Do physicians’ children perform differently in medical education? A multi-center field study in China

Abstract

Background

Intergenerational transmission refers to the transfer of occupations, knowledge, or skills across generations. There is a consensus in the medical field that children of doctors are more likely to want to become doctors and that doctors from medical families are more likely to be trusted by their patients. This study explores the current state of intergenerational transmission in Chinese medical universities and its impact on students’ academic and professional development, which towards more supportive policies for medical manpower development in low- and middle-income countries.

Methods

A survey was conducted among 434 students at the universities of Chinese medicine in Beijing and Nanjing. This study assessed the prevalence of intergenerational transmission and its influence on student competencies in medical thinking, practice, and innovation.

Results

Approximately 18.66% of the students reported intergenerational inheritance of medicine, with 10.37% from direct lineage, 5.07% from collateral lineage, and 3.23% from other relatives. A majority (77.88%) of the respondents believed that doctors’ family backgrounds positively impacted the learning and growth of medical students. Students with direct or collateral intergenerational inheritance demonstrated significantly higher innovation ability ($\:{\chi\:}^{2}$=12.28, p < 0.05) and medical thinking skills (Coefficient = 9.52,p < 0.05) compared to those without such backgrounds. Regional factors and family inheritance influence students’ overall competencies in medical studies.

Conclusions

Nearly one in five students had a family background in medicine, and most recognized its positive impact on their learning. Intergenerational transmission enhances innovation and medical thinking among students. Medical universities should incorporate intergenerational experiences into their training programs and encourage cross-cultural and intergenerational exchanges to develop students’ critical thinking skills, practical skills, and innovation capacities.

Introduction

Intergenerational transmission refers to the continuation and transmission of particular occupations, knowledge, or skills between generations within a family or society and has been proven by several scholars in the fields of health status, socioeconomic status, and psychology [1]. Intergenerational family transmission significantly impacts the next generation’s career choices and academic performance [2, 3]. Scholars from various countries have different views on whether children with medical family backgrounds exhibit a preference for pursuing medical education, the potential advantages that medical students with such backgrounds may possess, and the underlying reasons for these trends. Achieving consensus among these perspectives is challenging.

Some scholars believe that a medical family background positively impacts the next generation in terms of career choices and performance during college or clinical practice. Evidence from Germany shows that nearly half of the applicants to the University Medical Center in Götting have a medical-related family background [4]. Both career choices and parental career values can affect children’s career values after entering university [5]. Compared to medical students from non-medical families, medical students from medical families score higher in emotional intelligence and academic performance [6]. Meanwhile, evidence suggests that non-first-generation medical students can allocate more time to consolidate their strengths after entering the workforce [7].

Other scholars believe that family background does not significantly affect students’ career choices, although excessive family expectations can negatively affect medical students, leading to psychological stress and burnout [8]. A study in Turkey found that family expectations did not significantly affect medical students’ choice of a medical specialty [9]. A study in Germany found that students with physician parents showed no advantage in medical school entrance exams or interview preparation and scored slightly lower than other students [4]. This may be because medical students with parents in the medical profession not only have to cope with the pressures of their studies and clinical clerkships but also with high expectations and social comparisons from their families, which may have led to psychological stress and burnout over having to meet the high standards set by their parents in their pursuit of academic and professional success [10].

Different scholars have differing opinions on whether intergenerational transfer of careers impacts medical students’ performance in school and whether the impact is positive or negative; the reasons for such an impact have been explained from different perspectives, such as social capital, mental health, and cultural inheritance [11]. Although some scholars have presented many realizations and cases from a qualitative perspective that children of medical professionals are more likely to follow their families in medicine in China, quantitative evidence remains lacking. This study surveyed medical universities in China to assess the current state of intergenerational transmission in medical colleges and to investigate its influence on students’ overall capabilities. Our study primarily addressed three key issues: the prevalence of medical family backgrounds among students in Chinese medical schools, the perceptions of Chinese medical students regarding the impact of medical family backgrounds on peer abilities, and the objective existence of such differences and their specific manifestations. This included evaluating their performance and academic achievements in the areas of Medical Thinking, Practice, and Innovation Activities, which were obtained from documentary evidence and expert discussions.

Materials and methods

Participants

This study was a cross-sectional study involving medical students. Participants were recruited from Beijing University of Chinese Medicine (BUCM) and Nanjing University of Chinese Medicine (NUCM). These two medical colleges, situated in southern and northern China, respectively, have affiliated hospitals and well-established disciplinary frameworks and enjoy a strong reputation and widespread recognition in China. The majors under the School of Chinese Medicine, School of Clinical Medicine, School of Acupuncture and Tuina, and School of Traditional Chinese Medicine belonged to the category of medicine and pharmacy and were considered medical majors in this survey, while students from the remaining colleges were considered other majors.

Survey procedure

The study used a self-developed questionnaire, and a pre-survey was conducted from November 2023 to December 2023 at BUCM. The objective was to enhance the predetermined questionnaire entries and assess the effectiveness of the survey to ensure that the questions were readily comprehended. The formal survey was conducted anonymously from December 2023 to January 2024 among BUCM and NUCM. An investigator conducted random sampling at the school. The participants had to be students of Chinese nationality. At the beginning of the survey, the participants were asked whether they volunteered to participate in the study and indicated that they were free to withdraw. The survey took 3–5 min to complete. This study involved human participants and was approved by the Ethics Committee of BUCM. Before starting the study, each participant provided written informed consent. The study was conducted in accordance with the ethical standards of the Helsinki Declaration (2008). All participants had a chance to receive a movie ticket reward after passing the questionnaire quality review. A total of 434 valid questionnaires were collected, exceeding the minimum sample size of 250 at a 95% confidence level and 5% precision. Therefore, the sample size was deemed sufficient to estimate and discuss the variables required for the study. The questionnaire was considered reliable because its Cronbach’s coefficient was 0.8580. The questionnaire is provided as supplementary material (Supplementary 1).

Study questionnaire

The survey requested that participants disclose their gender, whether they were only children, type of household registration, region of birth, typical monthly expenditure, rationale for selecting their major, and other relevant information. The intergenerational transmission of the respondents was categorized into four groups: none, direct line (some of their immediate family members were in the medical industry), collateral line (some of their other blood relatives within the three generations were in the medical industry), and other friends or relatives who worked in the medical industry and influenced them. The questionnaire was used to analyze the responses through questions such as “Do you think that students with a family background in Chinese medicine have an advantage in studying this specialty?” The questionnaire gathered the respondents’ views on intergenerational transmission. The questionnaire also examined how intergenerational family background affects students’ perceptions of transmission, academic performance, and comprehensive quality in different schools and universities based on medical thinking, practice, and innovation activities.

Data analysis

All data analyses were performed using Stata 17.0 support, and visualization graphics were generated using Origin. According to the survey data, the current status of intergenerational medical transmission in Chinese medical colleges and universities was descriptively, statistically, and visually expressed. The Chi-square test was used to compare students’ perceptions of the intergenerational transmission of medical backgrounds between those with and without a medical family history.

The chi-squared test was used to examine group differences in categorical variables, including participation in innovation and entrepreneurship activities, levels of proficiency in clinical competencies (e.g., blood pressure measurement techniques and first aid protocols). Additionally, one-way analysis of variance (ANOVA) was conducted to evaluate variations in quantitative measures across sample subgroups, with specific attention to medical thinking self-assessment scores and academic performance rankings on a 100-point scale.

This study comprehensively assessed the overall competence of students at medical universities in China. The assessment was based on three dimensions: innovation, medical thinking, and medical practice. Innovation refers to medical students’ capacity to integrate theoretical knowledge with practical experience to address and resolve complex challenges or critical issues in the healthcare sector [12, 13]. Medical thinking refers to whether medical students have the mindset that clinicians should have, including a learning mindset, professionalism in reading cutting-edge theories and research, and a strong sense of altruism [14]. Practice refers to the ability to operate the equipment and instruments required in clinical settings and the mastery of a full set of first-aid operation procedures. The entropy method was used to standardize the nine indicators of the three dimensions into a score with a value range of 0–1, which represented the comprehensive quality score (Fig. 1). Multiple beta regression was used to examine factors affecting the comprehensive quality.

Fig. 1

Evaluation indexes of comprehensive quality

Results

In total, 434 valid questionnaires were collected. Among them, 357 were from BUCM, and 77 were from NUCM. Among the respondents, there were 328 female respondents and 106 male respondents (Table 1).

Table 1 Sample characteristics and one-way ANOVA analysis and chi-squared test of ability of Chinese medical students

When each explanatory variable was considered as an independent variable, the following phenomena were observed: The self-evaluation of medical thought quality significantly differed among students from different universities or intergenerational transmissions (p < 0.05); there were significant differences in the practical proficiency between students between universities, schools, and intergenerational transmissions (p < 0.05); the difference in the students’ innovation ability between intergenerational transmissions was statistically significant (p < 0.05). The presence of siblings and intergenerational transmission of medicine contributed to variations in the self-reported influence of intergenerational transmission on individual development (p < 0.05).

The proportion of direct intergenerational transmission from the father’s side of the family was greater than that from the mother’s side of the family (Fig. 2). Among the participants, 18.66% said that they had encountered the intergenerational transmission of medicine: 10.37% direct, 5.07% collateral, and 3.23% from other relatives and acquaintances.

Fig. 2

Schematic diagram of intergenerational transmission of students in Chinese medical universities

Students in Chinese medical universities were categorized into medical majors (n = 314), who primarily focused on studying therapeutic methods, and non-medical majors (n = 120), who had different learning objectives. Statistically significant differences were observed in the levels of innovation capacity and self-evaluation of medical thought among students specializing in medical majors with different intergenerational transmissions (p < 0.05). However, no such differences were identified among students pursuing non-medical majors (Table 2).

Table 2 Comparison of intergenerational differences in thinking, practice, and innovation among students in different majors

The impact of intergenerational transmission on individual development showed a strong correlation with intergenerational transmission (p < 0.05). For students who received intergenerational inheritance, the perception of the advantage in education decreased as the relationship between the source of inheritance and the student became more distant. The percentage of those who believed that an advantage existed was 79.9%, which was higher than the 59.1% for collateral intergenerational inheritance but lower than the 82.2% for direct intergenerational inheritance. Simultaneously, students with varying intergenerational inheritance have distinct interpretations of the specific facets of the benefits of intergenerational inheritance in institutional education. Students with direct intergenerational inheritance mainly believe that their advantages are reflected in cultural inheritance, the accumulation of professional knowledge, and the expansion of their horizons to gain inspiration, which are potential influences, whereas other students tend to think there are more practical effects. Students who have experienced collateral intergenerational transfer and other forms of transmission have acknowledged the advantages of obtaining tangible support, such as proactive planning and preparation, to achieve greater success in examinations (Fig. 3).

Fig. 3

Perceived advantages of intergenerational transmission among students in Chinese medical universities. Note: Figure (a) represented the responses to the question “Are students with intergenerational transmission more advantageous in the education of Chinese medical universities?” in students from different sources of intergenerational transmission. Figure (b) show the percentage of choosing “What are the advantages of intergenerational transmission?” in the students

Multiple covariance diagnosis was performed for each factor; the tolerance was greater than 0.5, and the variance inflation factors (VIF) were less than 2, indicating no serious covariance problem among the factors and no multicollinearity problem in the models. To analyze the quality scores of extracurricular Chinese medicine in Model 1, the control variables were included in the regression equation, and the results showed that the average monthly consumption and region of origin significantly affected the comprehensive quality score (p < 0.05). In Model 2, only medical intergenerational transmission abilities were considered in the regression analysis of the comprehensive quality scores. Significant disparities in medical intergenerational transmission abilities were observed between respondents with direct intergenerational connections and those without (p < 0.05) and between respondents with collateral intergenerational connections and those without (p < 0.05). All variables were included in Model 3, and the results showed that the intergenerational transmission of medicine positively predicted the comprehensive quality score (Model 2:β_Direct = 0.31, p < 0.05, β_Collateral = 0.29, p < 0.05; Model 3:β_Direct = 0.29, p<0.05, β_Collateral = 0.29, p<0.05) (Table 3).

Table 3 Multiple regression analysis of comprehensive quality scores

Discussions

Among all the students surveyed at two medical universities in Beijing and Nanjing, 18.66% had direct, collateral, or other intergenerational transmission, which is lower than that reported in studies on intergenerational transmission in medical education in other countries [4]. This may be related to the fact that Chinese universities admit students through exams rather than application reviews.

Students with intergenerational inheritance performed better in innovation and medical thinking; specifically, they had significantly higher self-assessment scores on participation in innovation and entrepreneurship competitions and generally gave themselves higher marks for professional thinking than students without intergenerational inheritance. These results may be due to the long-term cultivation of medical knowledge and resource support within the family environment. The results also provide an optimization idea for medical education, suggesting that universities should widely absorb the advantages of career education in medical families, pay more attention to cultural inheritance and personalized teaching processes, improve students’ participation in the curriculum, and enhance interactivity in education and teaching [15]. For example, some universities introduced a new policy called “double-qualified teachers,” raised about the positive impact on students’ spare time.

However, differences in practical skills and academic achievement were not statistically significant. Students are obligated to complete the demanding training and evaluation of the institutional system, regardless of whether they have a family background in medicine [16]. Proficiency in medical practice skills, including clinical operation and diagnostic abilities, is predominantly honed through clinical internships and repetitive practice. The development of these skills is less influenced by familial background and is more contingent on individual diligence and access to training opportunities. Despite strong family support, inadequate time allocation or subpar simulation equipment in educational institutions can impede the attainment of desired proficiency levels for all students. In turn, students’s academic achievement is influenced by factors other than intergenerational transmission.

The intergenerational transmission of medicine will only affect the comprehensive quality among medical students in China. For students of other majors in medical universities, such as those studying management, the differences in school performance and the ranking of study performance were not statistically significant, Suggested that the intergenerational transmission effect exists only in the same specialty, not in the same industry [17]. This discovery confirmed the passing down of careers from one generation to the next, which has been observed in many areas, especially wealth and social status [18].

The factors that significantly influence comprehensive quality among Chinese medical students include average monthly consumption level, economic zone where the birthplace is located, and intergenerational transmission, which can be divided into family economic status and intergenerational transmission of occupation. The average monthly consumption level and economic zone of the birthplace significantly affected students’ comprehensive quality. Students with a better family economic status performed better in terms of comprehensive quality, which may be related to their access to more learning resources and support. In addition, students from the eastern and western regions showed significant differences in their comprehensive quality scores, which may reflect the influence of educational resources and the environment in different regions on students [7, 19].

Based on the findings of this study, incorporating intergenerational wisdom into the current medical education is crucial. In terms of enrollment policy, it is advisable to moderately ease the admission criteria for students with a background in medical literacy. This adjustment can facilitate the cultivation of a higher proportion of medical professionals across generations and mitigate the shortage of healthcare personnel. Facilitating regular interactions and communication between young medical professionals and seasoned experts through seminars and workshops is essential. These initiatives not only foster stronger connections between different generations but also enable younger professionals to benefit from the wealth of experience amassed by their predecessors. Enhancing the collaboration between schools and families by encouraging parental involvement in children’s education, such as through participation in school events or lectures, provides a platform for parents to share career insights with their children. This approach not only strengthens parent–child relationships but also cultivates a sense of support and motivation among students.

Limitations

This study had some limitations. First, the questionnaire relied on self-reported data, which may have led to social expectation bias. To address this problem, multiple reverse questions were included in the questionnaire design to reduce the effects of social desirability bias. In addition, this study only examined academic performance and comprehensive quality, and future studies should consider more dimensions, such as mental health and career satisfaction. This study aimed to investigate the current state of intergenerational inheritance of medicine in Chinese medicine universities. It also examined the influence of the intergenerational inheritance of medicine on career development and explored its impact on students’ overall medical comprehensive quality and academic performance. Future research should explore the influence of intergenerational inheritance on psychological factors.

Conclusions

Currently, approximately 20% of the students at medical universities come from families with medical backgrounds. Most of these students believed that inheriting medical knowledge from previous generations would provide them with professional benefits. The intergenerational transfer of medicine positively affects the comprehensive quality of Chinese medical students. The intergenerational transmission of careers has been found to significantly enhance medical reasoning and innovative skills among medical students in China. However, this did not significantly impact practical skills or academic performance. In addition to intergenerational career transmission, family economic status is an important factor that affects students’ comprehensive quality. To promote the development of medical education, universities should incorporate the experience of intergenerational transmission and improve training programs for medical students to enhance their comprehensive quality. These findings provide valuable insights and suggestions for future transmission and innovation.