Career perception as an upstream determinant of mental health and professional competencies in health professions education during systemic disruption.

BACKGROUND: Systemic disruptions, including public health emergencies, natural disasters, and large-scale interruptions to clinical training, can destabilize health professions education and reshape students' perceptions of their future careers. Career perception may function as a cognitive anchor that links disrupted learning environments with both psychological well-being and professional development, yet its structural role remains insufficiently understood. This study examined whether career perception operates as an upstream determinant of mental health, dropout intention, and professional competencies among medical and nursing students in a pandemic-era disrupted educational context.

METHODS: A cross-sectional study was conducted using secondary data from 1,707 undergraduate medical and nursing students during the pandemic. Career perception was assessed via a single-item measure of perceived change during COVID-19. Validated instruments measured empathy, lifelong learning, mental health symptoms, life satisfaction, and dropout intention. Group differences were examined using one-way and two-way ANOVA. Pearson correlation analysis assessed bivariate associations. Bayesian network analysis with bootstrap resampling was applied to explore directed probabilistic dependencies among variables.

RESULTS: Students with more positive career perceptions demonstrated higher levels of empathy, lifelong learning orientation, and life satisfaction, and lower levels of anxiety, depression, and dropout intention (all p < 0.001). Career perception was significantly associated with all major outcomes (|r| = 0.12-0.41). Bayesian network analysis identified career perception as an upstream node with robust directed effects on dropout intention (arc strength = 1.00) and lifelong learning (arc strength = 0.89). Dropout intention emerged as a central mediator linking career perception to depression, anxiety, and satisfaction. Lifelong learning and satisfaction, in turn, directly influenced empathy. These structural relationships were highly stable across bootstrap samples.

CONCLUSION: In a disrupted health professions education context, career perception functioned as an upstream determinant shaping both mental health and professional competencies. The findings suggest that professional meaning-making and career reflection should be treated as core educational support during periods of systemic instability.