{"id":71944,"date":"2022-12-20T08:32:51","date_gmt":"2022-12-20T00:32:51","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/taps\/?post_type=issues&#038;p=71944"},"modified":"2023-04-04T08:17:12","modified_gmt":"2023-04-04T00:17:12","slug":"has-novel-coronavirus-infection-affected-the-professional-identity-recognised-by-medical-students-a-historical-cohort-study","status":"publish","type":"issues","link":"https:\/\/medicine.nus.edu.sg\/taps\/issues\/has-novel-coronavirus-infection-affected-the-professional-identity-recognised-by-medical-students-a-historical-cohort-study\/","title":{"rendered":"Has novel coronavirus infection affected the professional identity recognised by medical students? &#8211; A historical cohort study"},"content":{"rendered":"<p>Submitted: 19 May 2022<br \/>\r\nAccepted: 21 September 2022<br \/>\r\nPublished online: 3 January<span lang=\"EN-GB\">, TAPS 2023, 8<\/span><span lang=\"EN-GB\">(1), 3-12<\/span><br \/>\r\n<a href=\"https:\/\/doi.org\/10.29060\/TAPS.2023-8-1\/OA2817\">https:\/\/doi.org\/10.29060\/TAPS.2023-8-1\/OA2817<\/a><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">Junji Haruta<sup>1,2<\/sup>, Ayumi Takayashiki<sup>2<\/sup>, Ryohei Goto<sup>2<\/sup>, Takami Maeno<sup>2<\/sup>, Sachiko Ozone<sup>2<\/sup> &amp; Tetsuhiro Maeno<sup>2<\/sup><\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><i><sup><span lang=\"EN-GB\">1<\/span><\/sup><\/i><i><span lang=\"EN-GB\">Medical Education Center, School of Medicine, Keio University, Japan; <sup>2<\/sup>Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan<\/span><\/i><i><span lang=\"EN-GB\"><\/span><\/i><\/p>\r\n<p style=\"text-align: center;\"><b><span lang=\"EN-GB\">Abstract<\/span><\/b><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-US\">Introduction:<\/span><\/b><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">The pandemic caused by the novel coronavirus (COVID-19) has produced dramatic changes in the learning environment for clinical practice in medical education, and the impact on medical students has been significant. However, few program evaluation studies<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">involving professional identity, now emphasised in medical education, have compared current with pre-COVID-19 programs. Here, we compared the professional identity recognised by medical students in the years before and during COVID-19.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-US\">Methods<\/span><\/b><b><span lang=\"EN-US\">:<\/span><\/b><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">Medical students who participated in clinical practice were evaluated using the Japanese version of the Professional Self-Identity Questionnaire (PSIQ), <\/span><span lang=\"EN-US\">a 9-item inventory rated using 7-point Likert scales<\/span><span lang=\"EN-US\">. They answered on the first day of a <\/span><span lang=\"EN-US\">4-week clinical practice module within a community-based medical education (CBME) program <\/span><span lang=\"EN-US\">and at graduation in 2018-2019 (pre-COVID-19 pandemic) and in 2019-2020 (during-COVID-19 <\/span><span lang=\"EN-US\">pandemic). We compared the mean difference in total PSIQ score of the 2019-2020 students to those of the 2018-2019 students as a historical cohort using an unpaired t-test. <\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-US\">Results:<\/span><\/b><span lang=\"EN-US\"> Participants were 104 medical students in the 2018-2019 academic year and 92 in the 2019-2020 academic year. PSIQ was increased at graduation. Mean difference in total PSIQ score was statistically higher for the 2019-2020 students (13.5 \u00b1 9.4) than for the 2018-2019 students (10.3 \u00b1 8.1)<\/span><span lang=\"EN-US\">\u00a0(t =2.6, df =195,\u00a0<em>p<\/em>\u00a0= 0.01)<\/span><span lang=\"EN-US\">.<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-US\">Conclusion<\/span><\/b><b><span lang=\"EN-US\">:<\/span><\/b><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">Although clinical practice was restricted by COVID-19, this had some positive impact on the strengthening of professional identity recognised by medical students. This finding may have been influenced by the imprinting of professional norms and changes in society.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><b><span lang=\"EN-GB\">Keywords<\/span><\/b><b><span lang=\"EN-GB\">:<\/span><\/b><span lang=\"EN-GB\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><i><span lang=\"EN-GB\">Novel Coronavirus Infection, Professional Identity, Clinical Practice, Questionnaire Survey, Program Evaluation<\/span><\/i><span lang=\"EN-GB\"><\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Practice Highlights<\/span><\/strong><\/p>\r\n<ul>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-AU\"> <\/span><span lang=\"EN-AU\">Professional identity recognised by medical students in Japan was assessed by questionnaire.<\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-AU\"> <\/span><span lang=\"EN-AU\">Changes during clinical practice were compared between two grades using a historical cohort.<\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-AU\"> <\/span><span lang=\"EN-AU\">Medical students&#8217; recognised professional identity scores improved after one year in both cohorts.<\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-AU\"> <\/span><span lang=\"EN-US\">Medical students <\/span><span lang=\"EN-AU\">experienced <\/span><span lang=\"EN-US\">the COVID-19 pandemic<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">showed some positive impact on professional identity.<\/span><span lang=\"EN-AU\"><\/span><\/li>\r\n\t<li style=\"text-align: justify;\"><span lang=\"EN-AU\"> <\/span><span lang=\"EN-AU\">Medical students internalised their role as healthcare professionals owing to COVID-19 pandemic.<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">I. INTRODUCTION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The pandemic caused by the novel coronavirus (COVID-19) has caused unprecedented disruption to medical education systems around the world <\/span><span lang=\"EN-US\">(Kaul et al., 2021; <\/span><span lang=\"EN-US\">Khasawneh<\/span><span lang=\"EN-US\"> et al., 2020; Lucey &amp; Johnston, 2020; Papapanou et al., 2021).<\/span><span lang=\"EN-US\"> In particular, the pandemic has made it difficult to continue medical educational programs, including regular lectures, and face-to-face lectures, experiments, and clinical practice involving patients <\/span><span lang=\"EN-US\">(Al Samaraee, 2020; Emanuel, 2020; Shankar &amp; Wilson, 2020).<\/span><span lang=\"EN-US\"> The Association of American Medical Colleges took the unprecedented decision to suspend clinical practice and issued guidance instructing medical students to avoid clinical practice involving direct patient contact (Association of American Medical Colleges, 2020). The many university hospitals in the U.S. have made it a priority to utilise students in controlling the spread of COVID-19 infection. Other countries followed this precedent. Medical students accordingly lost the opportunity to learn through patients in clinical practice. In Japan also, clinical practice was suspended at many universities.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Commonly implemented alternative teaching methods were online interactive discussions and video lectures <\/span><span lang=\"EN-US\">(<\/span><span lang=\"EN-US\">Chiodini<\/span><span lang=\"EN-US\">, 2020; <\/span><span lang=\"EN-US\">Mian &amp; Khan<\/span><span lang=\"EN-US\">, 2020).<\/span><span lang=\"EN-US\"> To prevent the spread of COVID-19 from medical students in clinical practice (Alsoghair et al., 2021), students were required to socially distance not only from patients but also from healthcare providers and faculty members. However, implementing the requisite changes to curricula, such as interrupting or drastically postponing clinical practice, was difficult, forcing faculties to develop curricula that provided students with opportunities to supplement their ongoing clinical practice as early as possible, while making use of online devices (Ross, 2020). These changes in the learning environment affected medical students&#8217; learning. For example, a survey of 2nd-6th grade students at the University of Geneva found that 2\/3 of the medical students experienced decreased motivation and concentration in distracting learning environments such as home, whereas some medical students who were exposed to clinical practice during the COVID-19 pandemic showed an increased sense of belonging to the profession<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">(<\/span><span lang=\"EN-US\">Wurth<\/span><span lang=\"EN-US\"> et al., 2022).<\/span><span lang=\"EN-US\"> A change in perception with remote learning in response to the COVID-19 pandemic among Canadian <\/span><span lang=\"EN-US\">undergraduate <\/span><span lang=\"EN-US\">students also revealed a significant decrease in students\u2019 achievement goals, engagement, and perceptions of success, and an increase in perceptions of cheating (Daniels et al., 2021).<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">Perceptions of learning due to changes in the curriculum due to COVID-19 have been investigated and controversially reported, but few reports have investigated professional identity as a foundation for becoming a physician.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">To be effective clinicians, it is important that medical students acquire not only knowledge and skills but also professional identity formation <\/span><span lang=\"EN-US\">(Cruess et al., 2014; Hafferty &amp; Franks, 1994).<\/span><span lang=\"EN-US\"> Professional identity is defined as &#8220;attitudes, values, knowledge, beliefs, and skills shared with others in a professional group\u201d <\/span><span lang=\"EN-US\">(Crossley &amp; Vivekananda-Schmidt, 2009)<\/span><span lang=\"EN-US\">.<\/span><span lang=\"EN-US\"> Professional identity formation is noted as an ongoing process influenced by several factors, including practice experience and professional socialisation (Adams et al., 2006). In this study, we adopted a theoretical framework which is based on a concept that illustrates the interplay of professional identity formation and socialisation through a complex conscious and unconscious process centered on role models, mentors, and the accumulation of individual experiences (Cruess et al., 2015)<\/span><span lang=\"EN-US\">. <\/span><span lang=\"EN-US\">Because clinical practice is a period in which medical students meet role models and mentors and gain their first experiences as a healthcare provider, clinical practice is major contributor to the development of professional identity in medical students (Haruta et al., 2020).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Although studies have reported that medical education programs altered by the COVID-19 pandemic have affected medical students&#8217; perceptions of the role of the physician and their learning strategies (Findyartini et al., 2020; Wurth et al., 2022), little is known about the influence of curricula changes on medical students with regard to their professional identity formation as physicians<\/span><span lang=\"EN-US\"> affected by role models, mentors, and individual experience<\/span><span lang=\"EN-US\"> (Stetson et al., 2020).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Here, we aimed to compare professional identity as a physician as perceived by medical students in clinical practice before and during COVID-19 using the Professional Self Identity Questionnaire (PSIQ).<\/span><span lang=\"EN-GB\">\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">II. METHODS<\/span><\/strong><\/p>\r\n<p><i><span lang=\"EN-US\"><\/span><\/i><i><span lang=\"EN-US\">A. Setting<\/span><\/i><i><span lang=\"EN-US\"><\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Japan first faced the challenge of the COVID-19 pandemic in January 2020, and a state of emergency was declared for all regions of Japan on April 16, 2020 (Prime Minister\u2019s Office of Japan, 2020).<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">During that time, some medical universities suspended clinical training and implemented online education instead. The COVID-19 Outline of Measures for COVID-19 formulated by the Japanese Ministry of Education, Culture, Sports, Science and Technology was sent to all higher education institutions, including medical schools, on June 5, 2020 (Hayashi et al., 2022), with the main advice that universities should operate in a resilient manner for experiential educational practices such as clinical practice. Under these circumstances, leaders of Japanese medical schools were asked to consult various stakeholders and make decisions on whether or not to continue clinical practice, often leaving detailed instructions to local operations managers in each field (Hayashi et al., 2022). \u00a0In contrast, primary care physicians were forced to adapt to local conditions (Haruta et al., 2021).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Students enter medical school in Japan after graduating from high school, and the curriculum is six years long. Clinical training usually takes place in the fourth to sixth years. This schedule is also implemented at the University of Tsukuba in Japan: clinical training is divided into a first half from October of the fourth year to September of the fifth year and a second half from October of the fifth year to June of the sixth year, for a total of 78 weeks. After<\/span><span lang=\"EN-US\"> clinical<\/span><span lang=\"EN-US\"> training, medical students spend time studying for graduation and national exams, in addition to attending lectures.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The first phase of this clinical practice consists of a four-week rotation in basic departments such as internal medicine, surgery, obstetrics and gynecology, pediatrics, and emergency medicine, mainly at affiliated hospitals. The second phase incorporates some elective subjects and includes 4 weeks\u2019 mandatory clinical practice in a CBME curriculum and a further 4 weeks\u2019 clinical practice in a department of interest. Typically, 15 to 17 students rotate every 4 weeks through clinical practice in the CBME curriculum. This clinical training was conducted before the pandemic, but was discontinued in response to it at the end of March 2020. In March, medical students continued clinical training while all elementary and junior high schools were closed. All clinical training was then cancelled in April 2020 and replaced with report assignments only. These were replaced in May and June with online training and on-demand assignments. Sixth-year students in the class of 2020, and subsequently also in 2021 and 2022, were required to adhere to health observation recording and infection prevention behaviors in accordance with the University of Tsukuba Hospital staff behavior guidelines, which had not been previously followed. Similarly, they were also restricted from participating in training hospital tours and extracurricular activities, which were usually a part of their training.<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">B. Study Design <\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Training in clinical practice at the University of Tsukuba consists of a first phase for 4th and 5th year students and a second phase for 5th and 6th year students. CBME is included in the latter phase. Data from 5th-year <\/span><span><span lang=\"EN-US\">medical students who <\/span><\/span><span lang=\"EN-US\">participated in<\/span><span lang=\"EN-US\"> clinical practice in a 4-week community-based medical education (CBME) program from October 2019 to March 2020 and who graduated in March 2021 were compared to those of the previous year&#8217;s students (2018-2019) as a historical cohort. This cohort included 6th-year medical students who graduated in March 2020 and who had participated in a similar clinical practice program the previous year, from October 2018 to May 2019. <\/span><span lang=\"EN-US\">As in the 2018-2019 academic year, a questionnaire was administered using the PSIQ in the 2019-2020 academic year. <\/span><span lang=\"EN-US\">The PSIQ, conducted as part of program evaluation of the CBME program, was administered on the first day of the 4-week clinical practice of the program and at graduation. Study participants included 118 fifth- and sixth-year medical students who participated in clinical practice in the CBME program from October 2018 to May 2019 (pre-COVID-19 pandemic) and 100 fifth- and sixth-year medical students who participated from October 2019 to March 2020 (during-COVID-19 pandemic). The 35 participants from April-May 2020, when the 4-week clinical practice in the CBME program was switched to online practice due to COVID-19, were excluded because they could not be pre-evaluated. <\/span><\/p>\r\n<p><i><span lang=\"EN-US\">C. Instrument: Japanese Version of the Professional Self Identity Questionnaire (PSIQ) <\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The Professional Self-Identity Questionnaire (PSIQ) is a 9-item inventory which is rated using 7-point Likert scales <\/span><span lang=\"EN-US\">(Crossley &amp; Vivekananda-Schmidt, 2009)<\/span><span lang=\"EN-US\">. This instrument measures the sense of students in identifying their current position on a continuum between \u2018first-day student\u2019 and \u2018qualified doctor\u2019 when engaged in each of nine domains of professional activity. <\/span><span lang=\"EN-US\">These nine domains include &#8220;Teamwork,&#8221; &#8220;Communication,&#8221; &#8220;Conducting assessment,&#8221; &#8220;Cultural awareness,&#8221; &#8220;Ethical awareness,&#8221; &#8220;Using records,&#8221; &#8220;Dealing with emergencies,&#8221; &#8220;Reflection,&#8221; and &#8220;Teaching&#8221;. Each item is rated on a 7-point Likert scale. <\/span><span lang=\"EN-US\">For this research, we set 1 point as &#8220;equivalent to the first day of clinical practice&#8221; and 7 points as &#8220;equivalent to the first day of initial residency&#8221;. <\/span><span lang=\"EN-US\">The PSIQ is an assessment sheet form originally designed in English. <\/span><span lang=\"EN-US\">The original study was validated in a sample of 496 medical students across multiple phases of education, and the overall internal reliability (Cronbach&#8217;s alpha) was reported to be 0.93 <\/span><span lang=\"EN-US\">(Crossley &amp; Vivekananda-Schmidt, 2009)<\/span><span lang=\"EN-US\">. <\/span><span lang=\"EN-US\">Previously, we developed a Japanese version of the PSIQ and operationally defined PSIQ scores as professional identity as a physician as perceived by medical students. <\/span><span lang=\"EN-US\">Cronbach&#8217;s alpha<\/span><span lang=\"EN-US\"> of the Japanese PSIQ was reported to be 0.93<\/span><span lang=\"EN-US\"> (Haruta et al., 2021), which allows students to measure changes in their own professional identity by tracking each of the nine professional activities over time.<\/span><span lang=\"EN-US\"> We set the total score on this scale as the main outcome of this study. The study showed that this was a reliable and valid tool for program evaluation during clinical practice (Haruta et al., 2021). <\/span><\/p>\r\n<p><i><span lang=\"EN-US\">D. Participants and Data Collection <\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">In 2018-2019 (pre-COVID-19 pandemic) and 2019-2020 (during-COVID-19 pandemic), we assessed the professional identity of medical students from October of their fifth year to May of the sixth year using PSIQ. The survey was administered on the first day of clinical practice in the CBME program as PSIQ 1 (September 2018 to May 2019 and September 2019 to March 2020) and at graduation as PSIQ 2 (2020 January, and January 2021) (Figure 1).<\/span><\/p>\r\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/12\/OA2817-Figure-1-300x137.png\" alt=\"\" class=\" wp-image-71949 aligncenter\" width=\"610\" height=\"278\" srcset=\"https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/12\/OA2817-Figure-1-300x137.png 300w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/12\/OA2817-Figure-1-1024x468.png 1024w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/12\/OA2817-Figure-1-768x351.png 768w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/12\/OA2817-Figure-1-1536x703.png 1536w, https:\/\/medicine.nus.edu.sg\/taps\/wp-content\/uploads\/sites\/10\/2022\/12\/OA2817-Figure-1.png 2046w\" sizes=\"auto, (max-width: 610px) 100vw, 610px\" \/><\/p>\r\n<p align=\"center\" style=\"margin: 0in; margin-bottom: .0001pt; text-align: center; background: white;\"><span lang=\"EN-US\" style=\"font-size: 8.5pt; font-family: 'Times New Roman',serif;\"><span style=\"font-size: 12pt;\">Figure 1. <span style=\"background: white;\">Timing in clinical practice and the PSIQ in <\/span>2018-2019 <span style=\"background: white;\">and <\/span>2019-2020<\/span><o:p><\/o:p><\/span><\/p>\r\n<div>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">On the first day of clinical practice in the CBME program, the authors (JH, TaM, AT) explained the purpose of the study to the students. The authors informed the students that the study would be undertaken as a program evaluation and research, and that their grades would not be influenced in case they did not agree to participate. Those students who agreed to participate signed a consent form giving permission to use their data. Subsequently, the authors asked medical students to fill out the PSIQ as a paper-based, self-administered questionnaire, and to include their student ID number. At graduation, all medical students completed the PSIQ on the internet or on paper as a self-administered questionnaire, again with their student ID number. The study was approved by the Ethics Committee of the University of Tsukuba (No. 1329).<\/span><\/p>\r\n<p><i><span lang=\"EN-US\">E. Data Analysis<\/span><\/i><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">To evaluate the differences in total PSIQ and scores for each item between the first day of clinical practice in the CBME program and the time of graduation, effect sizes (Cohen&#8217;s d) were determined for the total PSIQ and scores for each item. In addition, the Shapiro-Wilk test was performed to determine data distribution. For comparison of means for the difference in total PSIQ between 2018-2019 and 2019-2020, an unpaired t-test was applied. <\/span><span lang=\"EN-US\">The Shapiro-Wilk test confirmed that data distribution for both PSIQ 1 and 2 were not normal. However, since the distribution of PSIQ 2-1 was consistent with normality, a t-test was employed.<\/span><span lang=\"EN-US\"> Missing values were excluded. Data analysis was conducted using SPSS ver. 26 with significance set at the p&lt;0.05 level for total scores as the primary outcome of the PSIQ. Additionally, to deal with the possibility of multiplicity in the simultaneous assessment of each item score, significance levels were Bonferroni corrected, with p&lt; 0.005 <\/span><span lang=\"EN-US\">(Lee &amp; Lee, 2018).<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">III. <\/span><span lang=\"EN-GB\">RESULTS<\/span><\/strong><\/p>\r\n<p><span lang=\"EN-US\">As shown in Table 1, participants analysed in the 2018-2019 academic year (pre-COVID-19 pandemic) included<\/span><span lang=\"EN-US\"> 104 medical students (response rate: 88.1%) <\/span><span lang=\"EN-US\">who responded at both time points <\/span><span lang=\"EN-US\">(first day of clinical practice in the CBME program and at graduation), 33 of whom were female.<\/span><span lang=\"EN-US\"> In the 2019-2020 academic year (during-COVID-19 pandemic), 92 medical students (response rate: 92.0%) who responded at both time points were included, 33 of whom were female. One student who did not give consent to have their data used in this study was excluded<\/span><span lang=\"EN-US\">.<\/span><\/p>\r\n<\/div>\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"center\" width=\"633\" class=\" aligncenter\" style=\"width: 633px;\">\r\n<tbody>\r\n<tr>\r\n<td width=\"245\" valign=\"top\" style=\"text-align: left;\"><\/td>\r\n<td width=\"184\" valign=\"top\" style=\"text-align: left;\">\r\n<p><span lang=\"EN-US\">2018-2019 (pre-COVID-19 pandemic)<br \/>\r\n(n=104)<\/span><\/p>\r\n<\/td>\r\n<td width=\"203\" valign=\"top\" style=\"text-align: left;\">\r\n<p><span lang=\"EN-US\">2019-2020 (during-COVID-19 pandemic) (n=92)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"245\" valign=\"top\" style=\"text-align: left;\">\r\n<p><span lang=\"EN-US\">Age, mean \u00b1 standard deviation<\/span><\/p>\r\n<\/td>\r\n<td width=\"184\" valign=\"top\" style=\"text-align: left;\">\r\n<p><span lang=\"EN-US\">20.6\u00b11.5<\/span><\/p>\r\n<\/td>\r\n<td width=\"203\" valign=\"top\" style=\"text-align: left;\">\r\n<p><span lang=\"EN-US\">21.2\u00b13.4<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"245\" valign=\"top\" style=\"text-align: left;\">\r\n<p><span lang=\"EN-US\">Gender, number of persons (%)<\/span><\/p>\r\n<\/td>\r\n<td width=\"184\" valign=\"top\" style=\"text-align: left;\"><\/td>\r\n<td width=\"203\" nowrap=\"nowrap\" valign=\"top\"><\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"245\" valign=\"top\" style=\"text-align: left;\">\r\n<p><span lang=\"JA\">\u3000\u3000<\/span><span lang=\"EN-US\">Male<\/span><\/p>\r\n<\/td>\r\n<td width=\"184\" valign=\"top\" style=\"text-align: left;\">\r\n<p><span lang=\"EN-US\">66 (63.5)<\/span><\/p>\r\n<\/td>\r\n<td width=\"203\" valign=\"top\" style=\"text-align: left;\">\r\n<p><span lang=\"EN-US\">51 (55.4)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"245\" valign=\"top\" style=\"text-align: left;\">\r\n<p><span lang=\"JA\">\u3000\u3000<\/span><span lang=\"EN-US\">Female<\/span><\/p>\r\n<\/td>\r\n<td width=\"184\" valign=\"top\" style=\"text-align: left;\">\r\n<p><span lang=\"EN-US\">33 (31.7)<\/span><\/p>\r\n<\/td>\r\n<td width=\"203\" valign=\"top\" style=\"text-align: left;\">\r\n<p><span lang=\"EN-US\">33 (35.9)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"245\" nowrap=\"nowrap\" valign=\"top\" style=\"text-align: left;\">\r\n<p><span lang=\"EN-US\">\u00a0\u00a0 Unknown<\/span><\/p>\r\n<\/td>\r\n<td width=\"184\" nowrap=\"nowrap\" valign=\"top\" style=\"text-align: left;\">\r\n<p><span lang=\"EN-US\">5 (4.8)<\/span><\/p>\r\n<\/td>\r\n<td width=\"203\" nowrap=\"nowrap\" valign=\"top\" style=\"text-align: left;\">\r\n<p><span lang=\"EN-US\">8 (8.7)<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 1. <\/span><span lang=\"EN-US\">Characteristics of medical students included in the analysis<\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Table 2 shows that the <\/span><span lang=\"EN-US\">means <\/span><span lang=\"EN-US\">of total PSIQ scores and each PSIQ item for 2018-2019 and 2019-2020 were increased at graduation. A comparison of the mean for the difference <\/span><span lang=\"EN-US\">using the unpaired t-test <\/span><span lang=\"EN-US\">in total PSIQ score for 2018-2019 and 2019-2020 revealed that it was statistically higher for the 2019-2020 students (13.5 \u00b1 9.4) than for the 2018-2019 students (10.3 \u00b1 8.1)<\/span><span lang=\"EN-US\">\u00a0(t =2.6, df =195,\u00a0<em>p<\/em>\u00a0= 0.01)<\/span><span lang=\"EN-US\">.<\/span><span lang=\"EN-US\">\u00a0However, there were no statistically significant differences using the unpaired t-test with Bonferronni correction at a 0.005 level of significance in<\/span><span lang=\"EN-US\"> mean scores for 9 items of the PSIQ, namely &#8220;Teamwork&#8221; <\/span><span lang=\"EN-US\">\u00a0(t=0.96 df=195,\u00a0<em>p<\/em>=0.341), <\/span><span lang=\"EN-US\">\u00a0&#8220;Communication&#8221;<\/span><span lang=\"EN-US\">\u00a0(t=1.84, df=195,\u00a0<em>p<\/em>=0.068), <\/span><span lang=\"EN-US\">\u00a0&#8220;Conducting assessment&#8221;<\/span><span lang=\"EN-US\">\u00a0(t=2.31, df=195,\u00a0<em>p<\/em>=0.24)<\/span><span lang=\"EN-US\"> &#8220;Cultural awareness&#8221;<\/span><span lang=\"EN-US\">\u00a0(t=1.41, df=195,\u00a0<em>p<\/em>=0.022), <\/span><span lang=\"EN-US\">\u00a0&#8220;Ethical awareness&#8221;<\/span><span lang=\"EN-US\">\u00a0(t=2.25, df=195,\u00a0<em>p<\/em>=0.161),<\/span><span lang=\"EN-US\"> &#8220;Using records&#8221; <\/span><span lang=\"EN-US\">\u00a0(t=2.67, df=195,\u00a0<em>p<\/em>=0.026), <\/span><span lang=\"EN-US\">\u00a0&#8220;Dealing with emergencies&#8221; <\/span><span lang=\"EN-US\">\u00a0(t=2.33, df=195,\u00a0<em>p<\/em>=0.008), <\/span><span lang=\"EN-US\">\u00a0&#8220;Reflection&#8221;<\/span><span lang=\"EN-US\">\u00a0(t=2.32, df=195,\u00a0<em>p<\/em>=0.021)<\/span><span lang=\"EN-US\"> and &#8220;Teaching&#8221;<\/span><span lang=\"EN-US\">\u00a0(t=2.19, df=195,\u00a0<em>p<\/em>=0.030)<\/span><span lang=\"EN-US\">. \u00a0<\/span><span lang=\"EN-US\">The effect size (Cohen&#8217;s d) for total PSIQ scores from the first day of <\/span><span lang=\"EN-US\">clinical practice in the CBME program <\/span><span lang=\"EN-US\">to graduation was \u03941.3 in 2018-2019 and \u03941.4 in 2019-2020. The effect size (Cohen&#8217;s d) for each item of the PSIQ was \u03941.4 in 2018-2019. Range for items was \u03940.8-1.1 in 2018-2019 and \u03940.9-1.2 in 2019-2020.<\/span><\/p>\r\n<table border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"944\" class=\" aligncenter\" style=\"width: 77.7488%;\">\r\n<tbody>\r\n<tr>\r\n<td width=\"198\" style=\"width: 13.8151%;\">\r\n<p align=\"center\"><span lang=\"JA\">\u3000<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">Fiscal year (usually April 1 to March 31)<\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">First day of the CBME program <\/span><span lang=\"EN-US\">(1)<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">At graduation<\/span><span lang=\"EN-US\">\u3000<\/span><span lang=\"EN-US\">(2)<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">Mean <\/span><span lang=\"EN-US\">difference in PSIQ<\/span><span lang=\"EN-US\">\u3000<\/span><span lang=\"EN-US\">(2)-(1)<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" style=\"width: 7.01382%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">t score<\/span><\/p>\r\n<\/td>\r\n<td width=\"47\" style=\"width: 4.99469%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">Df<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" style=\"width: 7.12009%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">p-value<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">Cohen&#8217;s <i>d<\/i><\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"198\" rowspan=\"2\" style=\"width: 13.8151%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">Total score<\/span><\/p>\r\n<p align=\"center\"><span lang=\"JA\">\u3000<\/span><span lang=\"EN-US\">(Main outcome)<\/span><\/p>\r\n<\/td>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2018-2019 (pre-COVID-19 pandemic)<\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">28.5\u00b17.6<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">38.8\u00b18.5<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">10.3\u00b18.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" rowspan=\"2\" style=\"width: 7.01382%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.60<\/span><\/p>\r\n<\/td>\r\n<td width=\"47\" rowspan=\"2\" style=\"width: 4.99469%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">195<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" rowspan=\"2\" style=\"width: 7.12009%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.01<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.3<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2019-2020 (during-COVID-19 pandemic)<\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">28.0\u00b16.6<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">41.6\u00b19.2<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">13.5\u00b19.4<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.4<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"198\" style=\"width: 13.8151%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">Sub-analysis<\/span><\/p>\r\n<\/td>\r\n<td width=\"161\" style=\"width: 20.2874%;\"><\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\"><\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\"><\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\"><\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" style=\"width: 7.01382%;\"><\/td>\r\n<td width=\"47\" nowrap=\"nowrap\" style=\"width: 4.99469%;\"><\/td>\r\n<td width=\"66\" style=\"width: 7.12009%;\">\r\n<p align=\"center\"><span lang=\"JA\">\u3000<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"198\" rowspan=\"2\" style=\"width: 13.8151%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">Teamwork<\/span><\/p>\r\n<\/td>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2018-2019 <\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.0\u00b11.2<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.4\u00b11.0<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.4\u00b11.2<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.01382%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.96<\/span><\/p>\r\n<\/td>\r\n<td width=\"47\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 4.99469%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">195<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.12009%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.341<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.1<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2019-2020<\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.0\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.6\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.6\u00b11.3<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.2<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"198\" rowspan=\"2\" style=\"width: 13.8151%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">Communication <\/span><\/p>\r\n<\/td>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2018-2019 <\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.7\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.7\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.0\u00b11.2<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.01382%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">1.84<\/span><\/p>\r\n<\/td>\r\n<td width=\"47\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 4.99469%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">195<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.12009%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.068<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.8<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2019-2020<\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.5\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.9\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.4\u00b11.3<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"198\" rowspan=\"2\" style=\"width: 13.8151%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">Conducting assessment<\/span><\/p>\r\n<\/td>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2018-2019 <\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.2\u00b11.0<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.4\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.2\u00b11.2<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.01382%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">2.27<\/span><\/p>\r\n<\/td>\r\n<td width=\"47\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 4.99469%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">195<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.12009%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.024<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2019-2020<\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.1\u00b11.0<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.7\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.6\u00b11.3<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.2<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"198\" rowspan=\"2\" style=\"width: 13.8151%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">Cultural awareness<\/span><\/p>\r\n<\/td>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2018-2019 <\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.9\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.2\u00b11.3<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.3\u00b11.3<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.01382%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.31<\/span><\/p>\r\n<\/td>\r\n<td width=\"47\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 4.99469%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">195<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.12009%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.022<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2019-2020<\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.8\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.5\u00b11.3<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.8\u00b11.5<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.2<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"198\" rowspan=\"2\" style=\"width: 13.8151%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">Ethics awareness<\/span><\/p>\r\n<\/td>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2018-2019 <\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.4\u00b11.2<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.5\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.1\u00b11.3<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.01382%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">1.41<\/span><\/p>\r\n<\/td>\r\n<td width=\"47\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 4.99469%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">195<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.12009%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.161<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.9<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2019-2020<\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.5\u00b11.2<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.9\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.4\u00b11.4<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"198\" rowspan=\"2\" style=\"width: 13.8151%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">Using record entries<\/span><\/p>\r\n<\/td>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2018-2019 <\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.4\u00b11.0<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.5\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.0\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.01382%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">2.25<\/span><\/p>\r\n<\/td>\r\n<td width=\"47\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 4.99469%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">195<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.12009%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.026<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.9<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2019-2020<\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.4\u00b10.9<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.8\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.4\u00b11.3<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.1<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"198\" rowspan=\"2\" style=\"width: 13.8151%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">Dealing with emergencies<\/span><\/p>\r\n<\/td>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2018-2019 <\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.5\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.8\u00b11.3<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.3\u00b11.2<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.01382%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">2.67<\/span><\/p>\r\n<\/td>\r\n<td width=\"47\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 4.99469%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">195<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.12009%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.008<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.1<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2019-2020<\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2.3\u00b11.2<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.1\u00b11.4<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.9\u00b11.7<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.1<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"198\" rowspan=\"2\" style=\"width: 13.8151%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">Reflection<\/span><\/p>\r\n<\/td>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2018-2019 <\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.3\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.3\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.0\u00b11.3<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.01382%;\">\r\n<p><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">2.32<\/span><\/p>\r\n<\/td>\r\n<td width=\"47\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 4.99469%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">195<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.12009%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.021<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.8<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2019-2020<\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.2\u00b10.9<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.6\u00b11.3<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.4\u00b11.5<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"198\" rowspan=\"2\" style=\"width: 13.8151%;\">\r\n<p align=\"center\"><span lang=\"JA\">\u3000<\/span><span lang=\"EN-US\">Teaching<\/span><\/p>\r\n<\/td>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2018-2019 <\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.1\u00b10.9<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.1\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.9\u00b11.1<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.01382%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">\u00a0<\/span><\/p>\r\n<p align=\"center\"><span lang=\"EN-US\">2.19<\/span><\/p>\r\n<\/td>\r\n<td width=\"47\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 4.99469%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">195<\/span><\/p>\r\n<\/td>\r\n<td width=\"66\" nowrap=\"nowrap\" rowspan=\"2\" style=\"width: 7.12009%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0. 030<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">0.8<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td width=\"161\" style=\"width: 20.2874%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">2019-2020<\/span><\/p>\r\n<\/td>\r\n<td width=\"142\" style=\"width: 17.9698%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">3.2\u00b11.0<\/span><\/p>\r\n<\/td>\r\n<td width=\"95\" style=\"width: 10.3082%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">4.5\u00b11.2<\/span><\/p>\r\n<\/td>\r\n<td width=\"94\" style=\"width: 9.98937%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1.3\u00b11.4<\/span><\/p>\r\n<\/td>\r\n<td width=\"76\" style=\"width: 8.18278%;\">\r\n<p align=\"center\"><span lang=\"EN-US\">1<\/span><\/p>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div>\r\n<p align=\"center\"><span lang=\"EN-GB\">Table 2. <\/span><span lang=\"EN-GB\">\u00a0<\/span><span lang=\"EN-US\">Unpaired t-test analysis and effect sizes for the Professional Identity Self-Assessment Form<\/span><b><span lang=\"EN-US\"><\/span><\/b><\/p>\r\n<\/div>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">IV. DISCUSSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">We found that the means of total and each PSIQ score of medical students who graduated during the COVID-19 pandemic were statistically increased compared to those of students graduating before the pre-COVID-19 pandemic. These findings indicate that, compared with students in the preceding year, the COVID-19 pandemic had a certain positive impact on professional identity formation in medical students with regard to clinical practice.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Considering the framework we used, in which the interaction and reflection of role models, mentors, and <\/span><span lang=\"EN-US\">individual<\/span><span lang=\"EN-US\"> experiences are key, we believe that all participants were influenced by COVID-19. In addition, professional identity formation is reported to be strongly influenced by environment, context, and other personal variables. (Jarvis-Selinger et al., 2012) The increase in total PSIQ score from the previous year&#8217;s medical students may have been due not only to changes in clinical practice, but also to changes in what is expected of medical students by the university hospital and society. In light of these factors, medical students had fewer opportunities to acquire the knowledge and skills required of physicians in the clinical setting directly from role models and mentors, but may nevertheless have been affected by compliance with COVID-19 control measures conducted by the university hospital, and thereby followed the norms of medical professionals communicated through intentional and unintentional messaging. In addition, with the all-engrossing impact of the COVID-19 pandemic throughout society, we speculate that at least some of the students in the COVID-19 group were consulted by family and social contacts as experts and authorities on a daily or more frequent basis, and that such constant reinforcement might also have encouraged PIF. That is, medical students under the COVID-19 pandemic may have internalised the values and norms of the medical professional (Kinnear et al., 2021). Since professional identity formation involves social and relational factors, it is possible that the students&#8217; life and social changes due to COVID-19 reinforced their recognised professional identity (Goldie, 2012).<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">The more uncertain and ambiguous the period, the more important reflection becomes in PIF. To cope with such uncertainties as the transition from the classroom curriculum to online platforms, rapid changes in the clinical practice environment, and the isolation caused by social distancing, medical students need a well-formed professional identity and socialisation practices (Costello, 2005).\u00a0 Poor PIF is reported to manifest in burnout (Abedini et al., 2018), and depression and anxiety disorders have increased in COVID-19 (Daniels et al., 2021). Since a core component of PIF is the acceptance of uncertainty and ambiguity, medical educators may have provided reflection opportunities for medical students to consciously consider the social factors manifested in COVID-19, such as individual and professional duties, resource priorities, and health disparities, all of which have a positive impact on PIF and socialisation (Stetson et al., 2020). Alternatively, emotion-focused coping strategies (e.g., arts engagement) and problem-solving strategies (e.g., volunteering) to reduce medical students&#8217; anxiety, fear, and stress may be effective (Moula et al., 2022). Students require time and space to reflect on their emergent identity as professionals in these crisis situations (Moula et al., 2022). The extended time for independent learning may have allowed the students to subconsciously reflect on their professional identity, taking seriously the changes in society caused by COVID-19. PIF scores may have accordingly increased in this study.<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">\u00a0<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">In general, medical teachers should have made efforts to promote medical students\u2019 professional identity formation even during the COVID-19 pandemic <\/span><span lang=\"EN-US\">(Goldhamer et al., 2020). Professional identity formation is not a process that should be left to chance; it should be explicitly supported through systematic support and curriculum initiatives (Cruess et al., 2015; Schumacher et al., 2012). In reality, it is necessary to require rapid changes in clinical practice to prevent infection caused by COVID-19, and it has been difficult to promote systematic support for professional identity formation for medical students. However, COVID-19 might not have negatively affected the professional identity recognised by medical students who were in clinical practice immediately after the pandemic. <\/span><span lang=\"EN-US\">The efforts of Japanese medical educators to implement online and other types of learning to replace clinical practice, and the well-considered efforts of faculty to make clinical practice as feasible as possible may have served as role models or mentors, and influenced medical students&#8217; professional identity formation.<\/span><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">This study has three limitations. First, because there was a difference of 8-17 months between the <\/span><span lang=\"EN-US\">first day of clinical practice in the CBME program and graduation, given that more clinical practice experience may strengthen the professional identity recognised by medical students, it is possible that differences in clinical practice experience may have affected PSIQ scores. Second, extrapolation from this study should be done with care, since it is a comparison of a one-year questionnaire survey at a single university. Third, a degree of response bias may be present due to the self-reporting design, with inclusion of student ID number. Fourth, evaluation at three or more points may allow a more precise comparison of changes, given that professional identity formation is a dynamic process.<\/span><span lang=\"EN-US\"> <\/span><span lang=\"EN-US\">Even allowing for these limitations, our findings provide meaningful feedback to medical students and faculty, particularly given the paucity of studies evaluating and comparing changes in professional identity formation &#8211; which consists of multiple factors &#8211; before and during the <\/span><span lang=\"EN-US\">COVID-19 pandemic. For the future of medical education, it is imperative to track the professional identity recognised by physicians whose student experience in clinical practice was restricted under the COVID-19 pandemic, and was accordingly significantly changed compared with other years.<\/span><\/p>\r\n<p style=\"text-align: center;\"><span lang=\"EN-GB\"><\/span><strong><span lang=\"EN-GB\">V. CONCLUSION<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">Comparison of the professional identity recognised by medical students whose experience of clinical practice was affected by the COVID-19 pandemic to that of students in the previous year showed some positive impact on professional identity. This lack of negative difference in recognised professional identity even under restricted clinical practice may have been influenced by the imprinting of professional norms and changes in society.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Notes on Contributors<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">JH, <\/span><span lang=\"EN-US\">AT, SO, TaM and TeM <\/span><span lang=\"EN-US\">were involved in the conception and design of this study. JH, AT, and TaM collected the data. JH and RG conducted data analysis. JH mainly wrote the paper. AT, SO, TaM and TeM gave critical feedback on the manuscript. <\/span><span lang=\"EN-US\">All authors have read and approved the final manuscript.<\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Ethical Approval<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">This study was approved by the Ethics Committee of the University of Tsukuba&#8217;s Faculty of Medicine and Medical Sciences (No. 1329). All participants have given written consent for their data to be used in the research and for publication.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Data Availability<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-GB\">It is not possible to share data since we did not obtain consent from participants to share all data collected. <\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Acknowledgement<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">We thank the faculty staff members Shoji Yokoya, Hisashi Yoshimoto, Shogen Suzuki, Naoto Sakamoto, Yu Yamamoto, Yoshihiro Kataoka, Shoichi Masumoto, Haruka Kuno, Takashi Inaba, Shuhei Hamada, Shogo Kawada, and Sayaka Nin of the Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba. Additionally, we thank the healthcare staff who taught the medical students at the CBME program sites in clinical practice. <\/span><span lang=\"EN-GB\"><\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Funding<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">This study was funded by<\/span><span lang=\"EN-US\"> the education\/research fund of Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba.<\/span><i><span lang=\"EN-AU\"><\/span><\/i><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">Declaration of Interest<\/span><\/strong><\/p>\r\n<p style=\"text-align: justify;\"><span lang=\"EN-US\">There are no companies or other entities with which the authors have conflict of interest relationships that should be disclosed in relation to the content of the paper.<\/span><\/p>\r\n<p align=\"center\"><strong><span lang=\"EN-GB\">References<\/span><\/strong><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Abedini, N. 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Professional identity formation in disorienting times. <i>Medical Education<\/i>,\u00a0<i>54<\/i>(8), 765\u2013766. <\/span><span lang=\"EN-US\"><a href=\"http:\/\/doi.org\/10.1111\/medu.14202\">http:\/\/doi.org\/10.1111\/medu.14202<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p style=\"text-align: left;\"><span lang=\"EN-US\">Wurth, S., Sader, J., Cerutti, B., Broers, B., Nadia Bajwa, M., Carballo, S., Escher, M., Galetto-Lacour, A., Grosgurin, O., Lavallard, V., Savoldelli, G., Serratrice, J., Nendaz, M., &amp; Aud\u00e9tat-Voiro, M. C. (2022). Correction to: Medical students&#8217; perceptions and coping strategies during the first wave of the COVID-19 pandemic: Studies, clinical implication, and professional identity. <i>BMC Medical Education<\/i>, <i>22<\/i>(1), Article 232. <\/span><span lang=\"EN-US\"><a href=\"https:\/\/doi.org\/10.1186\/s12909-022-03307-9\">https:\/\/doi.org\/10.1186\/s12909-022-03307-9<\/a><\/span><span lang=\"EN-US\"><\/span><\/p>\r\n<p><span lang=\"EN-NZ\"><span lang=\"EN-AU\">*<span lang=\"EN-GB\">Junji Haruta<\/span><br \/>\r\n<span lang=\"EN-US\">35 Shinanomachi Shinjukuku Tokyo<\/span><br \/>\r\n<\/span><span lang=\"EN-AU\"><span lang=\"EN-US\">160-8582, Japan<\/span><br \/>\r\n<span lang=\"EN-US\">Email: junharujp@keio.jp<\/span><\/span><\/span><\/p>","protected":false},"featured_media":0,"parent":0,"menu_order":2,"template":"","issues_category":[12],"archive_category":[],"issue_type":[25],"volume_category":[61875],"class_list":["post-71944","issues","type-issues","status-publish","hentry","issues_category-original-articles","issue_type-past-issue","volume_category-volume-8-number-1-january-2023"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Has novel coronavirus infection affected the professional identity recognised by medical students? 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