Research Anxiety Among China's "Four-Certificates-in-One" Master's Degree Candidates in Obstetrics and Gynecology: A Qualitative Study and Policy Optimization Pathways

Research Anxiety Among China's "Four-Certificates-in-One" Master's Degree Candidates in Obstetrics and Gynecology: A Qualitative Study and Policy Optimization Pathways | 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 Research Anxiety Among China's "Four-Certificates-in-One" Master's Degree Candidates in Obstetrics and Gynecology: A Qualitative Study and Policy Optimization Pathways Rourou Xiao, Wei Zhang, Huijun Chen, Wenhui Liu, Xuechen Yu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7010029/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aims to examine the mechanisms and institutional origins of research anxiety among master’s degree candidates in Obstetrics and Gynecology (OB/GYN) enrolled in China's "Four-Certificates-in-One" program. The goal is to provide a foundation for optimizing the training framework for specialized OB/GYN Master's students and to mitigate the scientific research pressures faced by medical students. Methods A qualitative research methodology was utilized, involving semi-structured, in-depth interviews with 16 clinical master’s students specializing in OB/GYN under the "Four-Certificates-in-One" program at a university in Wuhan, China. The interview transcripts were subjected to thematic analysis using NVivo 12 software to identify core themes and conflicting mechanisms. Results Guided by Role Conflict Theory and Institutional Contradiction Theory, the analysis of interview data identified five principal themes: (1) The impact of a demanding clinical workload on research time allocation; (2) The discrepancy between supervisors' high expectations and the provision of guidance and support; (3) The inadequacy of research training support systems for students pursuing specialized Master's programs; (4) The absence of positive feedback in research endeavors; (5) The lack of research motivation and its conflict with career planning. Conclusion Research anxiety within the "Four-Certificates-in-One" model emerges from the interaction between institutional contradictions and individual adaptive challenges. To effectively mitigate anxiety and enhance the well-being of this student population, a coordinated approach is necessary, encompassing policy development, institutional collaboration, departmental support, supervisor mentorship, and individual adaptation. Research Anxiety "Four-Certificates-in-One" Obstetrics and Gynecology Qualitative Research Optimization Pathways Background In 2015, the State Council of China promulgated the Opinions on Deepening the Coordination of Medical Education and Healthcare to Further Advance Medical Education Reform and Development , [ 1 ] which mandated the enhancement of clinical practice training to establish an integrated "medical education-healthcare" cultivation system. Within this framework, students are required to simultaneously complete clinical rotations, research training, and standardized residency training, ultimately qualifying for four certifications: the Physician Practice Qualification Certificate, Standardized Training Completion Certificate, Master’s Diploma, and Master’s Degree Certificate, collectively referred to as the "Four-Certificates-in-One" policy. [ 1 , 2 ] While this model has standardized the acquisition of clinical skills, it has also imposed considerable research-related pressures on students. Key stressors, such as time constraints, insufficient research support systems, and the emphasis on publications as critical criteria for doctoral program admissions and employment, have contributed to pervasive research anxiety. Empirical studies suggest that post-implementation trainees experience varying levels of physiological discomfort and psychological changes, with a notable increase in depressive symptoms. [ 3 – 5 ] The term "research anxiety" encompasses negative emotional states—such as tension, unease, and irritability—induced by the various pressures and uncertainties inherent in scientific research activities. The prevailing literature primarily conceptualizes this phenomenon through a linear perspective, emphasizing time constraints and perceived competence gaps, while neglecting the significant impact of institutional constraints. [ 5 , 6 ] Moreover, existing research tends to focus on phenomenological descriptions and quantitative analyses, lacking a thorough exploration of individual experiences within the "Four-Certificates-in-One" model. Notably absent are qualitative investigations into the mechanisms that generate research anxiety within this group, and there is limited evidence-based research on pathways for policy optimization. [ 7 ] This study utilized semi-structured interviews with "Four-Certificates-in-One" Master's candidates specializing in Obstetrics and Gynecology (OB/GYN) at a medical university in Wuhan, China. The aim was to document their genuine experiences during standardized residency training, identify institutional sources contributing to their research-related anxiety, and offer targeted interventions. Ultimately, the study seeks to propose practical and effective strategies to alleviate psychological distress and enhance well-being. Methods 1. Study Participants A cohort of sixteen clinical master’s students, enrolled in the "Four-Certificates-in-One" program with a specialization in OB/GYN was selected for semi-structured interviews. These participants were drawn from a medical university located in Wuhan, China. The OB/GYN specialty was chosen due to its reputation as the most clinically demanding discipline, thereby maximizing the potential to observe the effects of time-related conflicts. Ethical approval for the study was granted by the Medical Ethics Committee of Zhongnan Hospital, Wuhan University (Approval No. 2025087K), and all participants provided voluntary written informed consent. 2. Research Methods A qualitative research methodology was utilized, emphasizing a comprehensive examination of participants within their natural environments. The data collection process prioritized an interpretive understanding of behaviors and the construction of meaning through interactive engagement between researchers and participants. Thematic analysis was subsequently applied to the collected data. 2.1 Development of the Interview Guide An interview guide (see Supplementary File 1) was meticulously crafted to encompass several key areas: the balance between clinical and research activities in daily routines, subjective reactions to research-related tasks, the quality of supervisory guidance, the availability and effectiveness of research support systems, and participants' future academic and career aspirations. 2.2 Data Collection Semi-structured, individualized, in-depth interviews were conducted, ensuring that participants fully understood the study's objectives and procedures beforehand. Each session, lasting between 30 to 60 minutes, was audio-recorded in environments free from distractions. The research team continuously refined the questions throughout the process to facilitate the elicitation of genuine narratives from participants. 2.3 Data Processing and Analysis Audio transcripts were transcribed verbatim within one week following each interview. Utilizing NVivo 12, two researchers independently executed the following procedures: 1) Coded qualitative data through iterative audio review and textual calibration; 2) Ensured coding consistency by conducting a blinded independent analysis of two randomly selected transcripts; 3) Resolved any discrepancies through arbitration by a third researcher to finalize the codebook; 4) Systematically applied the finalized codebook across all transcripts to identify themes; 5) Maintained confidentiality by employing anonymized coding (N1–N16) and securely archiving the data. Thematic analysis was conducted in accordance with Braun and Clarke’s framework, [ 8 ] emphasizing inductive theme generation based on participant-driven narratives. Results 1. Participant Demographics A total of sixteen participants were interviewed for this study, consisting of 4 first-year postgraduate students, 5 second-year postgraduate students, and 7 third-year postgraduate students. The participants' admission backgrounds were as follows: 6 students were enrolled through the 5 + 3 integrated program, which combines a five-year undergraduate education with a three-year postgraduate education, including concurrent standardized residency training, culminating in a master's degree; 8 students were admitted from external institutions through entrance examinations; and 2 students were admitted internally through entrance examinations. A summary of the demographic characteristics of the participants is presented in Table 1 . Table 1 Demographic Characteristics of Participants (N = 16) ID Gender Residency Year Admission Background N1 Female First-year External entrance N2 Female Third-year 5 + 3 integrated program N3 Male Third-year Internal entrance N4 Female Third-year External entrance N5 Female Third-year 5 + 3 integrated program N6 Female Second-year Internal entrance N7 Female First-year External entrance N8 Female First-year External entrance N9 Female Second-year External entrance N10 Female Third-year 5 + 3 integrated program N11 Female Second-year External entrance N12 Female Second-year External entrance N13 Female First-year External entrance N14 Female Second-year 5 + 3 integrated program N15 Male Third-year 5 + 3 integrated program N16 Female Third-year 5 + 3 integrated program Interview Findings Thematic analysis identified five core themes: Theme 1: The impact of a demanding clinical workload on research time allocation 1.1 The Time-Energy Depletion Crisis Between Clinical Rotations and Research Participants universally identified scheduling conflicts and energy allocation as primary barriers to balancing clinical duties and research. The extensive demands of clinical responsibilities consumed significant time and energy, leaving insufficient capacity for research activities following clinical duties. Prolonged workloads and night shifts induced severe exhaustion and emotional instability. N1: "Time is the fundamental problem—most hours are spent on clinical work. The OB/GYN residency is exceptionally demanding. After shifts, we just want to sleep and rest—our energy simply cannot keep up." N2: "The primary issue is time pressure: clinical duties, coursework, and exams create significant stress. Secondly, there is an energy conflict: experiments and manuscript revisions have deadlines, yet clinical work cannot be neglected, leading to inevitable clashes." N11: "The core issue is scheduling. Work computers are occupied during the day, necessitating clinical research follow-ups after 6 PM. Contacting patients post-duty conflicts with their rest time, resulting in limited daily contact." 1.2 The Fragmented Research Time Undermining Efficiency Numerous participants reported encountering significant obstacles in sustaining research continuity due to their clinical schedules, which severely compromised their productivity. N16: "I read literature during clinical breaks, but efficiency is generally low in such states." N10: "I try doing experiments during work intervals, but only get fragmented results." N12: "Sometimes I’m forced to halt experiments midway and return to clinical tasks." Theme 2: The discrepancy between supervisors' high expectations and the provision of guidance and support 2.1 High Research Output Demands and Group Meeting Pressures Participants consistently expressed experiencing considerable stress stemming from supervisors and obligatory group meetings. The frequency of these meetings, coupled with unpredictable research progress due to clinical obligations, induced anxiety, distress, and psychological overwhelm. Unrealistically high expectations and recurrent critical feedback further exacerbated emotional instability even disrupted sleep patterns. N7: "Lab group meetings are extremely frequent. If there’s no progress, we get repeatedly criticized, which sometimes makes people feel very depressed." N10: "I think our supervisor has excessively high expectations for us. Whether we’re Academic or clinical postgraduates, we’re all required to produce similar research output." N14: "Our research group holds weekly meetings. Regardless of clinical performance, everyone must report research results every week and it’s quite stressful. I feel extremely overwhelmed. My emotions become unstable—it affects my rest, causes anxiety-induced insomnia, and I need sleeping pills to fall asleep." 2.2 Absence of Structured Mentorship and Planning Several participants underscored a lack of adequate supervisory guidance, characterized by undefined training trajectories and milestone targets. The clinical commitments of supervisors or their lack of relevant research expertise limited the provision of substantive support. N9: "I believe supervisors should first establish clear training plans and roadmaps for students, defining achievable goals. Right now, doing experiments seems solely for publishing papers, with no phased arrangements." N12: "Our supervisors are usually clinicians—they can’t focus entirely on students’ research. Sometimes my supervisor doesn’t even understand what I’m actually doing." 2.3 Deficiency in Hands-on Research Mentoring The lack of dedicated research mentorship during the initial stages led to confusion in experimental design, implementation, and troubleshooting. N4: "Not having a proper 'pathfinder' makes me lost. I don’t know where to start." N12: "When I first entered the master’s program, all peers were clinical postgraduates. Almost no one around had lab experience. So, I felt utterly confused about advancing my project and pushing experiments forward—it put huge pressure on me." N15: "Some research teams have junior supervisors dedicated to scientific guidance. They provide comprehensive, professional support. Our team lacks this, making me somewhat uneasy." 2.4 Autonomy Constraints in Supervisor-Dominated Research Models Participants reported experiencing restrictive research environments where supervisors-imposed protocols, thereby relegating students to the role of executors rather than fostering their development as independent investigators. N6: "I face too many constraints in research. Every result must be reported to my supervisor for scrutiny—there’s no freedom." N9: "The ideal mentor-student relationship is for the mentor to act like a 'pathfinder' who corrects your course when you deviate. But reality is different: we’re often told exactly what to do, turning students into 'lab technicians'." Theme 3: The inadequacy of research training support systems for students pursuing specialized Master's programs 3.1 Deficient Foundational Training and Ineffective Course Design with Insufficient Learning Resources The participants' lack of undergraduate research training significantly impeded their progress in graduate studies. Institutional support systems were inadequate in addressing specific needs, compelling students to engage in self-directed online learning due to the absence of necessary resource systems. N8: "I had no research exposure during undergrad—the university offered no related courses. Current research courses mainly cover epidemiology, lacking specific experimental technique training." N13: "Our learning feels unsystematic. We only study what’s immediately needed. School courses are scheduled during clinical hours, making attendance nearly impossible." N15: "The university provides research courses, but they’re too basic and outdated to be useful. Ultimately, I teach myself by reading literature or learning from websites through trial and error." 3.2 Uneven Resource Allocation and Funding Constraints Participants highlighted the preferential allocation of resources toward research-focused Master’s students, which resulted in limited access to laboratory facilities and stringent funding conditions that hindered the scientific development of specialized students. N3: "Lab conditions are mediocre—many experiments can’t be performed there, forcing us to public platforms. Lab supervisors strictly control funding, deliberating over every expense. Some costs aren’t reimbursed at all." N11: "Academic Master’s students get abundant resources from the university and supervisors. Clinical Master’s teams don’t cultivate you like them—we’re not doing daily lab research." Theme 4: The absence of positive feedback in research endeavors 4.1 Frustration from Inherent Delayed Feedback in Experimental Science and Peer Competition Pressure Frequent failures in research efforts diminished motivation among students. The uncertainty surrounding the ownership of research outcomes, combined with technical challenges in fundamental research and intensified peer competition, exacerbated feelings of self-doubt and anxiety among clinical master’s students. N10: "Most peers in the lab are research-focused master’s students. They spend most time on research and have stronger overall scientific capabilities than us clinical-track students. This peer pressure is quite severe pressure from contemporaries makes me anxious." N11: "Completing a project only to find statistically insignificant results is truly discouraging." N14: "I’m involved in a large-scale project with a long cycle, starting from pilot experiments. It’s hard to get quick results and positive feedback. I feel only pursuing a PhD can complete this project, causing overwhelming anxiety. Whether experimental results are good or bad also affects my mood—emotional fluctuations become intense." 4.2 Interpersonal Relationship Pressure The frequent requests for leave, necessitated by experimental schedules, generated tension with clinical mentors and fostered resentment among peers. N3: "Experiments must follow the lab’s pace, sometimes requiring clinical leave. This inevitably leads to complaints from clinical colleagues. It somewhat damages interpersonal relationships among students." N5: "Clinical mentors never underwent standardized training. They may not understand or even criticize us—I feel wronged." Theme 5: The lack of research motivation and its conflict with career planning 5.1 Questioning Research Value and Forced Research Engagement Some individuals perceived research as a compulsory activity for graduation or career progression rather than a pursuit driven by intellectual curiosity, leading to skepticism and negativity towards research-related tasks. N1: "Grant applications now all require basic experimental work. Clinical projects seem useless to me. Though I dislike research, I’ll still do it for career prospects." N10: "I lack enthusiasm for research or paper-writing. I aspire to be a clinician, but the system forces doctors to produce outputs, papers, and conduct research." 5.2 PhD Application Competition and Career Plan Compromise Most participants observed that research output has increasingly become the primary criterion for assessing clinical competence. The dual emphasis of the "Four-Certificates-in-One" model gradually diminishes the competitiveness of PhD candidates, compelling them to make compromises in their career plans. N12: "Reality is clinical skills can’t be measured. PhD supervisors and employers can’t evaluate them. But research is quantifiable—everyone sees your publication count and quality." N16: "I want to pursue a PhD, but applications mainly score research output and publications. Clinical master’s students lack advantage here." N14: "Current PhD applications demand outstanding Master’s achievements. After realizing I can’t balance clinical and research work, I’ve essentially abandoned PhD plans." Discussion This study, through interviews with OB/GYN trainees participating in the "Four-Certificates-in-One" program, uncovers widespread research anxiety within the context of China's medical education collaboration reform. We elucidate the mechanisms and structural contradictions contributing to this anxiety among clinical Master's students. Five primary factors were identified: The impact of a demanding clinical workload on research time allocation; The discrepancy between supervisors' high expectations and the provision of guidance and support; The inadequacy of research training support systems for students pursuing specialized Master's programs; The absence of positive feedback in research endeavors; and the lack of research motivation and its conflict with career planning. By integrating empirical findings with existing literature, we propose multi-tiered policy optimization strategies to address these issues. Coordinated interventions involving individual students, supervisors, clinical departments, and institutions are crucial to alleviating psychological distress and enhancing both physical and mental well-being. Theme 1: The impact of a demanding clinical workload on research time allocation The conflict between clinical responsibilities and allocated research time emerges as a fundamental contributor to research-related anxiety, a challenge consistently highlighted by all interviewees within the OB/GYN department. Numerous domestic and international studies have identified the lack of time as the most frequently cited impediment to research participation. [ 9 – 11 ] A study specifically examining barriers to research during the training of oral and maxillofacial surgery (OMS) residents also identified insufficient time as the primary obstacle. [ 12 ] Previous research across various surgical specialties consistently underscores inadequate time as a significant barrier to research engagement. [ 13 – 17 ] Although medical-educational integration policies aim to enhance clinical competency, they often fall short in adequately addressing the necessity for coherent research training. Typically, clinical rotations and research assessments are designed as separate modules, devoid of integration mechanisms, resulting in severely fragmented research time. The compounded pressures of clinical duties and research obligations lead to both physical and mental exhaustion. [ 4 ] This situation may arise from an institutional contradiction wherein hospitals enforce stringent requirements for clinical hours that conflict with the inherently flexible time demands of research activities. To address this issue, a multi-faceted strategy is proposed. At the individual level, trainees should adopt time management techniques utilized by successful physician-scientists to effectively prioritize among research, clinical rotations, and routine tasks. [ 18 ] This includes breaking down large research projects into manageable sub-tasks, such as 30–60 minute research modules, and scheduling dedicated weekly time slots for these modules, potentially outside of peak clinical hours. Such an approach can enhance continuity, minimize the penalties associated with task-switching, and improve the efficient allocation of fragmented time. [ 19 ] At the Departmental support level: It is highly recommended that trainees be provided with sufficient protected research time. [ 14 , 20 ] In clinical departments where night shift demands are less intense, the implementation of compensatory leave systems may prove advantageous. For instance, two consecutive night shifts could be compensated with an additional rest day. Alternatively, a clinical workload credit system could be established, allowing individuals who exceed their clinical obligations to exchange credits for protected research time. Moreover, the introduction of flexible adjustment periods of 1–2 weeks prior to significant research milestones, such as manuscript submissions or mid-term evaluations, is advisable. During these periods, trainees could apply, ideally two weeks in advance, to defer clinical responsibilities in order to secure dedicated time for research activities. At the institutional level, whether in schools or hospitals, optimizing rotation schedules is of paramount importance. The introduction of dedicated "research rotation blocks" or the implementation of quarterly "research weeks," during which clinical duties are suspended, can facilitate systematic training, data analysis, and manuscript preparation. This approach could be complemented by mandatory quarterly progress reports to assess goal attainment. Research has demonstrated that residents in 6-year urology residency programs, which include a dedicated research year, produce nearly twice the academic output compared to those in 5-year programs. [ 11 ] Furthermore, dedicated research time is positively associated with residents pursuing fellowship training or academic careers. [ 11 , 21 ] Crucially, when planning institutional "research weeks," it is crucial to allocate personnel across departments carefully to prevent disruptions in clinical operations; AI-assisted scheduling can be instrumental in achieving balanced staffing. Additionally, the establishment of a "protected research day" policy during rotations, such as designating one fixed weekday free from clinical duties, could promote sustained research engagement. At the policy level, adjustments to training duration or task allocation ratios should be considered. Implementing flexible program lengths, such as extended timelines, could alleviate periods of intense pressure in the short term. Theme 2: The discrepancy between supervisors' high expectations and the provision of guidance and support The majority of participants reported experiencing pressure originating from their supervisors. The expectations set by supervisors, along with their mentoring abilities and training methodologies, can significantly contribute to the stress experienced by trainees. Supervisors are pivotal in influencing academic productivity, [ 11 , 22 , 23 ] , and inadequate mentorship during training is acknowledged as a factor leading to decreased interest in pursuing academic careers. [ 24 ] Certain supervisors employ a "pressure-to-produce" strategy, characterized by frequent group meetings and directive task assignments, whereas others provide limited guidance, adopting a "laissez-faire" approach. While frequent meetings may become sources of criticism and anxiety, the "laissez-faire" approach and insufficient mentorship can further exacerbate research inefficiencies and increase anxiety related to decision-making. The fundamental cause of the institutional contradiction lies in the performance evaluation criteria for supervisors, which prioritize scientific research achievements—such as publications and projects—over the educational experience of students. This emphasis on "output" rather than "education" results in a research environment that restricts students' autonomy in selecting research topics and fails to ensure their academic independence, thereby fostering dependence and passivity. Additionally, due to the demands of clinical work or misalignment in research directions, the absence of mandatory provisions for a dual-supervisor collaboration system at the university further impedes the provision of substantive guidance to students. To address the aforementioned issues, the university might contemplate implementing a Scientific Research Objective Agreement between faculty and students upon admission. This agreement would delineate the responsibilities, expected outcomes, and communication frequency for both parties, [ 25 ] thereby mitigating the additional pressure on students resulting from high expectations set by their advisors regarding research output. Furthermore, to ensure that students receive comprehensive guidance, institutions could establish a "dual mentorship collaboration mechanism". [ 26 , 27 ] Under this system, each student would be paired with both a clinical mentor and a research mentor, with clearly defined roles and evaluation criteria. A joint mentorship agreement would be signed, specifying the responsibilities of each mentor, as well as the minimum duration and content of mentorship sessions, which would include intensive literature review and project design. Additionally, trainees often lack foundational knowledge in areas such as statistics. This deficiency is corroborated by the study conducted by Best et al., which found that residents generally have a limited understanding of biostatistics. [ 28 ] To enhance the support provided to students undertaking clinical projects, we recommend that they seek interdisciplinary research mentors or establish a joint advisory committee comprising clinical, statistical, and ethical experts to offer comprehensive guidance. Faculty members in medical colleges and universities play a crucial role in addressing students' psychological challenges. They should demonstrate genuine concern for students, assist them in embracing challenges, and encourage them to view setbacks and failures as opportunities for learning rather than reflections of personal inadequacy. To improve the mentoring capabilities of faculty, it is essential for new mentors to undergo training that includes communication skills and career planning guidance. Additionally, enhancing mentors' emotional intelligence through training in non-violent communication, active listening, and related skills can contribute to a positive laboratory environment. [ 25 ] To assess the effectiveness of mentorship, institutions could implement an anonymous evaluation system where students provide feedback at the end of each semester. [ 29 ] These evaluations should be considered in the review process for mentors' professional advancement. To address the deficiency in teaching, the university might contemplate appointing "scientific research counselors" for clinical master's students. This initiative would involve experienced senior full-time doctoral students, senior students, and junior students dedicating two hours per week to address inquiries within a "scientific research clinic." Participation in this program could be incentivized through scholarship credits. Additionally, a structured, tiered training program could be implemented during the master's phase, encompassing three stages: "introductory, advanced, and practical application" in scientific research. Furthermore, personalized one-on-one skills coaching would be offered. [ 30 ] Conversely, to enhance the autonomy and innovative capabilities of students, the university could establish an "Innovation and Exploration Fund" specifically for clinical master's degree candidates. This would allow students to apply directly for financial support for project development, independent of their supervisors. Furthermore, a reform of student-led group meetings could be implemented within research groups. For instance, a monthly "Student Proposal Group Meeting" could be organized, where students independently determine the topics, such as addressing experimental challenges, while faculty advisors offer professional guidance and resource support. Theme 3: The inadequacy of research training support systems for students pursuing specialized Master's programs The absence of comprehensive research training in undergraduate programs, combined with the substantial publication expectations during Master's studies, significantly contributes to students' "competence anxiety". [ 31 ] The inadequacy of practical curricula and the uneven distribution of resources compel students to depend heavily on self-directed learning or peer assistance. A fundamental institutional issue resides in the medical education system's inability to establish a coherent pathway for the development of "clinical-research" competencies. The disjunction between undergraduate and Master's education, along with insufficient institutional research support for clinically-oriented master’s students, results in knowledge transfer being excessively reliant on the expertise of individual supervisors. This situation perpetuates foundational deficiencies among students, ultimately giving rise to a "Matthew effect," wherein individuals with initial advantages continue to accrue further benefits. Numerous studies indicate that the absence of established research curricula is a significant factor contributing to diminished scholarly activity. [ 9 , 32 ] A survey conducted among internal medicine residents revealed that 44% of participants identified the lack of research courses as a major impediment. [ 33 ] Panchal et al. highlighted that the implementation of structured research curricula, alongside securing funding and providing support from research staff, can significantly enhance resident productivity. [ 34 ] To effectively bridge the gap between undergraduate education and graduate studies, institutions should undertake curricular reforms by introducing mandatory research courses for junior students. These courses could include titles such as "Research Training from 0 to 1," "Medical Research Design," and "Practical Statistics" , focusing on essential skills like literature critique and experimental design. Additionally, the development of an online repository for research courses would enable students to access and review materials flexibly, accommodating their work commitments. The integration of 3D virtual laboratories, such as surgical simulations and statistical software scenarios, can mitigate practical barriers, while providing complimentary access to premium online skill courses facilitates self-directed learning. Furthermore, extending laboratory hours to evenings and weekends, coupled with on-demand equipment training videos, can decrease the costs associated with self-learning. Clinical master’s students often lack substantial time blocks for conducting basic research, leading most to satisfy graduation requirements through clinical projects or database analyses supplemented by small-scale experimental validation. Nonetheless, these students still invest considerable time in collecting clinical data and acquiring bioinformatics skills independently. To address these challenges, academic institutions could develop a standardized research case repository and a shared platform for de-identified clinical databases, alongside a virtual simulation laboratory that demonstrates the entire process from clinical inquiry to publication. Students could apply for access to data for retrospective studies, thereby reducing the time required for data collection and manuscript preparation. Encouraging collaborative models, where students share data, can alleviate individual burdens and promote mutually beneficial outcomes. To mitigate limitations in experimental platforms and research funding, institutions might consider establishing specialized facilities and offering small seed grants to support exploratory pilot studies. [ 35 ] Alternatively, they could implement a lump-sum research funding model that allocates basic research budgets on a per-student basis for independent use. It is recommended that students document unsuccessful experimental data in shared technical memoranda to prevent redundant trial-and-error processes. For sustainable solutions, comprehensive healthcare reforms are essential, including the introduction of foundational undergraduate courses such as scientific literature analysis and experimental design, as well as the active promotion of undergraduate involvement in innovative research projects. Theme 4: The absence of positive feedback in research endeavors Participants frequently reported encountering substantial adjustment pressures and psychological challenges during the initial transition into the clinical phase. Students often struggle to reconcile their dual roles as "clinicians" and "research trainees," resulting in difficulties balancing multiple responsibilities. This role conflict frequently induces interpersonal stress. When combined with slow project progress and the pressure of peer competition, these factors readily cultivate negative emotions such as frustration, anxiety, and even depression. In the absence of staged recognition in research exploration (e.g., normalization of experimental failures), students become vulnerable to a cognitive dilemma characterized by an "effort-feedback disconnect." [ 4 ] The institutional origins of this issue can be traced to an evaluation system that excessively emphasizes competition, fostering an "involution" culture—characterized by intense, zero-sum competition—that exacerbates anxiety and self-doubt. [ 31 ] Additionally, there is insufficient coverage of university psychological counseling services and a lack of embedded psychological intervention mechanisms. Medical schools are advised to promote an educational environment where students are encouraged to proactively engage with and address challenges, as opposed to circumventing them. To facilitate this, institutions should regularly organize career planning workshops aimed at assisting students in defining their professional objectives. [ 36 ] Furthermore, alumni who have successfully navigated setbacks should be periodically invited to share their experiences, thereby aiding in the mitigation of perfectionist tendencies and self-doubt among current students. It is imperative that equal emphasis is placed on the physical and mental well-being of clinical medicine graduate students, alongside the development of their professional knowledge and skills. To this end, regular mental health screenings should be instituted, including the establishment of counseling facilities within research buildings and the administration of psychological assessments, such as the SCL-90 scale, on a semesterly basis. It is recommended that cross-grade peer support groups be established, accompanied by regular non-academic exchange activities. Students exhibiting high levels of emotional intelligence should be designated as "mental health ambassadors" and, following appropriate training, provide initial psychological support. Additionally, professional psychologists should be employed to deliver on-demand counseling services. An anonymous intra-institutional forum should be created, incorporating a "Tree Hole" section where psychological support teams can offer regular feedback. For individuals assessed as low-risk, mindfulness meditation and breathing exercises should be provided bi-monthly. Conversely, for high-risk individuals, targeted interventions should be implemented, including 6-week group Cognitive Behavioral Therapy (CBT) sessions aimed at restructuring negative thought patterns. These comprehensive strategies are intended to mitigate students' challenges in adjustment. Theme 5: The lack of research motivation and its conflict with career planning The collaborative medical education policy inadequately delineates the professional roles of clinical master's students, with vague training objectives further exacerbating role conflicts, which are rooted in institutional shortcomings. Research conducted by Chan J Y et al. suggests that trainees' belief in the intrinsic value of research significantly influences their engagement in research activities, thereby impacting their career trajectories. [ 32 ] Interviews with professional master's students reveal a prevalent utilitarian perspective on the value of research, coupled with a deficiency in intrinsic motivation. This underscores a compelling logic linking research to career progression: despite perceiving research as having limited intrinsic value, students feel obligated to engage in it due to external pressures such as doctoral program applications, grant submissions, and professional title evaluations. As a result, they adopt "short-cycle" research strategies, such as bioinformatics analysis and data mining, which deviate from the core principles of innovative research, reducing it to a mere "access pass." This utilitarian approach starkly contradicts the students' initial aspirations, forcing them to choose between "short-term survival" and "long-term development." It is imperative to establish clear career trajectories for students pursuing clinical master's degrees. Hospitals should consider implementing a dual-track system that differentiates between "clinical specialists" and "clinical scientists" to promote career diversification. Healthcare institutions should be encouraged to revise recruitment and promotion criteria to incorporate clinical skills, patient satisfaction, and other essential indicators. [ 37 ] Medical schools should aim to reduce the emphasis on paper-centric evaluation systems and develop diversified assessment frameworks. For example, graduation requirements could include clinical case reports, literature reviews, teaching contributions, and other multifaceted achievements. [ 38 ] For students intending to pursue doctoral studies, the formation of "Ph.D. application advisory teams" is recommended to provide comprehensive support, including strategies for school selection and guidance on recommendation letters. Furthermore, flexible academic reforms should be implemented for students unable to meet graduation deadlines on time, allowing them to apply for extensions of 0.5 to 1 year six months in advance to alleviate short-term pressures. This comprehensive approach effectively could alleviate systemic pressures on students while fostering the development of diverse talents. Conclusions The education of resident physicians in research is of paramount importance. Improving the quality of training is essential for fostering innovation among students, enhancing institutional capabilities, and advancing the field at large. Research-related anxiety, particularly under the "four-certificates-in-one" model, emerges as a complex interplay of institutional contradictions within the collaborative reform of medical education and individual adaptive challenges. The anxiety experienced by this cohort constitutes a pressing social issue that necessitates immediate attention. Professional postgraduate students need not only a mindset oriented towards personal growth and proactive coping strategies for effective adaptation but also supportive guidance from instructors and comprehensive research support and evaluation mechanisms provided by their institutions. Addressing this challenge necessitates a comprehensive and coordinated approach encompassing policy design, institutional collaboration, departmental support, mentorship, and individual adaptation. Achieving this objective involves optimizing time management, enhancing research capacity building, and reforming evaluation systems to facilitate the seamless integration of clinical practice and research. Future research should investigate the feasibility of policy implementation and offer tailored solutions for medical students across diverse regions and specialties. Only through collaborative efforts across multiple domains can anxiety within this population be effectively mitigated, thereby enhancing their self-care awareness and capabilities and promoting their physical and mental well-being. This, in turn, will contribute to strengthening their professional identity and enthusiasm, ultimately boosting their confidence and expectations for the future. Limitations of This Study The participants chosen for this study had thoroughly contemplated these issues. The sample predominantly comprised female interviewees, reflecting the current demographic trends within the OB/GYN specialty, which may not be representative of all postgraduate students pursuing the "four-certificates-in-one" program at this university. Furthermore, as the interviewees were drawn from a particular medical school in Wuhan, the results may not be applicable to other medical institutions. Abbreviations OB/GYN Obstetrics and Gynecology Declarations Ethics approval and consent to participate Ethical approval for the study was granted by the Medical Ethics Committee of Zhongnan Hospital, Wuhan University (Approval No. 2025087K), and all participants provided voluntary written informed consent. The research procedures complied fully with the ethical standards of the Declaration of Helsinki. Clinical trial number Not applicable Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors disclose that there are no financial interests or personal relationships that could have potentially influenced the findings or interpretations presented in this study. Funding This study has received support from the National Natural Science Foundation of China (82303671 and 82103620) Authors' contributions Xuechen Yu and Rourou Xiao drafted the manuscript. Wenhui Liu performed the literature collection and classification. Wei Zhang and Huijun Chen performed the manuscript review and editing. All authors read and approved of the final manuscript. Acknowledgements We thank the 16 graduate students for participating in this study and sharing their genuine thoughts on research. References Li J, Fuquan L. 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The Difference a Year Can Make: Academic Productivity of Residents in 5 vs 6-Year Urology Programs. Urology. 2015;86(2):220–3. Thompson R, Houston CM, Lohse DA, Husmann BC, Leibovich, Gettman MT. Predictors of Scholarly Productivity, Pursuit of Fellowship, and Academic Practice Among Urology Residents Using Medical Student Application Materials. Urology. 2018;120:49–55. Ho AH, Matthew J, Sansevere, Chou JC. Barriers to research among residents in oral and maxillofacial surgery. J Dent Educ. 2024;88(6):755–64. Abramson EL, Monique M, Naifeh MD, Stevenson E, Mauer HT, Hammad LM, Gerber, Su-Ting T, Li. Scholarly Activity Training During Residency: Are We Hitting the Mark? A National Assessment of Pediatric Residents. Acad Pediatr. 2018;18(5):542–9. Barriers and Attitudes to Research Among Residents in Plastic and Reconstructive Surgery: A National Multicenter Cross-Sectional Study. J Surg Educ, 2017. 74(6): pp. 1094–104. Mansi A, Karam WN, Chaaban MR. Attitudes of Residents and Program Directors Towards Research in Otolaryngology Residency. The Annals of Otology, Rhinology, and Laryngology, 2019. 128(1): pp. 28–35. Fournier I, Stephenson K, Fakhry N, Jia H, Sampathkumar R, Lechien JR, Melkane AE, Bahgat AY, De Carvalho K, Lopes T, Kennel N, Teissier, Ayad T. Barriers to research among residents in Otolaryngology - Head & Neck Surgery around the world. European Annals of Otorhinolaryngology, Head and Neck Diseases, 2019. 136(3S): pp. S3-S7. Faber LS, Jurado M, Bennett-Perez R, Alba FM. Scholarly Activity and Research Training in Urology Residency Programs: Assessment of Current Practice and Barriers. Urology. 2022;168:41–9. Edna Martinez C, Ordu atthewR, Della Sala, McFarlane A. Striving to Obtain a School-Work-Life Balance: The Full-Time Doctoral Student. Int J Doctoral Stud. 2013;8:039–59. Schiller JH, Brent Stansfield R, Belmonte DC, Joel A, Purkiss RM, Reddy JB, House, Santen SA. Medical Students' Use of Different Coping Strategies and Relationship With Academic Performance in Preclinical and Clinical Years. Teaching and Learning In Medicine, 2018. 30(1): pp. 15–21. Rivera JA, Rachel B, Levine, Wright SM. Completing a scholarly project during residency training. Perspectives of residents who have been successful. J Gen Intern Med. 2005;20(4):366–9. Grady EC, Roise A, Barr D, Lynch D, Lee KB-S, Daskivich T, Dhand A, Butler PD. Defining Scholarly Activity in Graduate Medical Education. J Graduate Med Educ. 2012;4(4):558–61. Stevenson MD, Elizabeth M, Smigielski MM, Naifeh EL, Abramson C, Todd, Su-Ting T, Li. Increasing Sch Activity Productivity Dur Residency: Syst Rev. 2017;92(2):250–66. Gangwish DJ, Carolyn A, Parshall F, Qeadan M, Jurado RN, Bennett, Alba FM. Predictors and Barriers to Faculty Scholarly Activity in United States Urology Residency Programs. Urology. 2020;139:37–43. Reck SJ, Erik J, Stratman C, Vogel, Mukesh BN. Assessment of Residents' Loss of Interest in Academic Careers and Identification of Correctable Factors. Arch Dermatol. 2006;142(7):855–8. Sarabipour S, Niemi N, Burgess S, Smith C, Filho A, Clark K. Insights Surv mentorship experiences graduate postdoctoral researchers. 2023. Rothberg MB, Kleppel R, Friderici JL, Hinchey K. Implementing a resident research program to overcome barriers to resident research. Acad Medicine: J Association Am Med Colleges. 2014;89(8):1133–9. Harrison LM, Randy J, Woods MC, McCarthy, Parikh PP. Development and implementation of a sustainable research curriculum for general surgery residents: A foundation for developing a research culture. Am J Surg. 2020;220(1):105–8. Best AM, Daniel M, Laskin. Oral and maxillofacial surgery residents have poor understanding of biostatistics. J Oral Maxillofacial Surgery: Official J Am Association Oral Maxillofacial Surg. 2013;71(1):227–34. Pekdemir E, Aktay S. Expectations, Problems and Solutions for Postgraduate Academic Advisory in Study of Primary School Teacher Education. Anadolu Üniversitesi Eğitim Fakültesi Dergisi; 2024. p. 8. Xu J, Ming F, Jingzhu D, Jia Z, Hong B. Exploration and practice of innovative model of ability-oriented training for general practitioners. Chin J Med Educ Res. 2022;21(1):78–81. (in Chinese). Jin Xue Z, Jianxin D, Aimei C, Chunhua Z, Guopeng. Experience and perception of general practice residents on standardized training based on stratified progressive teaching model: a qualitative study. Chin J Gen Practitioners. 2023;22(12):1248–53. (in Chinese). Chan JY, Narasimhalu K, Goh O, Xin X, Wong TY, Thumboo J, Phua GC. Resident research: why some do and others don’t. Singapore Med J. 2017;58(4):212–7. Rivera JA, Rachel B, Levine, Wright SM. Brief report: Completing a scholarly project during residency training. J Gen Intern Med. 2005;20(4):366–9. Panchal A, Denninghoff K, Munger B, Keim S. Scholar Quest: A Residency Research Program Aligned With Faculty Goals. Western J Emerg Med. 2014;15(3):299–305. Lv M. The Problems and Coping Strategies of Scientific Research Management in Universities under the Background of Big Data. Volume 6. Education Reform and Development; 2024. 5. Liu Junxiang L, Yiyao, Wang, Zhonghui. The Exploration of the Psychological Mechanism of Mindfulness Meditation in Alleviating Anxiety. Med Philos. 2022;43(16):30–3. (in Chinese). Mei Lin Z, Kan Z, Rong. Analysis of Influencing Factors of Standardized Training of Residents in Shanghai. Chin Hosp Manage. 2018;38(6):42–6. (in Chinese). Zhang Pengsi W, Qiong Z, Minghui F, Yue P, Dongmei. Research on Present Situation and Standardized Residency Training Model in General Practice. China Continuing Med Educ. 2020;12(17):74–7. (in Chinese). Additional Declarations No competing interests reported. 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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-7010029","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":498958834,"identity":"2b8d6196-3ab4-49df-b7b3-7da3932f7d88","order_by":0,"name":"Rourou Xiao","email":"","orcid":"","institution":"Zhongnan Hospital of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Rourou","middleName":"","lastName":"Xiao","suffix":""},{"id":498958841,"identity":"e423ebeb-6e46-4c86-b850-42f5a97dcd36","order_by":1,"name":"Wei Zhang","email":"","orcid":"","institution":"Zhongnan Hospital of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Zhang","suffix":""},{"id":498958842,"identity":"8b03179c-b3c0-448a-a5ba-eeda46c8a266","order_by":2,"name":"Huijun Chen","email":"","orcid":"","institution":"Zhongnan Hospital of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Huijun","middleName":"","lastName":"Chen","suffix":""},{"id":498958844,"identity":"9c8f0212-93af-4966-89fa-b1727e465f30","order_by":3,"name":"Wenhui Liu","email":"","orcid":"","institution":"Zhongnan Hospital of Wuhan University","correspondingAuthor":false,"prefix":"","firstName":"Wenhui","middleName":"","lastName":"Liu","suffix":""},{"id":498958848,"identity":"0084de70-3fd8-4174-9b6b-81a8623ad131","order_by":4,"name":"Xuechen Yu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwklEQVRIiWNgGAWjYLCCDzwScvzMzAcfEK2DcYaMjbFkO1uyAdFamDls0hINzvOYCRCl3OBGjvFnhpzDCcaHGcwYGGpsoonQkpZgXHDmcJ7ZYYa0BwzH0nIbCGtJPpA8s+dwMVDLcQPGhsPEaElsOMz773Di5mbGNgkitSQfbObhSUvcwMzMRpwWyTPPkhln8NgYSxxmYzZIIMYvfMdzjD+Ao7L//McHH2psCGtROIDMSyCkHATkCRo6CkbBKBgFowAA6rpBaCO+cP4AAAAASUVORK5CYII=","orcid":"","institution":"Zhongnan Hospital of Wuhan University","correspondingAuthor":true,"prefix":"","firstName":"Xuechen","middleName":"","lastName":"Yu","suffix":""}],"badges":[],"createdAt":"2025-06-30 11:23:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7010029/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7010029/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":97324773,"identity":"cfb7822e-c7a9-4669-acf5-53f6d2732d12","added_by":"auto","created_at":"2025-12-03 08:26:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1414706,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7010029/v1/c469ae41-fbca-416a-99f5-6c484b32bbf4.pdf"},{"id":89002282,"identity":"6aaad69e-e532-4dae-942e-428755151ce6","added_by":"auto","created_at":"2025-08-13 15:37:16","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":19606,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1InterviewGuide.docx","url":"https://assets-eu.researchsquare.com/files/rs-7010029/v1/ad0eeca62ff7ef0d4b5e0057.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Research Anxiety Among China's \"Four-Certificates-in-One\" Master's Degree Candidates in Obstetrics and Gynecology: A Qualitative Study and Policy Optimization Pathways","fulltext":[{"header":"Background","content":"\u003cp\u003eIn 2015, the State Council of China promulgated the \u003cem\u003eOpinions on Deepening the Coordination of Medical Education and Healthcare to Further Advance Medical Education Reform and Development\u003c/em\u003e,\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e which mandated the enhancement of clinical practice training to establish an integrated \"medical education-healthcare\" cultivation system. Within this framework, students are required to simultaneously complete clinical rotations, research training, and standardized residency training, ultimately qualifying for four certifications: the Physician Practice Qualification Certificate, Standardized Training Completion Certificate, Master\u0026rsquo;s Diploma, and Master\u0026rsquo;s Degree Certificate, collectively referred to as the \"Four-Certificates-in-One\" policy.\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e While this model has standardized the acquisition of clinical skills, it has also imposed considerable research-related pressures on students. Key stressors, such as time constraints, insufficient research support systems, and the emphasis on publications as critical criteria for doctoral program admissions and employment, have contributed to pervasive research anxiety. Empirical studies suggest that post-implementation trainees experience varying levels of physiological discomfort and psychological changes, with a notable increase in depressive symptoms.\u003csup\u003e[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe term \"research anxiety\" encompasses negative emotional states\u0026mdash;such as tension, unease, and irritability\u0026mdash;induced by the various pressures and uncertainties inherent in scientific research activities. The prevailing literature primarily conceptualizes this phenomenon through a linear perspective, emphasizing time constraints and perceived competence gaps, while neglecting the significant impact of institutional constraints.\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e Moreover, existing research tends to focus on phenomenological descriptions and quantitative analyses, lacking a thorough exploration of individual experiences within the \"Four-Certificates-in-One\" model. Notably absent are qualitative investigations into the mechanisms that generate research anxiety within this group, and there is limited evidence-based research on pathways for policy optimization.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e This study utilized semi-structured interviews with \"Four-Certificates-in-One\" Master's candidates specializing in Obstetrics and Gynecology (OB/GYN) at a medical university in Wuhan, China. The aim was to document their genuine experiences during standardized residency training, identify institutional sources contributing to their research-related anxiety, and offer targeted interventions. Ultimately, the study seeks to propose practical and effective strategies to alleviate psychological distress and enhance well-being.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e1. Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cohort of sixteen clinical master\u0026rsquo;s students, enrolled in the \u0026quot;Four-Certificates-in-One\u0026quot; program with a specialization in OB/GYN was selected for semi-structured interviews. These participants were drawn from a medical university located in Wuhan, China. The OB/GYN specialty was chosen due to its reputation as the most clinically demanding discipline, thereby maximizing the potential to observe the effects of time-related conflicts. Ethical approval for the study was granted by the Medical Ethics Committee of Zhongnan Hospital, Wuhan University (Approval No. 2025087K), and all participants provided voluntary written informed consent.\u003c/p\u003e\n\u003ch3\u003e2. Research Methods\u003c/h3\u003e\n\u003cp\u003e A qualitative research methodology was utilized, emphasizing a comprehensive examination of participants within their natural environments. The data collection process prioritized an interpretive understanding of behaviors and the construction of meaning through interactive engagement between researchers and participants. Thematic analysis was subsequently applied to the collected data.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Development of the Interview Guide\u003c/h2\u003e\u003cp\u003eAn interview guide (see Supplementary File 1) was meticulously crafted to encompass several key areas: the balance between clinical and research activities in daily routines, subjective reactions to research-related tasks, the quality of supervisory guidance, the availability and effectiveness of research support systems, and participants' future academic and career aspirations.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Data Collection\u003c/h2\u003e\u003cp\u003eSemi-structured, individualized, in-depth interviews were conducted, ensuring that participants fully understood the study's objectives and procedures beforehand. Each session, lasting between 30 to 60 minutes, was audio-recorded in environments free from distractions. The research team continuously refined the questions throughout the process to facilitate the elicitation of genuine narratives from participants.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Data Processing and Analysis\u003c/h2\u003e\u003cp\u003eAudio transcripts were transcribed verbatim within one week following each interview. Utilizing NVivo 12, two researchers independently executed the following procedures: 1) Coded qualitative data through iterative audio review and textual calibration; 2) Ensured coding consistency by conducting a blinded independent analysis of two randomly selected transcripts; 3) Resolved any discrepancies through arbitration by a third researcher to finalize the codebook; 4) Systematically applied the finalized codebook across all transcripts to identify themes; 5) Maintained confidentiality by employing anonymized coding (N1\u0026ndash;N16) and securely archiving the data. Thematic analysis was conducted in accordance with Braun and Clarke\u0026rsquo;s framework,\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e emphasizing inductive theme generation based on participant-driven narratives.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\n\u003ch3\u003e1. Participant Demographics\u003c/h3\u003e\n\u003cp\u003eA total of sixteen participants were interviewed for this study, consisting of 4 first-year postgraduate students, 5 second-year postgraduate students, and 7 third-year postgraduate students. The participants' admission backgrounds were as follows: 6 students were enrolled through the 5\u0026thinsp;+\u0026thinsp;3 integrated program, which combines a five-year undergraduate education with a three-year postgraduate education, including concurrent standardized residency training, culminating in a master's degree; 8 students were admitted from external institutions through entrance examinations; and 2 students were admitted internally through entrance examinations. A summary of the demographic characteristics of the participants is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic Characteristics of Participants (N\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eID\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eResidency Year\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdmission Background\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFirst-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExternal entrance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThird-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u0026thinsp;+\u0026thinsp;3 integrated program\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThird-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInternal entrance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThird-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExternal entrance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThird-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u0026thinsp;+\u0026thinsp;3 integrated program\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSecond-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInternal entrance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFirst-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExternal entrance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFirst-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExternal entrance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSecond-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExternal entrance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThird-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u0026thinsp;+\u0026thinsp;3 integrated program\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSecond-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExternal entrance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSecond-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExternal entrance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFirst-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExternal entrance\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSecond-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u0026thinsp;+\u0026thinsp;3 integrated program\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThird-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u0026thinsp;+\u0026thinsp;3 integrated program\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThird-year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u0026thinsp;+\u0026thinsp;3 integrated program\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eInterview Findings\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThematic analysis identified five core themes:\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 1: The impact of a demanding clinical workload on research time allocation\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e1.1 The Time-Energy Depletion Crisis Between Clinical Rotations and Research\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants universally identified scheduling conflicts and energy allocation as primary barriers to balancing clinical duties and research. The extensive demands of clinical responsibilities consumed significant time and energy, leaving insufficient capacity for research activities following clinical duties. Prolonged workloads and night shifts induced severe exhaustion and emotional instability.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN1: \"Time is the fundamental problem\u0026mdash;most hours are spent on clinical work. The OB/GYN residency is exceptionally demanding. After shifts, we just want to sleep and rest\u0026mdash;our energy simply cannot keep up.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN2: \"The primary issue is time pressure: clinical duties, coursework, and exams create significant stress. Secondly, there is an energy conflict: experiments and manuscript revisions have deadlines, yet clinical work cannot be neglected, leading to inevitable clashes.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN11: \"The core issue is scheduling. Work computers are occupied during the day, necessitating clinical research follow-ups after 6 PM. Contacting patients post-duty conflicts with their rest time, resulting in limited daily contact.\"\u003c/em\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e1.2 The Fragmented Research Time Undermining Efficiency\u003c/h2\u003e\u003cp\u003eNumerous participants reported encountering significant obstacles in sustaining research continuity due to their clinical schedules, which severely compromised their productivity.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN16: \"I read literature during clinical breaks, but efficiency is generally low in such states.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN10: \"I try doing experiments during work intervals, but only get fragmented results.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN12: \"Sometimes I\u0026rsquo;m forced to halt experiments midway and return to clinical tasks.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 2: The discrepancy between supervisors' high expectations and the provision of guidance and support\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.1 High Research Output Demands and Group Meeting Pressures\u003c/h2\u003e\u003cp\u003e Participants consistently expressed experiencing considerable stress stemming from supervisors and obligatory group meetings. The frequency of these meetings, coupled with unpredictable research progress due to clinical obligations, induced anxiety, distress, and psychological overwhelm. Unrealistically high expectations and recurrent critical feedback further exacerbated emotional instability even disrupted sleep patterns.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN7: \"Lab group meetings are extremely frequent. If there\u0026rsquo;s no progress, we get repeatedly criticized, which sometimes makes people feel very depressed.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN10: \"I think our supervisor has excessively high expectations for us. Whether we\u0026rsquo;re Academic or clinical postgraduates, we\u0026rsquo;re all required to produce similar research output.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN14: \"Our research group holds weekly meetings. Regardless of clinical performance, everyone must report research results every week and it\u0026rsquo;s quite stressful. I feel extremely overwhelmed. My emotions become unstable\u0026mdash;it affects my rest, causes anxiety-induced insomnia, and I need sleeping pills to fall asleep.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Absence of Structured Mentorship and Planning\u003c/h2\u003e\u003cp\u003eSeveral participants underscored a lack of adequate supervisory guidance, characterized by undefined training trajectories and milestone targets. The clinical commitments of supervisors or their lack of relevant research expertise limited the provision of substantive support.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN9: \"I believe supervisors should first establish clear training plans and roadmaps for students, defining achievable goals. Right now, doing experiments seems solely for publishing papers, with no phased arrangements.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN12: \"Our supervisors are usually clinicians\u0026mdash;they can\u0026rsquo;t focus entirely on students\u0026rsquo; research. Sometimes my supervisor doesn\u0026rsquo;t even understand what I\u0026rsquo;m actually doing.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Deficiency in Hands-on Research Mentoring\u003c/h2\u003e\u003cp\u003eThe lack of dedicated research mentorship during the initial stages led to confusion in experimental design, implementation, and troubleshooting.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN4: \"Not having a proper 'pathfinder' makes me lost. I don\u0026rsquo;t know where to start.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN12: \"When I first entered the master\u0026rsquo;s program, all peers were clinical postgraduates. Almost no one around had lab experience. So, I felt utterly confused about advancing my project and pushing experiments forward\u0026mdash;it put huge pressure on me.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN15: \"Some research teams have junior supervisors dedicated to scientific guidance. They provide comprehensive, professional support. Our team lacks this, making me somewhat uneasy.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Autonomy Constraints in Supervisor-Dominated Research Models\u003c/h2\u003e\u003cp\u003eParticipants reported experiencing restrictive research environments where supervisors-imposed protocols, thereby relegating students to the role of executors rather than fostering their development as independent investigators.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN6: \"I face too many constraints in research. Every result must be reported to my supervisor for scrutiny\u0026mdash;there\u0026rsquo;s no freedom.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN9: \"The ideal mentor-student relationship is for the mentor to act like a 'pathfinder' who corrects your course when you deviate. But reality is different: we\u0026rsquo;re often told exactly what to do, turning students into 'lab technicians'.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 3: The inadequacy of research training support systems for students pursuing specialized Master's programs\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Deficient Foundational Training and Ineffective Course Design with Insufficient Learning Resources\u003c/h2\u003e\u003cp\u003eThe participants' lack of undergraduate research training significantly impeded their progress in graduate studies. Institutional support systems were inadequate in addressing specific needs, compelling students to engage in self-directed online learning due to the absence of necessary resource systems.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN8: \"I had no research exposure during undergrad\u0026mdash;the university offered no related courses. Current research courses mainly cover epidemiology, lacking specific experimental technique training.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN13: \"Our learning feels unsystematic. We only study what\u0026rsquo;s immediately needed. School courses are scheduled during clinical hours, making attendance nearly impossible.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN15: \"The university provides research courses, but they\u0026rsquo;re too basic and outdated to be useful. Ultimately, I teach myself by reading literature or learning from websites through trial and error.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Uneven Resource Allocation and Funding Constraints\u003c/h2\u003e\u003cp\u003eParticipants highlighted the preferential allocation of resources toward research-focused Master\u0026rsquo;s students, which resulted in limited access to laboratory facilities and stringent funding conditions that hindered the scientific development of specialized students.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN3: \"Lab conditions are mediocre\u0026mdash;many experiments can\u0026rsquo;t be performed there, forcing us to public platforms. Lab supervisors strictly control funding, deliberating over every expense. Some costs aren\u0026rsquo;t reimbursed at all.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN11: \"Academic Master\u0026rsquo;s students get abundant resources from the university and supervisors. Clinical Master\u0026rsquo;s teams don\u0026rsquo;t cultivate you like them\u0026mdash;we\u0026rsquo;re not doing daily lab research.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 4: The absence of positive feedback in research endeavors\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003e4.1 Frustration from Inherent Delayed Feedback in Experimental Science and Peer Competition Pressure\u003c/h2\u003e\u003cp\u003eFrequent failures in research efforts diminished motivation among students. The uncertainty surrounding the ownership of research outcomes, combined with technical challenges in fundamental research and intensified peer competition, exacerbated feelings of self-doubt and anxiety among clinical master\u0026rsquo;s students.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN10: \"Most peers in the lab are research-focused master\u0026rsquo;s students. They spend most time on research and have stronger overall scientific capabilities than us clinical-track students. This peer pressure is quite severe pressure from contemporaries makes me anxious.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN11: \"Completing a project only to find statistically insignificant results is truly discouraging.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN14: \"I\u0026rsquo;m involved in a large-scale project with a long cycle, starting from pilot experiments. It\u0026rsquo;s hard to get quick results and positive feedback. I feel only pursuing a PhD can complete this project, causing overwhelming anxiety. Whether experimental results are good or bad also affects my mood\u0026mdash;emotional fluctuations become intense.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003e4.2 Interpersonal Relationship Pressure\u003c/h2\u003e\u003cp\u003eThe frequent requests for leave, necessitated by experimental schedules, generated tension with clinical mentors and fostered resentment among peers.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN3: \"Experiments must follow the lab\u0026rsquo;s pace, sometimes requiring clinical leave. This inevitably leads to complaints from clinical colleagues. It somewhat damages interpersonal relationships among students.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN5: \"Clinical mentors never underwent standardized training. They may not understand or even criticize us\u0026mdash;I feel wronged.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 5: The lack of research motivation and its conflict with career planning\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003e5.1 Questioning Research Value and Forced Research Engagement\u003c/h2\u003e\u003cp\u003eSome individuals perceived research as a compulsory activity for graduation or career progression rather than a pursuit driven by intellectual curiosity, leading to skepticism and negativity towards research-related tasks.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN1: \"Grant applications now all require basic experimental work. Clinical projects seem useless to me. Though I dislike research, I\u0026rsquo;ll still do it for career prospects.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN10: \"I lack enthusiasm for research or paper-writing. I aspire to be a clinician, but the system forces doctors to produce outputs, papers, and conduct research.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003e5.2 PhD Application Competition and Career Plan Compromise\u003c/h2\u003e\u003cp\u003eMost participants observed that research output has increasingly become the primary criterion for assessing clinical competence. The dual emphasis of the \"Four-Certificates-in-One\" model gradually diminishes the competitiveness of PhD candidates, compelling them to make compromises in their career plans.\u003c/p\u003e\u003cp\u003e\u003cem\u003eN12: \"Reality is clinical skills can\u0026rsquo;t be measured. PhD supervisors and employers can\u0026rsquo;t evaluate them. But research is quantifiable\u0026mdash;everyone sees your publication count and quality.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN16: \"I want to pursue a PhD, but applications mainly score research output and publications. Clinical master\u0026rsquo;s students lack advantage here.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eN14: \"Current PhD applications demand outstanding Master\u0026rsquo;s achievements. After realizing I can\u0026rsquo;t balance clinical and research work, I\u0026rsquo;ve essentially abandoned PhD plans.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e This study, through interviews with OB/GYN trainees participating in the \"Four-Certificates-in-One\" program, uncovers widespread research anxiety within the context of China's medical education collaboration reform. We elucidate the mechanisms and structural contradictions contributing to this anxiety among clinical Master's students. Five primary factors were identified: The impact of a demanding clinical workload on research time allocation; The discrepancy between supervisors' high expectations and the provision of guidance and support; The inadequacy of research training support systems for students pursuing specialized Master's programs; The absence of positive feedback in research endeavors; and the lack of research motivation and its conflict with career planning. By integrating empirical findings with existing literature, we propose multi-tiered policy optimization strategies to address these issues. Coordinated interventions involving individual students, supervisors, clinical departments, and institutions are crucial to alleviating psychological distress and enhancing both physical and mental well-being.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 1: The impact of a demanding clinical workload on research time allocation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe conflict between clinical responsibilities and allocated research time emerges as a fundamental contributor to research-related anxiety, a challenge consistently highlighted by all interviewees within the OB/GYN department. Numerous domestic and international studies have identified the lack of time as the most frequently cited impediment to research participation.\u003csup\u003e[\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e A study specifically examining barriers to research during the training of oral and maxillofacial surgery (OMS) residents also identified insufficient time as the primary obstacle.\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e Previous research across various surgical specialties consistently underscores inadequate time as a significant barrier to research engagement.\u003csup\u003e[\u003cspan additionalcitationids=\"CR14 CR15 CR16\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e Although medical-educational integration policies aim to enhance clinical competency, they often fall short in adequately addressing the necessity for coherent research training. Typically, clinical rotations and research assessments are designed as separate modules, devoid of integration mechanisms, resulting in severely fragmented research time. The compounded pressures of clinical duties and research obligations lead to both physical and mental exhaustion.\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e This situation may arise from an institutional contradiction wherein hospitals enforce stringent requirements for clinical hours that conflict with the inherently flexible time demands of research activities.\u003c/p\u003e\u003cp\u003eTo address this issue, a multi-faceted strategy is proposed.\u003c/p\u003e\u003cp\u003eAt the individual level, trainees should adopt time management techniques utilized by successful physician-scientists to effectively prioritize among research, clinical rotations, and routine tasks.\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e This includes breaking down large research projects into manageable sub-tasks, such as 30\u0026ndash;60 minute research modules, and scheduling dedicated weekly time slots for these modules, potentially outside of peak clinical hours. Such an approach can enhance continuity, minimize the penalties associated with task-switching, and improve the efficient allocation of fragmented time.\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAt the Departmental support level: It is highly recommended that trainees be provided with sufficient protected research time.\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e In clinical departments where night shift demands are less intense, the implementation of compensatory leave systems may prove advantageous. For instance, two consecutive night shifts could be compensated with an additional rest day. Alternatively, a clinical workload credit system could be established, allowing individuals who exceed their clinical obligations to exchange credits for protected research time. Moreover, the introduction of flexible adjustment periods of 1\u0026ndash;2 weeks prior to significant research milestones, such as manuscript submissions or mid-term evaluations, is advisable. During these periods, trainees could apply, ideally two weeks in advance, to defer clinical responsibilities in order to secure dedicated time for research activities.\u003c/p\u003e\u003cp\u003eAt the institutional level, whether in schools or hospitals, optimizing rotation schedules is of paramount importance. The introduction of dedicated \"research rotation blocks\" or the implementation of quarterly \"research weeks,\" during which clinical duties are suspended, can facilitate systematic training, data analysis, and manuscript preparation. This approach could be complemented by mandatory quarterly progress reports to assess goal attainment. Research has demonstrated that residents in 6-year urology residency programs, which include a dedicated research year, produce nearly twice the academic output compared to those in 5-year programs.\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e Furthermore, dedicated research time is positively associated with residents pursuing fellowship training or academic careers.\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e Crucially, when planning institutional \"research weeks,\" it is crucial to allocate personnel across departments carefully to prevent disruptions in clinical operations; AI-assisted scheduling can be instrumental in achieving balanced staffing. Additionally, the establishment of a \"protected research day\" policy during rotations, such as designating one fixed weekday free from clinical duties, could promote sustained research engagement.\u003c/p\u003e\u003cp\u003eAt the policy level, adjustments to training duration or task allocation ratios should be considered. Implementing flexible program lengths, such as extended timelines, could alleviate periods of intense pressure in the short term.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 2: The discrepancy between supervisors' high expectations and the provision of guidance and support\u003c/b\u003e\u003c/p\u003e\u003cp\u003e The majority of participants reported experiencing pressure originating from their supervisors. The expectations set by supervisors, along with their mentoring abilities and training methodologies, can significantly contribute to the stress experienced by trainees. Supervisors are pivotal in influencing academic productivity,\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, and inadequate mentorship during training is acknowledged as a factor leading to decreased interest in pursuing academic careers.\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e Certain supervisors employ a \"pressure-to-produce\" strategy, characterized by frequent group meetings and directive task assignments, whereas others provide limited guidance, adopting a \"laissez-faire\" approach. While frequent meetings may become sources of criticism and anxiety, the \"laissez-faire\" approach and insufficient mentorship can further exacerbate research inefficiencies and increase anxiety related to decision-making. The fundamental cause of the institutional contradiction lies in the performance evaluation criteria for supervisors, which prioritize scientific research achievements\u0026mdash;such as publications and projects\u0026mdash;over the educational experience of students. This emphasis on \"output\" rather than \"education\" results in a research environment that restricts students' autonomy in selecting research topics and fails to ensure their academic independence, thereby fostering dependence and passivity. Additionally, due to the demands of clinical work or misalignment in research directions, the absence of mandatory provisions for a dual-supervisor collaboration system at the university further impedes the provision of substantive guidance to students.\u003c/p\u003e\u003cp\u003eTo address the aforementioned issues, the university might contemplate implementing a Scientific Research Objective Agreement between faculty and students upon admission. This agreement would delineate the responsibilities, expected outcomes, and communication frequency for both parties,\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e thereby mitigating the additional pressure on students resulting from high expectations set by their advisors regarding research output. Furthermore, to ensure that students receive comprehensive guidance, institutions could establish a \"dual mentorship collaboration mechanism\".\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e Under this system, each student would be paired with both a clinical mentor and a research mentor, with clearly defined roles and evaluation criteria. A joint mentorship agreement would be signed, specifying the responsibilities of each mentor, as well as the minimum duration and content of mentorship sessions, which would include intensive literature review and project design. Additionally, trainees often lack foundational knowledge in areas such as statistics. This deficiency is corroborated by the study conducted by Best et al., which found that residents generally have a limited understanding of biostatistics.\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e To enhance the support provided to students undertaking clinical projects, we recommend that they seek interdisciplinary research mentors or establish a joint advisory committee comprising clinical, statistical, and ethical experts to offer comprehensive guidance.\u003c/p\u003e\u003cp\u003eFaculty members in medical colleges and universities play a crucial role in addressing students' psychological challenges. They should demonstrate genuine concern for students, assist them in embracing challenges, and encourage them to view setbacks and failures as opportunities for learning rather than reflections of personal inadequacy. To improve the mentoring capabilities of faculty, it is essential for new mentors to undergo training that includes communication skills and career planning guidance. Additionally, enhancing mentors' emotional intelligence through training in non-violent communication, active listening, and related skills can contribute to a positive laboratory environment.\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e To assess the effectiveness of mentorship, institutions could implement an anonymous evaluation system where students provide feedback at the end of each semester.\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e These evaluations should be considered in the review process for mentors' professional advancement.\u003c/p\u003e\u003cp\u003eTo address the deficiency in teaching, the university might contemplate appointing \"scientific research counselors\" for clinical master's students. This initiative would involve experienced senior full-time doctoral students, senior students, and junior students dedicating two hours per week to address inquiries within a \"scientific research clinic.\" Participation in this program could be incentivized through scholarship credits. Additionally, a structured, tiered training program could be implemented during the master's phase, encompassing three stages: \"introductory, advanced, and practical application\" in scientific research. Furthermore, personalized one-on-one skills coaching would be offered.\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eConversely, to enhance the autonomy and innovative capabilities of students, the university could establish an \"Innovation and Exploration Fund\" specifically for clinical master's degree candidates. This would allow students to apply directly for financial support for project development, independent of their supervisors. Furthermore, a reform of student-led group meetings could be implemented within research groups. For instance, a monthly \"Student Proposal Group Meeting\" could be organized, where students independently determine the topics, such as addressing experimental challenges, while faculty advisors offer professional guidance and resource support.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 3: The inadequacy of research training support systems for students pursuing specialized Master's programs\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe absence of comprehensive research training in undergraduate programs, combined with the substantial publication expectations during Master's studies, significantly contributes to students' \"competence anxiety\".\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e The inadequacy of practical curricula and the uneven distribution of resources compel students to depend heavily on self-directed learning or peer assistance. A fundamental institutional issue resides in the medical education system's inability to establish a coherent pathway for the development of \"clinical-research\" competencies. The disjunction between undergraduate and Master's education, along with insufficient institutional research support for clinically-oriented master\u0026rsquo;s students, results in knowledge transfer being excessively reliant on the expertise of individual supervisors. This situation perpetuates foundational deficiencies among students, ultimately giving rise to a \"Matthew effect,\" wherein individuals with initial advantages continue to accrue further benefits.\u003c/p\u003e\u003cp\u003eNumerous studies indicate that the absence of established research curricula is a significant factor contributing to diminished scholarly activity.\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e A survey conducted among internal medicine residents revealed that 44% of participants identified the lack of research courses as a major impediment.\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e Panchal et al. highlighted that the implementation of structured research curricula, alongside securing funding and providing support from research staff, can significantly enhance resident productivity.\u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e To effectively bridge the gap between undergraduate education and graduate studies, institutions should undertake curricular reforms by introducing mandatory research courses for junior students. These courses could include titles such as \u003cem\u003e\"Research Training from 0 to 1,\" \"Medical Research Design,\" and \"Practical Statistics\"\u003c/em\u003e, focusing on essential skills like literature critique and experimental design. Additionally, the development of an online repository for research courses would enable students to access and review materials flexibly, accommodating their work commitments. The integration of 3D virtual laboratories, such as surgical simulations and statistical software scenarios, can mitigate practical barriers, while providing complimentary access to premium online skill courses facilitates self-directed learning. Furthermore, extending laboratory hours to evenings and weekends, coupled with on-demand equipment training videos, can decrease the costs associated with self-learning.\u003c/p\u003e\u003cp\u003eClinical master\u0026rsquo;s students often lack substantial time blocks for conducting basic research, leading most to satisfy graduation requirements through clinical projects or database analyses supplemented by small-scale experimental validation. Nonetheless, these students still invest considerable time in collecting clinical data and acquiring bioinformatics skills independently. To address these challenges, academic institutions could develop a standardized research case repository and a shared platform for de-identified clinical databases, alongside a virtual simulation laboratory that demonstrates the entire process from clinical inquiry to publication. Students could apply for access to data for retrospective studies, thereby reducing the time required for data collection and manuscript preparation. Encouraging collaborative models, where students share data, can alleviate individual burdens and promote mutually beneficial outcomes.\u003c/p\u003e\u003cp\u003eTo mitigate limitations in experimental platforms and research funding, institutions might consider establishing specialized facilities and offering small seed grants to support exploratory pilot studies.\u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e Alternatively, they could implement a lump-sum research funding model that allocates basic research budgets on a per-student basis for independent use. It is recommended that students document unsuccessful experimental data in shared technical memoranda to prevent redundant trial-and-error processes. For sustainable solutions, comprehensive healthcare reforms are essential, including the introduction of foundational undergraduate courses such as scientific literature analysis and experimental design, as well as the active promotion of undergraduate involvement in innovative research projects.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 4: The absence of positive feedback in research endeavors\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Participants frequently reported encountering substantial adjustment pressures and psychological challenges during the initial transition into the clinical phase. Students often struggle to reconcile their dual roles as \"clinicians\" and \"research trainees,\" resulting in difficulties balancing multiple responsibilities. This role conflict frequently induces interpersonal stress. When combined with slow project progress and the pressure of peer competition, these factors readily cultivate negative emotions such as frustration, anxiety, and even depression. In the absence of staged recognition in research exploration (e.g., normalization of experimental failures), students become vulnerable to a cognitive dilemma characterized by an \"effort-feedback disconnect.\"\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e The institutional origins of this issue can be traced to an evaluation system that excessively emphasizes competition, fostering an \"involution\" culture\u0026mdash;characterized by intense, zero-sum competition\u0026mdash;that exacerbates anxiety and self-doubt.\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e Additionally, there is insufficient coverage of university psychological counseling services and a lack of embedded psychological intervention mechanisms.\u003c/p\u003e\u003cp\u003eMedical schools are advised to promote an educational environment where students are encouraged to proactively engage with and address challenges, as opposed to circumventing them. To facilitate this, institutions should regularly organize career planning workshops aimed at assisting students in defining their professional objectives.\u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e Furthermore, alumni who have successfully navigated setbacks should be periodically invited to share their experiences, thereby aiding in the mitigation of perfectionist tendencies and self-doubt among current students. It is imperative that equal emphasis is placed on the physical and mental well-being of clinical medicine graduate students, alongside the development of their professional knowledge and skills. To this end, regular mental health screenings should be instituted, including the establishment of counseling facilities within research buildings and the administration of psychological assessments, such as the SCL-90 scale, on a semesterly basis.\u003c/p\u003e\u003cp\u003eIt is recommended that cross-grade peer support groups be established, accompanied by regular non-academic exchange activities. Students exhibiting high levels of emotional intelligence should be designated as \"mental health ambassadors\" and, following appropriate training, provide initial psychological support. Additionally, professional psychologists should be employed to deliver on-demand counseling services. An anonymous intra-institutional forum should be created, incorporating a \"Tree Hole\" section where psychological support teams can offer regular feedback. For individuals assessed as low-risk, mindfulness meditation and breathing exercises should be provided bi-monthly. Conversely, for high-risk individuals, targeted interventions should be implemented, including 6-week group Cognitive Behavioral Therapy (CBT) sessions aimed at restructuring negative thought patterns. These comprehensive strategies are intended to mitigate students' challenges in adjustment.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 5: The lack of research motivation and its conflict with career planning\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe collaborative medical education policy inadequately delineates the professional roles of clinical master's students, with vague training objectives further exacerbating role conflicts, which are rooted in institutional shortcomings. Research conducted by Chan J Y et al. suggests that trainees' belief in the intrinsic value of research significantly influences their engagement in research activities, thereby impacting their career trajectories.\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e Interviews with professional master's students reveal a prevalent utilitarian perspective on the value of research, coupled with a deficiency in intrinsic motivation. This underscores a compelling logic linking research to career progression: despite perceiving research as having limited intrinsic value, students feel obligated to engage in it due to external pressures such as doctoral program applications, grant submissions, and professional title evaluations. As a result, they adopt \"short-cycle\" research strategies, such as bioinformatics analysis and data mining, which deviate from the core principles of innovative research, reducing it to a mere \"access pass.\" This utilitarian approach starkly contradicts the students' initial aspirations, forcing them to choose between \"short-term survival\" and \"long-term development.\"\u003c/p\u003e\u003cp\u003eIt is imperative to establish clear career trajectories for students pursuing clinical master's degrees. Hospitals should consider implementing a dual-track system that differentiates between \"clinical specialists\" and \"clinical scientists\" to promote career diversification. Healthcare institutions should be encouraged to revise recruitment and promotion criteria to incorporate clinical skills, patient satisfaction, and other essential indicators.\u003csup\u003e[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e Medical schools should aim to reduce the emphasis on paper-centric evaluation systems and develop diversified assessment frameworks. For example, graduation requirements could include clinical case reports, literature reviews, teaching contributions, and other multifaceted achievements.\u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e For students intending to pursue doctoral studies, the formation of \"Ph.D. application advisory teams\" is recommended to provide comprehensive support, including strategies for school selection and guidance on recommendation letters. Furthermore, flexible academic reforms should be implemented for students unable to meet graduation deadlines on time, allowing them to apply for extensions of 0.5 to 1 year six months in advance to alleviate short-term pressures. This comprehensive approach effectively could alleviate systemic pressures on students while fostering the development of diverse talents.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe education of resident physicians in research is of paramount importance. Improving the quality of training is essential for fostering innovation among students, enhancing institutional capabilities, and advancing the field at large. Research-related anxiety, particularly under the \"four-certificates-in-one\" model, emerges as a complex interplay of institutional contradictions within the collaborative reform of medical education and individual adaptive challenges. The anxiety experienced by this cohort constitutes a pressing social issue that necessitates immediate attention. Professional postgraduate students need not only a mindset oriented towards personal growth and proactive coping strategies for effective adaptation but also supportive guidance from instructors and comprehensive research support and evaluation mechanisms provided by their institutions.\u003c/p\u003e\u003cp\u003eAddressing this challenge necessitates a comprehensive and coordinated approach encompassing policy design, institutional collaboration, departmental support, mentorship, and individual adaptation. Achieving this objective involves optimizing time management, enhancing research capacity building, and reforming evaluation systems to facilitate the seamless integration of clinical practice and research. Future research should investigate the feasibility of policy implementation and offer tailored solutions for medical students across diverse regions and specialties. Only through collaborative efforts across multiple domains can anxiety within this population be effectively mitigated, thereby enhancing their self-care awareness and capabilities and promoting their physical and mental well-being. This, in turn, will contribute to strengthening their professional identity and enthusiasm, ultimately boosting their confidence and expectations for the future.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations of This Study\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe participants chosen for this study had thoroughly contemplated these issues. The sample predominantly comprised female interviewees, reflecting the current demographic trends within the OB/GYN specialty, which may not be representative of all postgraduate students pursuing the \"four-certificates-in-one\" program at this university. Furthermore, as the interviewees were drawn from a particular medical school in Wuhan, the results may not be applicable to other medical institutions.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOB/GYN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eObstetrics and Gynecology\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for the study was granted by the Medical Ethics Committee of Zhongnan Hospital, Wuhan University (Approval No. 2025087K), and all participants provided voluntary written informed consent. The research procedures complied fully with the ethical standards of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\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\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or 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 disclose that there are no financial interests or personal relationships that could have potentially influenced the findings or interpretations presented in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has received support from the National Natural Science Foundation of China (82303671 and 82103620)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXuechen Yu and Rourou Xiao drafted the manuscript. Wenhui Liu performed the literature collection and classification. Wei Zhang and Huijun Chen performed the manuscript review and editing. All authors read and approved of the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the 16 graduate students for participating in this study and sharing their genuine thoughts on research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLi J, Fuquan L. The current status and countermeasures of postgraduate training for master degree of clinical medicine by the synergy of medical education. Chin J Med Educ Res. 2017;16(11):1081\u0026ndash;5. (in Chinese).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu Shangjing H, Yanbin C, Yiting D, Changzhu. Problems and countermeasures of clinical medical postgraduate of academic degree with the synergy of medical and education. 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(in Chinese).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Research Anxiety, \"Four-Certificates-in-One\", Obstetrics and Gynecology, Qualitative Research, Optimization Pathways","lastPublishedDoi":"10.21203/rs.3.rs-7010029/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7010029/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study aims to examine the mechanisms and institutional origins of research anxiety among master\u0026rsquo;s degree candidates in Obstetrics and Gynecology (OB/GYN) enrolled in China's \"Four-Certificates-in-One\" program. The goal is to provide a foundation for optimizing the training framework for specialized OB/GYN Master's students and to mitigate the scientific research pressures faced by medical students.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA qualitative research methodology was utilized, involving semi-structured, in-depth interviews with 16 clinical master\u0026rsquo;s students specializing in OB/GYN under the \"Four-Certificates-in-One\" program at a university in Wuhan, China. The interview transcripts were subjected to thematic analysis using NVivo 12 software to identify core themes and conflicting mechanisms.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eGuided by Role Conflict Theory and Institutional Contradiction Theory, the analysis of interview data identified five principal themes: (1) The impact of a demanding clinical workload on research time allocation; (2) The discrepancy between supervisors' high expectations and the provision of guidance and support; (3) The inadequacy of research training support systems for students pursuing specialized Master's programs; (4) The absence of positive feedback in research endeavors; (5) The lack of research motivation and its conflict with career planning.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eResearch anxiety within the \"Four-Certificates-in-One\" model emerges from the interaction between institutional contradictions and individual adaptive challenges. To effectively mitigate anxiety and enhance the well-being of this student population, a coordinated approach is necessary, encompassing policy development, institutional collaboration, departmental support, supervisor mentorship, and individual adaptation.\u003c/p\u003e","manuscriptTitle":"Research Anxiety Among China's \"Four-Certificates-in-One\" Master's Degree Candidates in Obstetrics and Gynecology: A Qualitative Study and Policy Optimization Pathways","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-13 15:29:11","doi":"10.21203/rs.3.rs-7010029/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"60ec75be-194b-4f84-a1bf-c9468e79b50d","owner":[],"postedDate":"August 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-03T08:25:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-13 15:29:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7010029","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7010029","identity":"rs-7010029","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}