acquired, and the questionnaire response rate was 93.8%. The mean age of the students was 20.80±1.25 years. The general demographic data of the subjects are shown in Table 1. Among the surveyed medical students, 52.1% were female, and 74.3% were of Han nationality. Students' residences were located in cities (25.4%), towns (24.9%) and villages (49.7%), respectively. The average levels of the sourcess of confidence in overcoming major public health events score (0-6), the changes in medical students' professional attitudes score (5-25), and medical students' attention to major public health events score (7-28) of respondents were 4.76±1.69, 21.14±4.56, and 21.48±4.21, respectively. Table 1 Demographic characteristics of the study population (N = 2775) Variables n Percentage(%) Gender Women 1445 52.1 Men 1330 47.9 Nationality Han 2063 74.3 Other 712 25.7 Place of residence Cities 772 25.4 Towns 757 24.9 Villages 1512 49.7 Grade Freshman 980 32.3 Sophomore 469 15.4 Junior 564 18.5 Senior 516 17.0 Fifth year 512 16.8 Subject category Liberal arts 673 22.1 Sciences 522 17.2 Engineering 580 19.1 Medicine 1266 41.6 Evaluation of the measurement instruments We evaluated the construct reliability and validity for the measurement instruments (Table 2). According to Hair et al [29], the indicator loadings should reach the standard of 0.70, whereas loadings between 0.40 and 0.70 should be deleted only when their deletion can improve the overall reliability to the minimum threshold value. The results showed that two indicator loadings were lower than 0.70, and the other indicator loadings were higher than 0.70. By deleting and analyzing the indicator loadings less than 0.7, the overall reliability was not improved. Therefore, all indicator loadings were retained for this study. The results reflected that the indicator loadings had good indicator reliability levels. Table 2 Evaluation of measurement instruments Construct Item Loadings Cronbach’s alpha Composite reliability AVE * KMO ** The sources of confidence in overcoming major public health events (SCO) SCO-1 0.706 0.865 0.860 0.508 0.836 SCO-2 0.775 SCO-3 0.770 SCO-4 0.734 SCO-5 0.639 SCO-6 0.639 The improvement of medical students' professional identity (IPI) CPA-1 0.801 0.899 0.932 0.732 0.882 CPA-2 0.844 CPA-3 0.883 CPA-4 0.883 CPA-5 0.865 Medical students' attention to major public health events (APHE) APHE-1 0.822 0.921 0.939 0.687 0.913 APHE-2 0.886 APHE-3 0.892 APHE-4 0.883 APHE-5 0.754 APHE-6 0.727 APHE-7 0.823 Note. * Average Variance Extracted; ** Kaiser-Meyer-Olkin Spearman Correlation Analysis Results A nonparametric statistical method was used for bivariate correlation. Table 3 shows the overall Spearman correlation results. There were significant correlations between all variables. The improvement of medical students' professional identity was positively correlated with the sources of confidence in overcoming major public health events (r=0.629, P <0.001) and medical students' attention to national crisis events (r=0.791, P <0.001). Table 3 Spearman correlations among study variables Variables 1 2 3 1. The sources of confidence in overcoming major public health events 1 The improvement of medical students' professional identity 0.629 ** 1 Medical students' attention to major public health events 0.617 ** 0.791 ** 1 Mean 4.76 21.14 21.48 SD 1.69 4.56 4.21 Note. N =2775 **All correlations were significant at P <0 .001 (two tailed). Mediation effect model Medical students' attention to major public health events was identified as a mediator between the sources of confidence in overcoming major public health events and the improvement of medical students' professional identity. In the SPSS PROCESS analysis, model 4 was used to evaluate the mediating effects of the study variables. The total, direct and indirect effect results are summarized in Table 5. Figure 2 shows the structural model of the mediating effect. The structural model was statistically significant ( F= 223.495, P <0.001), and the R and R 2 values were 0.373 and 0.139, respectively (Table 4). The total effect of the mediation model was significant. The direct effect of the sources of confidence in overcoming major public health events on the improvement of medical students' professional identity was significant. The indirect effect of the sources of confidence in overcoming major public health events (X) on the improvement of medical students' professional identity (Y) through medical students' attention to major public health events (M) was significant. The mediation effect accounted for 23.3% of the total effect. The mediation effect accounted for 30.4% of the direct effect. Therefore, these research results indicate that a partial mediating effect exists. Table 4 Regression model with the improvement of medical students' professional identity as outcome variable Variables coeff se t value P value LLCI ULCI constant 11.892 0.447 26.591 <0.001 11.015 12.769 Medical students' attention to major public health events 0.328 0.019 16.898 <0.001 0.290 0.366 The sources of confidence in overcoming major public health events 0.464 0.048 9.597 <0.001 0.369 0.559 Table 5 Total, direct and indirect effects of mediation analysis Effect Estimate t/Z value P value 95% LCL 95% UCL Total effect 0.605 12.101 <0.001 0.507 0.703 Direct effect 0.464 9.597 <0.001 0.369 0.559 Indirect effect 0.141 8.092* <0.001 0.106 0.182 Note . * Z value. Discussion In this study, we first evaluated the role of medical students' attention to major public health events on the sources of confidence in overcoming major public health events and the improvement of medical students' professional identity. The results showed that the total effect value, direct effect value and indirect effect value were 0.605, 0.464 and 0.141, respectively. The mediation effect accounted for 23.3% of the total effect, and the mediation effect accounted for 30.4% of the direct effect. Medical students' attention to major public health events is a mediation path that links the sources of confidence in overcoming major public health events and the improvement of medical students' professional identity. The mediation perspective suggests that the sources of confidence in overcoming major public health events are positively associated with the improvement of medical students' professional identity. In the mediating model, a partial intermediary effect existed. These findings have important implications for strengthening medical students’s education management theory and practice in context of existing research, which we elaborate next. Implications for theory Our key contribution to the professional education of medical students is the introduction of a pathway. There are few studies on the sources of confidence in overcoming major public health events affecting the improvement of medical students' professional identity, which did not include the mediating variable of medical students' attention to major public health events and hence provided relatively little in the way of theoretical development. We developed a conceptual impact path model of the improvement of medical students' professional identity. Medical students' attention to major public health events plays a partial medium role in the sources of confidence in overcoming major public health events and the improvement of medical students' professional identity. Theoretically, we make three specific contributions to the professional identity education of medical students. First, the sources of confidence in overcoming major public health events play an important role in improving the professional identity of medical students. According to the theory of emotional cognition, emotion is influenced by environmental events, physiological conditions and cognitive processes [30]. Compared with the outbreak of SARS or other epidemics, COVID-19 has more far-reaching influence. Compared with SARS, the emergency management system of COVID-19 has been improved, for example, the state promulgated a transparent policy, the government improved the medical security system, the local organization of temperature and nucleic acid testing activities was improved, the timely dissemination of epidemic information by the media, and the patients received fair and timely rescue, among other implementations. As a whole, the emergency management of major public health events requires full participation, mobilizing the forces of individuals, families, communities, social organizations and other aspects, forming an environmental atmosphere for the public to fight against the epidemic. The common positive emotional experience and social mutual trust make the public firmly believe that the risk of public health events will be overcome [22]. Emotion is central to the decision-making process, both as an input and an output [31]. Many of our choices are guided by the experience of these emotions or the anticipation of the emotions that may be elicited [32]. During the epidemic period, civil servants, police, teachers, security guards, couriers, cleaners and other industries showed a firm anti epidemic spirit. In particular, medical staff members day and night in the medical front, and they have established a lofty sense of professional responsibility and morality for medical students, characterized by practical action and benevolence, which will inspire them to make efforts for the development of national medical and healthcare services and the improvement of human physical and mental health [33]. Healthcare practitioners and technical occupations have a high social status, but they are included among the high-intensity and high-risk professions due to the high risk of medical work, the high occupational pressure and the long working hours [34]. Previous studies have shown that medical students' professional emotions scores are lower than their professional values scores, and some medical students do not feel satisfied with the medical profession [18]. However, the COVID-19 pandemic has significantly improved the professional identity of medical students and deeply reinforced their sense of responsibility and missions, because of the strong support of social groups to medical work, the high frequency and high intensity positive reports of medical personnel by the news media, the ardent expectations of the public regarding COVID-19 prevention and control, and the improvement of national quality. Studies have shown that 59.0% of medical students are willing to participate in front-line epidemic prevention actions, and 87.7% of medical students have experienced a positive impact on their professional identity [34]. Other studies have shown that 42.9% of medical students have not been shaken in their professional beliefs during the COVID-19 epidemic, and 53.6% of medical students have strengthened their beliefs [35]. Therefore, the effective measures taken by the government departments and industries to unite to fight the epidemic have enhanced the confidence in defeating major public health events, which is conducive to enhancing medical students' medical professional identity. Second, our contribution was finding that the sources of confidence in overcoming major public health events among medical students are closely related to their increasing attention to major public health events. Social media plays an important role in spread ing information and guiding the public opinion of major public health events and is the main channel by which people obtain information [36]. According to statistics, WeChat (82.4%) and Twitter (75.8%) were the main channels, followed by television (42.9%), websites (41.1%) and news client (40.8%) [37]. Some surveys have shown that the public focus was different at different stages of the epidemic, and the degree and core of public concern affect public confidence in fighting the epidemic. As follows, in the early days of the outbreak, the public was concerned about the situation of the epidemic, the sources of the virus, epidemic prevention measures, access to face masks, science popularization, and the postponement of university openings, postgraduate reexaminations and college entrance examinations caused by the epidemic [38-39]. The public showed negative emotions, such as worry, panic and anxiety [7]. In the middle of the outbreak, the public paid more attention to epidemic prevention measures and the progress of donation, actively made suggestions to the government, and encouraged social groups to fight the epidemic [39]. In the late stage of the outbreak, the epidemic was essentially controlled, praise became the mainstream, and gratitude gradually increased [39]. Consequently, the public focused on major public health events through social media and kept abreast of the progress of the epidemic in real time. During this special period, the atmosphere of solidarity and confidence created by the public affected everyone. During the spread of COVID-19, the dedication and perseverance of the government, medical staff, scientific research personnel and grassroots were sources of confidence and motivation for all people to unite and fight the epidemic. Studies show that 43.3%, 46.3%, 53.6% and 42.7% of the public have confidence in scientific researchers, medical staff, government and grassroots to overcome major public health events respectively [37]. Medical students pay more attention to information related to epidemic prevention and control due to their professional background and the particularity of their expected career. The COVID-19 has been effectively controlled, prevention and control supplies have been provided, anti-epidemic deeds and personalities have been reported, medical staff have been praised by the society and other related events have made medical students feel full of confidence in coping with the crisis, which have further encouraged medical students to pay close attention to the development of major public health events. Positive attention to major public health events makes medical students deeply aware of the sense of responsibility, justice and faith, which is conducive to avoiding the panic caused by public opinion and stabilizing social order [40]. From this point of view, the sources of confidence in overcoming major public health events are beneficial to promoting medical students' attention to major public health events. Finally, attention to major public health events directly affected the improvement of medical students' professional identity. During the outbreak of COVID-19, the CCTV news audience rating increased to 11.72%, among which 15~24 year-old audience ratings increased by 186% [41]. In the process of paying attention to major public events, medical students have a further understanding of the medical and health system, the distribution of health resources, emergency knowledge and technology, doctor-patient conflicts, and medical violence incidents, which will affect their future career choice and identity. In addition to endogenous and exogenous attention mechanisms, the emotional relevance of a stimulus is an important feature that affects attentional selection and prioritization [42]. Adverse events such as medical disputes and violent medical injuries are more likely to attract public attention and seriously damage the professional identity of medical students. 47 A survey showed that 69.7% of medical students are very concerned about the medical injuries reported by the media, and 37.9% of medical students fully believe in the occurrence of the violent medical injuries reported by the media [43]. Studies have reported that 69.3% of medical students believe that the current situation of doctor-patient relationships will affect their career choice. Even if they choose to continue to work in the medical industry, their professional identity and work enthusiasm are also declining [44]. During the period of COVID-19, the state, the government and society gave medical personnel support and cooperation, and increased public understanding of medical work. The achievement of epidemic control has enhanced the social status and propaganda of medical staff and severely cracked down on violent medical injuries. This greatly increased the medical students' sense of occupation and sense of security, was conducive to improving the professional identity of medical students, and directly influenced the learning enthusiasm and motivation of future career development of medical students [45]. A study found that approximately 83.85% of medical students were moved by the behavior exhibited by front-line medical staff, who devoted much of their time and energy to work [46]. If there is a need in the future, 85.7% of medical students are willing to take the initiative to participate in front-line work [44]. These indicate that medical students' attention to major public health events influences their attitudes and their choice of medical career. It is also suggested that the active promotion of the noble medical ethics by colleges or education and training institutions is an effective way to encourage medical students to affirm their emotions and thoughts regarding the medical profession. Implications for practice The improvement of medical students' professional identity is an important goal of professional identity education and an important task of national development and social stability. First, community practice can provide a theoretical basis for professional identity [47]. During the period of COVID-19, the anti-epidemic activities of medical staff were the most typical, large-scale community practices in the epidemic areas. Colleges should pay attention to the role of community practice courses in shaping professional identity. Community practice is a persistent and sustainable personal social network and an overlapping knowledge base for sharing and development, in which the generation of beliefs, values, history and experience can be concentrated [48]. The professional socialization of interns occurs through their community practice in all kinds of socialized organizations. Medical students could establish their professional image through experiential learning in the Centers for Disease Control and Prevention (CDC), Community Health Centers, clinical hospitals and other organizations [49]. They make full use of the knowledge and skills to conduct basic information surveys and physical examinations, popularize health knowledge, and enhance public awareness of disease prevention for community residents. In the interactive process of social practice, they can think, act and feel like medical staff, and gradually understand the essence of professional identity and the socialization process of identity formation [47]. According to situational learning theory, acquired knowledge is a mixture of explicit and implicit, and most of the knowledge related to identity formation is implicit [50-51]. Some scholars believe that the most powerful factors influencing the formation of professional identity are role models and mentors, as well as experiential learning in clinical and nonclinical situations [32,52]. In the process of community practice, students consciously acquire knowledge through observation, imitation and practice [34,53,54]. Role models and mentors can encourage medical students to constantly reflect and summarize in empirical learning to greatly enhance their learning effect [34]. These measures should enable medical students to avoid overreliance on historical precedent, intuition, or perceived common sense, and really improve their underlying public health service skills. In addition, medical colleges need to set up special practical skills courses on how to deal with the doctor-patient relationship to improve medical students' medical confidence and thus enhance their willingness to practice medicine [55]. Second, using various types of social media can improve all cognitive domains [56]. Medical students pay close attention to the progress of public health events through social media. They discuss issues with peers online, give feedback and show their attitude, and are influenced by each other through the media [57]. Although social media cannot replace face-to-face communication with peers, role models and mentors, it plays an important role in information exchange in medical education, greatly improving the enthusiasm and participation of medical students in professional identity education. Positive reports of major public health events can improve medical students' confidence in overcoming major public health events and their understanding of the medical industry. However, relevant information about the major public health events is often exaggerated in the spread of social media. Even those who are not directly affected will form a certain position or attitude, causing forwarding, commenting and other behaviors, further promoting the spread and diffusion of public opinion information on social media platforms, and leading to the spread of anxiety, panic and other negative emotions, thus shaking confidence in overcoming crisis events [58]. Furthermore, the attention of medical students to media reports reflects the important role of media in the construction of medical students' values and professional sense to a certain extent. In recent years, the negative reports on doctor-patient disputes by the news media have made medical students’ levels of cognition and emotion toward medical work more one-sided, and they are more inclined to recognize medical work according to the traditional concept of \"curing diseases and saving lives\" in society [59]. From this, government departments should first take a clear stand on public opinion during the crisis, reasonably guide public opinion, and positively build public confidence in dealing with major public health events. Then, they need to monitor and analyze the public opinion information of public health emergencies, guide medical students to objectively understand the medical and practice environments and clarify the professional situation of medical staff. The media should report the significance of medical personnel in dealing with major public health events to enhance the personal sense of crisis for medical students and make them more proactive in learning new knowledge to improve themselves, which is conducive to stabilizing the supply of medical and health human resources and improving the quality of medical services. Additionally, the idea of modern medical education is to guide medical students to make full use of network media in a positive way to improve their thinking ability and professional attitude, and to promote the transformation of their self-awareness from university medical students to future health care professionals [60]. Consequently, the correct levels of guidance from the government and the media are necessary factors for medical students to choose their jobs objectively and strengthen their professional beliefs when paying attention to major public health events. Finally, the support of society and family are important conditions for medical students to strengthen their professional consciousness. During the period of COVID-19, the sources of confidence in overcoming major public health events from government and society reflected the strongest social support. Society and family are important factors that affect medical students' professional identity in addition to professional courses and employment guidance and training. When the professional identity of medical staff is low, dismissals can occur, especially for male nurses who are negatively affected by gender stereotypes and heavy workloads [30][61]. Many nurses think that nursing work is not respected by patients, and nurses have a lower social status. It is well known that nursing staff are an indispensable part of medical activities. In particular, the role of male nurses has become increasingly prominent, which should warn national relevant department such as holding regulators, hospitals and nursing educational institutions, to develop professional identity of male nurses, with an emphasis on personalized training and guidance, such as lectures, competitions or salons, to fully realize their social value. Participation in these activities can change their perception of the nursing profession and help maintain the stability of male caregivers [62-63]. In addition, family conflict was negatively correlated with professional identity. Faced with the current heavy academic burden and high social requirements of medical students, families should first create a healthy and relaxed environment. When the country is in the midst of a major public health crisis, families should actively support medical students to take part in primary health care work, and encourage them to promote their professional competence and vocational awareness. Strengths and limitations The study makes an important contribution to the literature by evaluating the associations among the sources of confidence in overcoming major public health events, the improvement of medical students' professional identity and medical students' attention to major public health events through data reported by medical students from three medical universities in Hunan Province. The present study confrms our research hypothesis that medical students' attention to national crisis events moderates the relationship between the sources of confidence in overcoming major public health events and the improvement of medical students' professional identity. Additionally, these findings all enrich the theory of professional identity education related research among medical students. Our study has several limitations. First, our study is a cross-sectional study, which can only account for the associations between these three, and cannot explain causal relationship between them. Second, medical students' professional attitudes are the result of many factors, and we explored only their attention to major public health events as an intermediary factor. Conclusions In conclusion, this study confirms the importance of the association among the sources of confidence in overcoming major public health events, the improvement of medical students' professional identity, and medical students' attention to major public health events. The sources of confidence in overcoming major public health events, medical students' attention to national crisis events have a significant predictive effect on the improvement of medical students' professional identity. Medical students' attention to major public health events mediated the relationship between the sources of confidence to overcome major public health events and the improvement of medical students' professional identity. These findings suggest that enhancing the confidence in overcoming major public health events and medical students' attention to major public health events can meaningfully improve medical students' professional identity. Our findings will serve as a springboard for future research on how to improve medical students' professional identity. Declarations Ethics approval and consent to participate This study was performed in accordance to the Declaration of Helsinki and received Nanyang Technological University’s Institutional Review Board approval (IRB 2019－09-024). All participants provided full informed consent to participate in this study. Consent for publication Not Applicable. Availability of data and materials The datasets analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This work was supported by the Teaching Reform Research Project of Universities in Hunan Province [HNJG-2022-0745]. Author contributions All authors contributed to the study conception and design. G.H. conceived and developed the idea for the project. G.H., Z.N., Z.Z.Y., O.L.Y., X.J. and T.J. investigated participants and identified themes. G.H. analyzed data. G.H. and Z.N. drafted the early versions of the manuscript. G.H. made subsequent critical revisions for important intellectual content. Z.N., X.J. and T.J. developed the idea for the project and identified themes. G.H. reviewed the early versions of the manuscript and made substantial contributions to the content and direction of the manuscript. 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Cite Share Download PDF Status: Published Journal Publication published 14 Jan, 2023 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Major revision 28 Nov, 2022 Reviews received at journal 18 Nov, 2022 Reviewers agreed at journal 04 Nov, 2022 Reviewers invited by journal 04 Nov, 2022 Editor assigned by journal 04 Nov, 2022 Editor invited by journal 12 Oct, 2022 Submission checks completed at journal 12 Oct, 2022 First submitted to journal 05 Oct, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-2136973\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":143739525,\"identity\":\"16124335-1dbb-49cb-b49c-0c33498b8d5c\",\"order_by\":0,\"name\":\"Na Zhu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"School of Nursing,University of South 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events.\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eThe high morbidity and mortality rates of COVID-19 have led to an acute shortage of medical human resources worldwide, which has placed a burden on healthcare systems [1\\u0026ndash;2]. Medical students are the reserve army of medical human resources. Improvement of their professional attitudes are a key factor maintaining the stability of medical personnel teams. Medical students are the active group of network media because of their high frequency of using internet media, they focus on the relevant reports of the state, government, society and the medical treatment in major crisis events, which are greatly affected their professional identity, and further changed their attitudes toward medicine [3]. In response to major public health events, the state and the people have demonstrated their respective institutional advantages and civilized awareness, which are the pivotal sources of confidence in the national fight against the epidemic and plays an important role in the cultivation of medical students\\u0026apos; professional awareness and spirit. However, the possible influence of these mechanisms on the improvement of medical students\\u0026apos; professional attitude is not clear among medical students. From this perspective, the present study focused on the the mediation effect of medical students\\u0026apos; attention to major public health events between the sources of confidence in overcoming major public health events and the improvement of medical students\\u0026apos; professional attitudes. In the mediation model, we hypothesize that the sources of confidence in overcoming major public health events positively affect the improvement of medical students\\u0026apos; professional attitude through their attention to major public health events. We test the mediation hypothesis in a sample of medical students from three regions of Hunan Province.\\u003c/p\\u003e\\n\\u003cdiv class=\\\"Section2\\\" id=\\\"Sec2\\\"\\u003e\\n \\u003ch2\\u003eModel and hypothesis development\\u003c/h2\\u003e\\n \\u003cp\\u003eWe schematically highlight the overall mediation model for the study in Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. We posit that the sources of confidence in overcoming major public health events positively influence the improvement of medical students\\u0026apos; professional identity, (e.g., identity and employment intention in the medical profession, sense of trust in medical staff, recognition of medical knowledge, respect for the medical profession, health and awareness). Furthermore, we assume that this positive effect is mediated by medical students\\u0026apos; attention to major public health events(e.g., concern about the progress of COVID-19, the front-line support of medical staff, prevention and control measures, epidemic prevention knowledge, donation activities in epidemic areas). During the prevention and control of COVID-19, government departments\\u0026apos; attention to fighting the epidemic and the public\\u0026rsquo;s cooperation in prevention and control work have brought medical students confidence in overcoming major public health events, promoting their constant attention to the progress of COVID-19, and subtly had a positive impact on their future professional identity.\\u003c/p\\u003e\\n \\u003cp\\u003eIn the theory of emotion and adaptation, emotions arise from an individual\\u0026rsquo;s appraisal of the situation. In the prevention and control of COVID-19, national leaders attached great importance to the epidemic, issued a series of policies, dispatched many medical teams to support the epidemic areas, and disseminated propaganda and education on epidemic prevention and control measures to gradually bring the epidemic under control. The effective measures taken by the government and society in the prevention and control of the epidemic are the sources of confidence for medical students that the whole country can overcome the epidemic. Attitudes are the evaluative judgments that integrate and summarize these cognitive affective reactions [4]. These evaluative abstractions vary in strength, which in turn has implications for persistence, resistance, and attitude-behavior consistency.\\u003c/p\\u003e\\n \\u003cp\\u003eDuring the epidemic, medical students\\u0026apos; confidence in the fight against the epidemic potentially affects the stability of their professional conception. As the main force in the fight against the epidemic, medical staff have made great efforts and contributions [5], and won high trust and praise from the international and society, which greatly improved the medical students\\u0026apos; professional identity. Studies have shown that the more government and society support medical personnel and their work, the stronger the medical students\\u0026rsquo; professional identity and employment intention [6].\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003eBased on the above, we propose:\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHypothesis 1\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e(H1): The sources of confidence in overcoming major public health events are positively associated with the improvement of medical students\\u0026apos; professional identity.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv class=\\\"Section2\\\" id=\\\"Sec3\\\"\\u003e\\n \\u003ch2\\u003eMedical students\\u0026apos; attention to major public health events as a mediator\\u003c/h2\\u003e\\n \\u003cp\\u003eFirst, we expect that the sources of confidence in overcoming major public health events would be positively associated with medical students\\u0026apos; attention to major public health events. \\u0026ldquo;Theory of Mind\\u0026rdquo; (ToM) is the ability to represent and attribute mental states such as knowledge, beliefs, expectations, intentions, and emotions to oneself and others, and can be used to understand and predict one\\u0026rsquo;s own and other\\u0026rsquo;s behavior [7]. In the face of the sudden occurrence of major public health incidents, the state has taken resolute measures and carried out strict prevention and control actions throughout the country, to ensure the safety and health of the people. Medical workers and people from all walks have offered support and cooperation to the epidemic areas, and pushed for an orderly epidemic prevention and control work. In this environment, medical students recognized the consistency and efficiency of the state and various social groups in fighting against the epidemic, which is an important source of confidence to believed that the country and people will overcome the epidemic. Visual attention is guided not only by the physical salience of one\\u0026apos;s environment but also by the mental representation of its social relevance [8]. Major COVID-19-related public health events have attracted attention from all walks of life. Compared with other students, medical students have higher medical knowledge levels and pay more attention to information related to epidemic situations, such as future development of disease, treatment methods, prognosis, protective measures, and vaccine development progress. The achievements of the state, government and society in fighting against the epidemic have strengthened the confidence of medical students that the country and its people will eventually overcome the virus, and further encouraged them to continue to pay attention to the development of national major public health events. Therefore, the sources of confidence in overcoming major public health events can enhance medical students\\u0026apos; attention to major public health events. They interact with each other.\\u003c/p\\u003e\\n \\u003cp\\u003eSecond, we expect that medical students\\u0026apos; attention to major public health events will be positively associated with the improvement of medical students\\u0026apos; professional identity. Shared attention involves a person perceiving the world from the perspective of the collective, and hence constitutes an inherently cognitive state [9\\u0026ndash;10]. Perceptions of shared attention may play an important role in the emergence of shared attitudes and beliefs, or instances of shared reality [11\\u0026ndash;12]. The COVID-19 outbreak has spread rapidly across the country and attracted extensive attention from society. The network media concentrated on reporting the effectiveness of joint prevention and control measures of various regions and departments, highlighted the important role of medical workers in fighting the epidemic, created a good public opinion atmosphere for epidemic prevention and control, and guided the public to form a common attitude and belief. In the process of paying attention to epidemic news, medical students felt the urgent situation of the shortage of medical staff in the country, understood the professional spirits of medical staff, and fully realized the values of health technical personnel, which was conducive to enhancing their faith and identity in the medical profession. When medical students are aware of their great sense of responsibility in health care, they will pay attention to the prevention and control measures in major health events and strengthen the study of public health knowledge to enhance their clinical practice and social service ability. At the same time, this further urge them to strengthen the study of public health knowledge to improve their clinical practice and social service capabilities.\\u003c/p\\u003e\\n \\u003cp\\u003eBased on the above, we propose:\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHypothesis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e(H2): The sources of confidence in overcoming major public health events is positively associated with medical students\\u0026apos; attention to major public health events.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHypothesis\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003cp\\u003e(H3): Medical students\\u0026apos; attention to major public health events are positively associated the improvement of medical students\\u0026apos; professional identity.\\u003c/p\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"Materials And Methods\",\"content\":\"\\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eParticipants\\u003c/h2\\u003e \\u003cp\\u003e The participants in this study were medical students from three universities in Hunan Province, including freshmen, sophomores, juniors and seniors. From March 15 to April 19, 2020, we conducted a survey on medical students who provided informed consent through the \\u0026ldquo;wenjuanxing\\u0026rdquo; platform. The questionnaire include demographic information such as age, gender, nationality, university, residences, grade level, and majors. A total of 2,960 college students from several colleges participated voluntarily in the survey, and all of them provided informed consent before completing the questionnaire. According to the preliminary analysis, 2775 valid questionnaires were collected, and the effective rate was 93.8%. Each participant was paid a total of 7 yuan (\\u003cspan\\u003e$\\u003c/span\\u003e1).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eMeasurements\\u003c/h2\\u003e \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eMedical students' attention to major public health events\\u003c/h2\\u003e \\u003cp\\u003eMedical students' attention to national crises was evaluated using seven items: Item 1: \\u0026ldquo; I am concerned about the progress of COVID-19, such as the trends change of confirmed, suspected, dead and cured number cases\\u0026rdquo;; Item 2: \\u0026ldquo;I am concerned about the measures taken by the national government to prevent and control the spread of COVID-19\\u0026rdquo;; Item 3: \\u0026ldquo;I am concerned about the measures taken by my local government to prevent and control the spread of COVID-19 \\u0026rdquo;; Item 4:\\u0026ldquo;I am concerned about the protection knowledge of COVID-19\\u0026rdquo;; Item 5: \\u0026ldquo;I shared the knowledge of COVID-19 with my friends and relatives during the epidemic period\\u0026rdquo;; Item 6: \\u0026ldquo;I am concerned about people's donation activities to the epidemic areas\\u0026rdquo;; Item 7: \\u0026ldquo;I am concerned about any news or information about the epidemic from the medical staff.\\u0026rdquo; Every item was calculated using a 4-point scale. All subjects could choose the most appropriate item according to their own actual situation. The highest score of 4 was \\u0026ldquo;I am concerned about it every day\\u0026rdquo;, and the lowest score of 1 was \\u0026ldquo;I did not pay attention to the news\\u0026rdquo;. The total score of the questionnaire was calculated from the sum of all items. Higher scores indicate that students paid close attention to major public health events. The questionnaire was created by the research team according to their professional knowledge, combined with a literature review, expert consultation and existing research instruments [13\\u0026ndash;17]. It had higher reliability and validity among medical students.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eThe improvement of medical students' professional identity\\u003c/h2\\u003e \\u003cp\\u003eThe improvement of medical students' professional identity were assessed by five items. Item 1: \\u0026ldquo;The understanding of global epidemic prevention and control through internet media has improved my awareness of health\\u0026rdquo;; Item 2: \\u0026ldquo;The understanding of global epidemic prevention and control through internet media has improved my cognition of scientific and academic rigour of medical knowledge\\u0026rdquo;; Item 3: \\u0026ldquo;The understanding of medical staffs epidemic prevention and control actions through internet media has increased my sense of trust in medical staff\\u0026rdquo;; Item 4: \\u0026ldquo;The understanding of medical staffs epidemic prevention and control actions through internet media has strengthened my respect for the medical profession\\u0026rdquo;; Item 5: \\u0026ldquo; This public health event has enhanced my sense of identity and employment intention in the medical profession\\u0026rdquo;. Every item was calculated using a 5-point scale ranging from 1 to 5. All subjects could choose the most appropriate item according to their own actual situation. The highest score of 5 was \\u0026ldquo;full improvement\\u0026rdquo; and the lowest score of 1 was \\u0026ldquo;declined a lot.\\u0026rdquo; The total score of the questionnaire was calculated from the sum of all items, and higher scores reflected that medical students\\u0026rsquo; professional attitudes promoted better. The questionnaire was created by the research team according to their professional knowledge, combined with a literature review, expert consultation and existing research instruments [18\\u0026ndash;23]. The results showed satisfactory reliability and validity of the instrument.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eThe sources of confidence in overcoming major public health events\\u003c/h2\\u003e \\u003cp\\u003eThe sources of confidence in overcoming major public health events were assessed by six items. Item 1: \\u0026ldquo;Our country has taken resolute measures to prevent and control the epidemic, which makes me believe that major public health events can be overcome\\u0026rdquo;; Item 2: \\u0026ldquo;National leaders attach great importance to epidemic prevention and control, which makes me believe that major public health events can be overcome\\u0026rdquo;; Item 3: \\u0026ldquo;The medical staff has provided strong assistance to the epidemic area, which makes me believe that major public health events can be overcome\\u0026rdquo;; Item 4: \\u0026ldquo;All over the country, groups have carried out charity donation activities to the epidemic areas, which makes me believe that major public health events can be overcome\\u0026rdquo;; Item 5: \\u0026ldquo;The prevention and control measures taken by the local government have gradually brought the epidemic under control, which makes me believe that major public health events can be overcome\\u0026rdquo;; Item 6: \\u0026ldquo;The public has gradually understood the knowledge of epidemic prevention and control, which makes me believe that major public health events can be overcome\\u0026rdquo;. Students responded \\u0026ldquo;yes\\u0026rdquo; (score 1 point) or \\u0026ldquo;no\\u0026rdquo; (score 0). The total score of the questionnaire was calculated from the sum of all items. All subjects could choose the most appropriate item according to their own actual situation. The questionnaire was completed by the research team according to their professional knowledge, combined with a literature review, expert consultation and existing research instruments [24\\u0026ndash;26]. The reliability and validity of the scale were fair ideal.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical Analysis\\u003c/h2\\u003e \\u003cp\\u003eStatistical Package for the Social Sciences software (SPSS, version 26.0) and Excel (Microsoft Corp, Redmond, WA, United States) were used for management and analysis. Descriptive statistics were used to analyze demographic data and all study variables. Spearman correlation analysis was used to analyze the correlation among the study variables. PROCESS Model 4 with 5000 bootstrap samples in SPSS was used to test the mediation model. The bias-corrected bootstrap method was used to estimate the highest statistical efficacy and the most accurate confidence interval [27]. The sources of confidence in overcoming major public health events were used as independent variables, medical students' attention to major public health events were used as a mediating variable, and the changes in medical students' professional attitudes were used as a dependent variable. The total, direct, and indirect effects were considered statistically significant at the 0.05 probability level if the results of the 95% bias-corrected confidence interval (CI) did not include zero [28].\\u003c/p\\u003e \\u003c/div\\u003e \\u003cp\\u003e\\u003cstrong\\u003eEthical approval\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study was approved by the ethics committees of the University of South China. All participants provided informed consent.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eCharacteristics of the study population\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA total of 2960 medical students were enrolled in the study. After excluding 185 invalid questionnaires, 2,775 valid questionnaires were ultimately acquired, and the questionnaire response rate was 93.8%. The mean age\\u0026nbsp;of the students was 20.80\\u0026plusmn;1.25\\u0026nbsp;years. The general demographic data of the subjects are shown in Table 1. Among the surveyed medical students, 52.1% were female, and 74.3% were of Han nationality. Students\\u0026apos; residences were located in cities (25.4%), towns (24.9%) and villages (49.7%), respectively. The average levels of the sourcess of confidence in overcoming major public health events\\u0026nbsp;score (0-6), the changes in medical students\\u0026apos; professional attitudes score (5-25),\\u0026nbsp;and medical students\\u0026apos; attention to major public health events score (7-28) of respondents were 4.76\\u0026plusmn;1.69, 21.14\\u0026plusmn;4.56, and 21.48\\u0026plusmn;4.21, respectively.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ch5\\u003eTable 1\\u0026nbsp;Demographic characteristics of the study population (N = 2775)\\u003c/h5\\u003e\\n\\u003cdiv\\u003e\\n \\u003ctable border=\\\"1\\\" cellpadding=\\\"0\\\" cellspacing=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003cp\\u003eVariables\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003en\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003cp\\u003ePercentage(%)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eGender\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003ch5\\u003e\\u0026nbsp;\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e\\u0026nbsp;\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eWomen\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003ch5\\u003e1445\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e52.1\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eMen\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003ch5\\u003e1330\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e47.9\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eNationality\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003ch5\\u003e\\u0026nbsp;\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e\\u0026nbsp;\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eHan\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e2063\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e74.3\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eOther\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e712\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e25.7\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003ePlace of residence\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e\\u0026nbsp;\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eCities\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e772\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e25.4\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eTowns\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e757\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e24.9\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eVillages\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e1512\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e49.7\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eGrade\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003ch5\\u003e\\u0026nbsp;\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e\\u0026nbsp;\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eFreshman\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e980\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e32.3\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eSophomore\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e469\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e15.4\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eJunior\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e564\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e18.5\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eSenior\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e516\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e17.0\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eFifth year\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e512\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e16.8\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eSubject category\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e\\u0026nbsp;\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eLiberal arts\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e673\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e22.1\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eSciences\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e522\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e17.2\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eEngineering\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e580\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e19.1\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"40.44117647058823%\\\"\\u003e\\n \\u003ch5\\u003eMedicine\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"28.431372549019606%\\\"\\u003e\\n \\u003cp\\u003e1266\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"31.127450980392158%\\\"\\u003e\\n \\u003ch5\\u003e41.6\\u003c/h5\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003ch3\\u003eEvaluation of the measurement instruments\\u003c/h3\\u003e\\n\\u003cp\\u003eWe evaluated the construct reliability and validity for the measurement instruments (Table 2). \\u0026nbsp;According to Hair et al [29], the indicator loadings should reach the standard of 0.70, whereas loadings between 0.40 and 0.70 should be deleted only when their deletion can improve the overall reliability to the minimum threshold value. The results showed that two indicator loadings were lower than 0.70, and the other indicator loadings were higher than 0.70. By deleting and analyzing the indicator loadings less than 0.7, the overall reliability was not improved. Therefore, all indicator loadings were retained for this study. The results reflected that the indicator loadings had good indicator reliability levels.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003ch3\\u003eTable 2\\u0026nbsp;Evaluation of measurement instruments\\u003c/h3\\u003e\\n\\u003ctable border=\\\"1\\\" cellpadding=\\\"0\\\" cellspacing=\\\"0\\\" width=\\\"634\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eConstruct\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eItem\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eLoadings\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCronbach\\u0026rsquo;s alpha\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eComposite reliability\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eAVE\\u003c/strong\\u003e*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eKMO\\u003c/strong\\u003e**\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003eThe sources of confidence in overcoming major public health events (SCO)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003eSCO-1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.706\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e0.865\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e0.860\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e0.508\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e0.836\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eSCO-2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.775\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eSCO-3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.770\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eSCO-4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.734\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eSCO-5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.639\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eSCO-6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.639\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003eThe improvement of medical students\\u0026apos; professional identity (IPI)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eCPA-1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.801\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e0.899\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e0.932\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e0.732\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e0.882\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eCPA-2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.844\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eCPA-3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.883\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eCPA-4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.883\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eCPA-5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.865\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003eMedical\\u0026nbsp;students\\u0026apos; attention to major public health events\\u0026nbsp;(APHE)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003cp\\u003eAPHE-1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.822\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e0.921\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e0.939\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e0.687\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e0.913\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eAPHE-2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.886\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eAPHE-3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.892\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eAPHE-4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.883\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eAPHE-5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.754\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eAPHE-6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.727\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"29.968454258675077%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.410094637223974%\\\"\\u003e\\n \\u003cp\\u003eAPHE-7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"11.987381703470032%\\\"\\u003e\\n \\u003cp\\u003e0.823\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.406940063091483%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.094637223974763%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"10.725552050473187%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eNote.\\u0026nbsp;*\\u0026nbsp;Average Variance Extracted;\\u0026nbsp;**\\u0026nbsp;Kaiser-Meyer-Olkin\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSpearman Correlation Analysis Results\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA nonparametric statistical method was used for bivariate correlation. Table 3 shows the overall Spearman correlation results. There were significant correlations between all variables. The improvement of medical students\\u0026apos; professional identity was positively correlated with the sources of confidence in overcoming major public health events (r=0.629, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.001) and medical students\\u0026apos; attention to national crisis events (r=0.791, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.001).\\u003c/p\\u003e\\n\\u003ch5\\u003eTable\\u0026nbsp;3\\u0026nbsp;Spearman correlations among study variables\\u003c/h5\\u003e\\n\\u003ctable border=\\\"1\\\" cellpadding=\\\"0\\\" cellspacing=\\\"0\\\" width=\\\"103%\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"63.265306122448976%\\\"\\u003e\\n \\u003cp\\u003eVariables\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" width=\\\"13.26530612244898%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" width=\\\"12.244897959183673%\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" width=\\\"11.224489795918368%\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"63.265306122448976%\\\"\\u003e\\n \\u003cp\\u003e1. The sources of confidence in overcoming major public health events\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.26530612244898%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"12.244897959183673%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.224489795918368%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"63.265306122448976%\\\"\\u003e\\n \\u003col\\u003e\\n \\u003cli\\u003eThe improvement of medical students\\u0026apos; professional identity\\u003c/li\\u003e\\n \\u003c/ol\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.26530612244898%\\\"\\u003e\\n \\u003cp\\u003e0.629\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"12.244897959183673%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.224489795918368%\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"63.265306122448976%\\\"\\u003e\\n \\u003col\\u003e\\n \\u003cli\\u003eMedical students\\u0026apos;\\u0026nbsp;attention to major public health events\\u003c/li\\u003e\\n \\u003c/ol\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.26530612244898%\\\"\\u003e\\n \\u003cp\\u003e0.617\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"12.244897959183673%\\\"\\u003e\\n \\u003cp\\u003e0.791\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.224489795918368%\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"63.265306122448976%\\\"\\u003e\\n \\u003cp\\u003eMean\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.26530612244898%\\\"\\u003e\\n \\u003cp\\u003e4.76\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"12.244897959183673%\\\"\\u003e\\n \\u003cp\\u003e21.14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.224489795918368%\\\"\\u003e\\n \\u003cp\\u003e21.48\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"63.265306122448976%\\\"\\u003e\\n \\u003cp\\u003eSD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"13.26530612244898%\\\"\\u003e\\n \\u003cp\\u003e1.69\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"12.244897959183673%\\\"\\u003e\\n \\u003cp\\u003e4.56\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" width=\\\"11.224489795918368%\\\"\\u003e\\n \\u003cp\\u003e4.21\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eNote. \\u003cem\\u003eN\\u0026nbsp;\\u003c/em\\u003e=2775\\u003c/p\\u003e\\n\\u003cp\\u003e**All correlations were significant at\\u0026nbsp;\\u003cem\\u003eP\\u003c/em\\u003e \\u0026lt;0\\u0026nbsp;.001 (two tailed).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMediation effect model\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eMedical students\\u0026apos; attention to major public health events was identified as a mediator between the sources of confidence in overcoming major public health events and the improvement of medical students\\u0026apos; professional identity. In the SPSS PROCESS analysis, model 4 was used to evaluate the mediating effects of the study variables.\\u0026nbsp;The total, direct and indirect effect results are summarized in Table 5. Figure 2 shows the structural model of the mediating effect. The structural model was statistically significant (\\u003cem\\u003eF=\\u003c/em\\u003e223.495,\\u0026nbsp;\\u003cem\\u003eP\\u003c/em\\u003e\\u0026lt;0.001), and the\\u0026nbsp;\\u003cem\\u003eR\\u0026nbsp;\\u003c/em\\u003eand\\u0026nbsp;\\u003cem\\u003eR\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/em\\u003e\\u003csup\\u003e\\u0026nbsp;\\u003c/sup\\u003evalues were 0.373 and 0.139, respectively (Table 4).\\u0026nbsp;The total effect of the mediation model was significant. The direct effect of the sources of confidence in overcoming major public health events on the improvement of medical students\\u0026apos; professional identity was significant. The indirect effect of the sources of confidence in overcoming major public health events (X) on the improvement of medical students\\u0026apos; professional identity (Y) through medical students\\u0026apos; attention to major public health events (M) was significant. The mediation effect accounted for 23.3% of the total effect. The mediation effect accounted for 30.4% of the direct effect. Therefore, these research results indicate that a partial mediating effect exists.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 4\\u0026nbsp;\\u003c/strong\\u003eRegression model with the improvement of medical students\\u0026apos; professional identity as outcome variable\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellpadding=\\\"0\\\" cellspacing=\\\"0\\\" width=\\\"605\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"29.702970297029704%\\\"\\u003e\\n \\u003cp\\u003eVariables\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.686468646864686%\\\"\\u003e\\n \\u003cp\\u003ecoeff\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"8.745874587458745%\\\"\\u003e\\n \\u003cp\\u003ese\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.891089108910892%\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003et\\u003c/em\\u003e value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.541254125412541%\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.541254125412541%\\\"\\u003e\\n \\u003cp\\u003eLLCI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.891089108910892%\\\"\\u003e\\n \\u003cp\\u003eULCI\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"29.702970297029704%\\\"\\u003e\\n \\u003cp\\u003econstant\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.686468646864686%\\\"\\u003e\\n \\u003cp\\u003e11.892\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"8.745874587458745%\\\"\\u003e\\n \\u003cp\\u003e0.447\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.891089108910892%\\\"\\u003e\\n \\u003cp\\u003e26.591\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.541254125412541%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.541254125412541%\\\"\\u003e\\n \\u003cp\\u003e11.015\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.891089108910892%\\\"\\u003e\\n \\u003cp\\u003e12.769\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"29.702970297029704%\\\"\\u003e\\n \\u003cp\\u003eMedical students\\u0026apos; attention to major public health events\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.686468646864686%\\\"\\u003e\\n \\u003cp\\u003e0.328\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"8.745874587458745%\\\"\\u003e\\n \\u003cp\\u003e0.019\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.891089108910892%\\\"\\u003e\\n \\u003cp\\u003e16.898\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.541254125412541%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.541254125412541%\\\"\\u003e\\n \\u003cp\\u003e0.290\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.891089108910892%\\\"\\u003e\\n \\u003cp\\u003e0.366\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"29.702970297029704%\\\"\\u003e\\n \\u003cp\\u003eThe sources of confidence in overcoming major public health events\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"14.686468646864686%\\\"\\u003e\\n \\u003cp\\u003e0.464\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"8.745874587458745%\\\"\\u003e\\n \\u003cp\\u003e0.048\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.891089108910892%\\\"\\u003e\\n \\u003cp\\u003e9.597\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.541254125412541%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"12.541254125412541%\\\"\\u003e\\n \\u003cp\\u003e0.369\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"10.891089108910892%\\\"\\u003e\\n \\u003cp\\u003e0.559\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 5\\u0026nbsp;\\u003c/strong\\u003eTotal, direct and indirect effects of mediation analysis\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellpadding=\\\"0\\\" cellspacing=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003eEffect\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003eEstimate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003et/Z\\u0026nbsp;\\u003c/em\\u003evalue\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eP\\u003c/em\\u003e value\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e95% LCL\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e95% UCL\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003eTotal effect\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e0.605\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e12.101\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e0.507\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e0.703\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003eDirect effect\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e0.464\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e9.597\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e0.369\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e0.559\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003eIndirect effect\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e0.141\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e8.092*\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e\\u0026lt;0.001\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e0.106\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd width=\\\"16.666666666666668%\\\"\\u003e\\n \\u003cp\\u003e0.182\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eNote\\u003cem\\u003e.\\u003c/em\\u003e\\u0026nbsp; * \\u003cem\\u003eZ\\u003c/em\\u003e value.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this study, we first evaluated the role of\\u0026nbsp;medical students\\u0026apos; attention to major public health events\\u0026nbsp;on the sources of confidence in overcoming major public health events and the improvement of medical students\\u0026apos; professional identity.\\u0026nbsp;The results showed that the total effect value, direct effect value and indirect effect value were 0.605, 0.464 and 0.141, respectively. The mediation effect accounted for 23.3% of the total effect, and the mediation effect accounted for 30.4% of the direct effect. Medical students\\u0026apos; attention to major public health events is a mediation path that links the sources of confidence in overcoming major public health events and the improvement of medical students\\u0026apos; professional identity. The mediation perspective suggests that the sources of confidence in overcoming major public health events are positively associated with the improvement of medical students\\u0026apos; professional identity. In the mediating model, a partial intermediary effect existed. These findings have important implications for strengthening medical students\\u0026rsquo;s education management theory and practice in context of existing research, which we elaborate next.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eImplications for theory\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eOur key contribution to the professional education of medical students is the introduction of a pathway. There are few studies on the sources of confidence in overcoming major public health events affecting the improvement of medical students\\u0026apos; professional identity, which did not include the mediating variable of medical students\\u0026apos; attention to major public health events and hence provided relatively little in the way of theoretical development. We developed a conceptual impact path model of the improvement of medical students\\u0026apos; professional identity. Medical students\\u0026apos; attention to major public health events plays a partial medium role in the sources of confidence in overcoming major public health events and the improvement of medical students\\u0026apos; professional identity. Theoretically, we make three specific contributions to the\\u0026nbsp;professional identity\\u0026nbsp;education of medical students.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eFirst, the sources of confidence in overcoming major public health events play an important role in improving the professional identity of medical students. According to the theory of emotional cognition, emotion is influenced by environmental events, physiological conditions and cognitive processes [30].\\u003csup\\u003e\\u0026nbsp;\\u003c/sup\\u003eCompared with the outbreak of SARS or other epidemics, COVID-19 has more far-reaching influence.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;Compared with SARS, the emergency management system of COVID-19 has been improved, for example, the state promulgated a transparent policy, the government improved the medical security system, the local organization of temperature and nucleic acid testing activities was improved,\\u0026nbsp;the timely dissemination of epidemic information by the media, and the patients received fair and timely rescue, among other implementations.\\u0026nbsp;As a whole, the emergency management of major public health events requires full participation,\\u0026nbsp;mobilizing the forces of individuals, families, communities, social organizations and other aspects, forming an environmental atmosphere for the public to fight against the epidemic.\\u0026nbsp;The common positive emotional experience and social mutual trust make the public firmly believe that the risk of public health events will be overcome [22]. Emotion is central to the decision-making process, both as an input and an output [31].\\u0026nbsp;Many of our choices are guided by the experience of these emotions or the anticipation of the emotions that may be elicited [32]. During the epidemic period, civil servants, police, teachers, security guards, couriers, cleaners and other industries showed a firm anti epidemic spirit.\\u0026nbsp;In particular, medical staff members day and night in the medical front, and they have established a lofty sense of professional responsibility and morality for medical students, characterized by practical action and benevolence, which will inspire them to make efforts for the development of national medical and healthcare services and the improvement of human physical and mental health [33].\\u003c/p\\u003e\\n\\u003cp\\u003eHealthcare practitioners and technical occupations have a high social status, but they are included among the high-intensity and high-risk professions due to the high risk of medical work, the high occupational pressure and the long working hours [34]. Previous studies have shown that medical students\\u0026apos; professional emotions scores are lower than their professional values scores, and some medical students do not feel satisfied with the medical profession [18]. However, the COVID-19 pandemic has significantly improved the professional identity of medical students and deeply reinforced their sense of responsibility and missions, because of the strong support of social groups to medical work, the high frequency and high intensity positive reports of medical personnel by the news media, the ardent expectations of the public regarding COVID-19 prevention and control, and the improvement of national quality. Studies have shown that 59.0% of medical students are willing to participate in front-line epidemic prevention actions, and 87.7% of medical students have experienced a positive impact on their professional identity [34]. Other studies have shown that 42.9% of medical students have not been shaken in their professional beliefs during the COVID-19 epidemic, and 53.6% of medical students have strengthened their beliefs [35]. Therefore, the effective measures taken by the government departments and industries to unite to fight the epidemic have enhanced the confidence in defeating major public health events, which is conducive to enhancing medical students\\u0026apos; medical professional identity.\\u003c/p\\u003e\\n\\u003cp\\u003eSecond, our contribution was finding that \\u0026nbsp;the sources of confidence in overcoming major public health events among medical students are closely related to their increasing attention to major public health events. Social media plays an important role in\\u0026nbsp;\\u003ca href=\\\"file:///C%3A/Program%2520Files%2520(x86)/Youdao/Dict/8.9.6.0/resultui/html/index.html#/javascript%3A;\\\"\\u003espread\\u003c/a\\u003eing information and guiding the public opinion of major public health events and is the main channel by which people obtain information [36]. According to statistics, WeChat (82.4%) and Twitter (75.8%) were the main channels, followed by television (42.9%), websites (41.1%) and news client (40.8%) [37]. Some surveys have shown that the public focus was different at different stages of the epidemic, and the degree and core of public concern affect public confidence in fighting the epidemic. As follows, in the early days of the outbreak, the public was concerned about the situation of the epidemic, the sources of the virus, epidemic prevention measures, access to face masks, science popularization, and the postponement of university openings, postgraduate reexaminations and college entrance examinations caused by the epidemic [38-39]. The public showed negative emotions, such as worry, panic and anxiety [7]. In the middle of the outbreak, the public paid more attention to epidemic prevention measures\\u0026nbsp;and the progress of donation, actively made suggestions to the government, and encouraged social groups to fight the epidemic [39]. In the late stage of the outbreak, the epidemic was essentially controlled, praise became the mainstream, and gratitude gradually increased [39].\\u0026nbsp;Consequently, the public focused on major public health events through social media and kept abreast of the progress of the epidemic in real time. During this special period, the atmosphere of solidarity and confidence created by the public affected everyone.\\u003c/p\\u003e\\n\\u003cp\\u003eDuring the spread of COVID-19, the dedication and perseverance of the government, medical staff, scientific research personnel and grassroots were sources of confidence and motivation for all people to unite and fight the epidemic. Studies show that 43.3%, 46.3%, 53.6% and 42.7% of the public have confidence in scientific researchers, medical staff, government and grassroots to overcome major public health events respectively [37]. Medical students pay more attention to information related to epidemic prevention and control due to their professional background and the particularity of their expected career.\\u0026nbsp;The COVID-19 has been effectively controlled, prevention and control supplies have been provided, anti-epidemic deeds and personalities have been reported, medical staff have been praised by the society and other related events\\u0026nbsp;have made medical students feel full of confidence in coping with the crisis, which have further encouraged medical students to pay close attention to the development of major public health events. Positive attention to major public health events makes medical students deeply aware of the sense of responsibility, justice and faith, which is conducive to avoiding the panic caused by public opinion and stabilizing social order [40]. \\u0026nbsp;From this point of view, the sources of confidence in overcoming major public health events are beneficial to promoting medical students\\u0026apos; attention to major public health events.\\u003c/p\\u003e\\n\\u003cp\\u003eFinally, attention to major public health events directly affected the improvement of medical students\\u0026apos; professional identity. During the outbreak of COVID-19, the CCTV news audience rating increased to 11.72%, among\\u0026nbsp;which 15~24 year-old audience ratings increased by 186% [41].\\u0026nbsp;In the process of paying attention to major public events, medical students have a further understanding of the medical and health system, the distribution of health resources, emergency knowledge and technology, doctor-patient conflicts, and medical violence incidents, which will affect their future career choice and identity. In addition to endogenous and exogenous attention mechanisms, the emotional relevance of a stimulus is an important feature that affects attentional selection and prioritization [42].\\u0026nbsp;Adverse events such as medical disputes and violent medical injuries are more likely to attract public attention and seriously damage the professional identity of medical students.\\u003csup\\u003e47\\u003c/sup\\u003e A survey showed that 69.7% of medical students are very concerned about the medical injuries reported by the media, and 37.9% of medical students fully believe in the occurrence of the violent medical injuries reported by the media [43].\\u0026nbsp;Studies have reported that 69.3% of medical students believe that the current situation of doctor-patient relationships will affect their career choice.\\u0026nbsp;Even if they choose to continue to work in the medical industry, their professional identity and work enthusiasm are also declining [44].\\u003c/p\\u003e\\n\\u003cp\\u003eDuring the period of COVID-19, the state, the government and society gave medical personnel support and cooperation, and increased public understanding of medical work. The achievement of epidemic control has enhanced the social status and propaganda of medical staff and severely cracked down on violent medical injuries. This greatly increased the medical students\\u0026apos; sense of occupation and sense of security, was conducive to improving the professional identity of medical students, and directly influenced the learning enthusiasm and motivation of future career development of medical students [45].\\u0026nbsp;A study found that approximately 83.85% of medical students were moved by the behavior exhibited by front-line medical staff, \\u0026nbsp;who devoted much of \\u0026nbsp;their time and energy to work [46].\\u0026nbsp;If there is a need in the future, 85.7% of medical students are willing to take the initiative to participate in front-line work [44].\\u0026nbsp;These indicate that medical students\\u0026apos; attention to major public health events influences their attitudes and their choice of medical career. It is also suggested that the active promotion of the noble medical ethics \\u0026nbsp;by colleges or education and training institutions is an effective way to encourage medical students to affirm their emotions and thoughts regarding the medical profession.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eImplications for practice\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe improvement of medical students\\u0026apos; professional identity is an important goal of professional identity education and an important task of national development and social stability.\\u003c/p\\u003e\\n\\u003cp\\u003eFirst, community practice can provide a theoretical basis for professional identity [47]. During the period of COVID-19, the anti-epidemic activities of medical staff were the most typical, large-scale community practices in the epidemic areas.\\u0026nbsp;Colleges should pay attention to the role of community practice courses in shaping professional identity. Community practice is a persistent and sustainable personal social network and an overlapping knowledge base for sharing and development, in which the generation of beliefs, values, history and experience can be concentrated [48].\\u0026nbsp;The professional socialization of interns occurs through their community practice in all kinds of socialized organizations. Medical students could establish their professional image through experiential learning in the Centers for Disease Control and Prevention (CDC), Community Health Centers, clinical hospitals and other organizations [49]. They make full use of the knowledge and skills to conduct basic information surveys and physical examinations, popularize health knowledge, and enhance public awareness of disease prevention for community residents. In the interactive process of social practice, they can think, act and feel like medical staff, and gradually understand the essence of professional identity and the socialization process of identity formation\\u0026nbsp;[47]. According to situational learning theory, acquired knowledge is a mixture of explicit and implicit, and most of the knowledge related to identity formation is implicit [50-51].\\u0026nbsp;Some scholars believe that the most powerful factors influencing the formation of professional identity are role models and mentors, as well as experiential learning in clinical and nonclinical situations [32,52]. In the process of community practice, students consciously acquire knowledge through observation, imitation and practice [34,53,54]. Role models and mentors can\\u0026nbsp;encourage\\u0026nbsp;medical students to constantly reflect and summarize in empirical learning to greatly enhance their learning effect [34].\\u0026nbsp;These measures should enable medical students to avoid overreliance on historical precedent, intuition, or perceived common sense, and really improve their underlying public health service skills.\\u0026nbsp;In addition, medical colleges need to set up special practical skills courses on how to deal with the doctor-patient relationship to improve medical students\\u0026apos; medical confidence and thus enhance their willingness to practice medicine [55].\\u003c/p\\u003e\\n\\u003cp\\u003eSecond, using various types of social media can improve all cognitive domains [56]. Medical students pay close attention to the progress of public health events through social media. They discuss issues with peers online, give feedback and show their attitude, and are influenced by each other through the media [57]. Although social media cannot replace face-to-face communication with peers, role models and mentors, it plays an important role in information exchange in medical education, greatly improving the enthusiasm and participation of medical students in professional identity education.\\u0026nbsp;Positive reports of major public health events can improve medical students\\u0026apos; confidence in overcoming major public health events and their understanding of the medical industry. However, relevant information about the major public health events is often exaggerated in the spread of social media.\\u0026nbsp;Even those who are not directly affected will form a certain position or attitude, causing forwarding, commenting and other behaviors, further promoting the spread and diffusion of public opinion information on social media platforms, and leading to the spread of anxiety, panic and other negative emotions, thus shaking confidence in overcoming crisis events [58]. Furthermore, the attention of medical students to media reports reflects the important role of media in the construction of medical students\\u0026apos; values and professional sense to a certain extent.\\u0026nbsp;In recent years, the negative reports on doctor-patient disputes by the news media have made medical students\\u0026rsquo; levels of cognition and emotion toward medical work more one-sided, and they are more inclined to recognize medical work according to the traditional concept of \\u0026quot;curing diseases and saving lives\\u0026quot; in society [59].\\u0026nbsp;From this, government departments should first take a clear stand on public opinion during the crisis, reasonably guide public opinion, and positively build public confidence in dealing with major public health events. Then, they need to monitor and analyze the public opinion information of public health emergencies, guide medical students to objectively understand the medical and practice environments and clarify the professional situation of medical staff. The media should report the significance of medical personnel in dealing with major public health events to enhance the personal sense of crisis for medical students and make them more proactive in learning new knowledge to improve themselves, which is conducive to stabilizing the supply of medical and health human resources and improving the quality of medical services.\\u0026nbsp;Additionally, the idea of modern medical education is to guide medical students to make full use of network media in a positive way to improve their thinking ability and professional attitude, and to promote the transformation of their self-awareness from university medical students to future health care professionals [60].\\u003csup\\u003e\\u0026nbsp;\\u003c/sup\\u003eConsequently, the correct levels of guidance from the government and the media are necessary factors for medical students to choose their jobs objectively and strengthen their professional beliefs when paying attention to major public health events.\\u003c/p\\u003e\\n\\u003cp\\u003eFinally, the support of society and family are important conditions for medical students to strengthen their professional consciousness.\\u0026nbsp;During the period of COVID-19, the sources of confidence in overcoming major public health events from government and society reflected the strongest social support.\\u0026nbsp;Society and family are important factors that affect medical students\\u0026apos; professional identity in addition to professional courses and employment guidance and training.\\u0026nbsp;When the professional identity of medical staff is low,\\u0026nbsp;dismissals can occur, especially for male nurses who are negatively affected by gender stereotypes and heavy workloads [30][61].\\u0026nbsp;Many nurses think that nursing work is not respected by patients, and nurses have a lower social status.\\u0026nbsp;It is well known that nursing staff are an indispensable part of medical activities. In particular, the role of male nurses has become increasingly prominent, which should warn national relevant department such as holding regulators, hospitals and nursing educational institutions, to develop professional identity of male nurses, with an emphasis on personalized training and guidance,\\u0026nbsp;such as lectures, competitions or salons,\\u0026nbsp;to fully realize their social value. Participation in these activities can change their perception of the nursing profession and help maintain the stability of male caregivers [62-63].\\u0026nbsp;In addition, family conflict was negatively correlated with professional identity.\\u0026nbsp;Faced with the current heavy academic burden and high social requirements of medical students, families should first create a healthy and relaxed environment. When the country is in the midst of a major public health crisis, families should actively support medical students to take part in primary health care work, and encourage them to promote their professional competence and vocational awareness.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStrengths and limitations\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study makes an important contribution to the literature by evaluating the associations among the sources of confidence in overcoming major public health events, the improvement of medical students\\u0026apos; professional identity and medical students\\u0026apos; attention to major public health events through data reported by medical students from three medical universities in Hunan Province. The present study confrms our research hypothesis that medical students\\u0026apos; attention to national crisis events moderates the relationship between the sources of confidence in overcoming major public health events and the improvement of medical students\\u0026apos; professional identity. Additionally, these findings all enrich the theory of professional identity education related research among medical students.\\u003c/p\\u003e\\n\\u003cp\\u003eOur study has several limitations. First, our study is a cross-sectional study, which can only account for the associations between these three, and cannot explain causal relationship between them. Second, medical students\\u0026apos; professional attitudes are the result of many factors, and we explored only their attention to major public health events as an intermediary factor.\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eIn conclusion, this study confirms the importance of the association among the sources of confidence in overcoming major public health events, the improvement of medical students\\u0026apos; professional identity, and medical students\\u0026apos; attention to major public health events. The sources of confidence in overcoming major public health events, medical students\\u0026apos; attention to national crisis events have a significant predictive effect on the improvement of medical students\\u0026apos; professional identity. Medical students\\u0026apos; attention to major public health events mediated the relationship between the sources of confidence to overcome major public health events and the improvement of medical students\\u0026apos; professional identity. \\u0026nbsp;These findings suggest that enhancing the confidence in overcoming major public health events and medical students\\u0026apos; attention to major public health events can meaningfully improve medical students\\u0026apos; professional identity. Our findings will serve as a springboard for future research on how to \\u0026nbsp;improve medical students\\u0026apos; professional identity.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was performed in accordance to the Declaration of Helsinki and received Nanyang Technological University\\u0026rsquo;s Institutional Review Board approval (IRB 2019－09-024). All participants provided full informed consent to participate in this study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot Applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets analyzed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis work was supported by the Teaching\\u0026nbsp;Reform\\u0026nbsp;Research\\u0026nbsp;Project\\u0026nbsp;of Universities\\u0026nbsp;in\\u0026nbsp;Hunan\\u0026nbsp;Province [HNJG-2022-0745].\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll authors contributed to the study conception and design. G.H. conceived and developed the idea for the project. G.H., Z.N., Z.Z.Y., O.L.Y., X.J. and T.J. investigated participants and identified themes. G.H. analyzed data. G.H. and Z.N. drafted the early versions of the manuscript. G.H. made subsequent critical revisions for important intellectual content. Z.N., X.J. and T.J. developed the idea for the project and identified themes. G.H. reviewed the early versions of the manuscript and made substantial contributions to the content and direction of the manuscript. All authors approve the final version and agree to be accountable for all aspects of the work including questions related to the accuracy or integrity of the work.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe thank American Journal Experts (https://www.aje.con) for editing this manuscript.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eZhang Y, Zeng G, Pan H, Li C, Hu Y, Chu K, et al. Safety, tolerability, and immunogenicity of an inactivated SARS-CoV-2 vaccine in healthy adults aged 18-59 years: a randomised, double-blind, placebo-controlled, phase 1/2 clinical trial. Lancet Infect Dis. 2021;21(2):181-92.\\u003c/li\\u003e\\n\\u003cli\\u003eTurale S, Meechamnan C, Kunaviktikul W. Challenging times: ethics, nursing and the COVID-19 pandemic. Int Nurs Rev. 2020;67(2):164-7.\\u003c/li\\u003e\\n\\u003cli\\u003eJie G, Jiao L, Ling Y. 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The Development and Impact of a Social Media and Professionalism Course for Medical Students. Teach Learn Med. 2017; 29(3):296-303. \\u003c/li\\u003e\\n\\u003cli\\u003eOhl\\u0026eacute;n J, Segesten K. The professional identity of the nurse: concept analysis and development. J Adv Nurs. 1998;28(4):720-7. \\u003c/li\\u003e\\n\\u003cli\\u003eYounas A, Sundus A. Experiences of and satisfaction with care provided by male nurses: A convergent mixed-method study of patients in medical surgical units. J Adv Nurs. 2018; 74(11):2640-53.\\u003c/li\\u003e\\n\\u003cli\\u003eChen Y, Zhang Y, Jin R. Professional Identity of Male Nursing Students in 3-Year Colleges and Junior Male Nurses in China. Am J Mens Health. 2020;14(4):1557988320936583. \\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-medical-education\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"meed\",\"sideBox\":\"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/meed/default.aspx\",\"title\":\"BMC Medical Education\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"COVID—19, medical education, social media, confidence in overcoming crisis events, professional identity\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-2136973/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-2136973/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eThe prevalence of COVID-19 highlights the shortage of medical human resources, and improving medical students' professional identity is a key condition to improve this situation. The sources of confidence in overcoming major public health events and medical students' attention to major public health events were key factors affecting their professional identity, but no study has yet investigated the mediating role of medical students' attention to major public health events in the relationship between them. This study aims to investigate the relationship among these three in medical university students in Hunan Province.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eThis was a cross-sectional survey of 2,960 medical students\\u0026rsquo; questionnaires collected from three universities in Hunan Province. An intermediary model was established to evaluate the role of medical students' attention to major public health events in the sources of confidence in overcoming major public health events and the improvement of medical students' professional identity.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eThe sources of confidence in overcoming major public health events, medical students' attention to national crisis events, the improvement of medical students' professional identity were positively associated with each other (\\u003cem\\u003eβ\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;0.328\\u0026thinsp;~\\u0026thinsp;0.464, \\u003cem\\u003eP\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001). The mediating effect accounted for 23.3% of the total effect and 30.4% of the direct effect. Medical students' attention to major public health events plays a partial mediating role in the relationship between the sources of confidence to overcome major public health events and the improvement of medical students' professional identity.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eThis study found that the sources of confidence in overcoming major public health events, medical students' attention to national crisis events have a signifcant predictive effect on the improvement of medical students' professional identity. Medical students' attention to major public health events mediated the relationship between the sources of confidence to overcome major public health events and the improvement of medical students' professional identity. The findings have emphasize the theoretical and practical significance of professional identity education for medical students.\\u003c/p\\u003e\",\"manuscriptTitle\":\"The relationship between the sources of confidence in overcoming major public health events and the improvement of medical students' professional identity: mediation by medical students' attention to major public health events.\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2022-10-17 20:23:53\",\"doi\":\"10.21203/rs.3.rs-2136973/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Major revision\",\"date\":\"2022-11-28T08:45:38+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2022-11-18T09:21:07+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"09258ff9-bfab-475a-84d0-96bcc0ab2e6c\",\"date\":\"2022-11-05T03:53:24+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2022-11-05T00:47:53+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2022-11-05T00:42:16+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2022-10-12T13:53:03+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2022-10-12T13:51:21+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Medical Education\",\"date\":\"2022-10-06T03:50:33+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-medical-education\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"meed\",\"sideBox\":\"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/meed/default.aspx\",\"title\":\"BMC Medical Education\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"adc35843-665d-480a-8e21-6574f01955a4\",\"owner\":[],\"postedDate\":\"October 17th, 2022\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2023-10-16T18:25:40+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-2136973\",\"link\":\"https://doi.org/10.1186/s12909-022-03994-4\",\"journal\":{\"identity\":\"bmc-medical-education\",\"isVorOnly\":false,\"title\":\"BMC Medical Education\"},\"publishedOn\":\"2023-01-14 18:17:33\",\"publishedOnDateReadable\":\"January 14th, 2023\"},\"versionCreatedAt\":\"2022-10-17 20:23:53\",\"video\":\"\",\"vorDoi\":\"10.1186/s12909-022-03994-4\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12909-022-03994-4\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-2136973\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-2136973\",\"identity\":\"rs-2136973\",\"version\":[\"v1\"]},\"buildId\":\"WrCJVZZCHTDjtuVLN7oU0\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}