Differentiated effects of medical educational collaboration on primary care employment intention: a multi-group analysis based on competence types

This study aimed to investigate the differential associations between medical educational collaboration and primary care employment intention among medical students with distinct competence profiles, drawing upon Social Cognitive Career Theory (SCCT) as the theoretical framework. A cross-sectional survey was conducted among 398 clinical medicine students from three medical schools in Yunnan Province, China. Latent profile analysis was employed to classify participants into competence profiles based on self-assessed clinical reasoning, communication skills, and procedural skills. Multi-group structural equation modeling was performed to examine whether the SCCT-based pathways from medical educational collaboration to primary care employment intention varied across profiles. Three competence profiles were identified: Practice-Oriented (35.7%), Balanced (33.7%), and Reasoning-Oriented (30.6%). The overall structural model demonstrated acceptable fit, with career self-efficacy and outcome expectations serving as parallel and sequential mediators, with approximately 66% of the total association transmitted through indirect pathways. The multi-group analysis revealed significant pathway heterogeneity across profiles. For Practice-Oriented students, outcome expectations served as the dominant mediating pathway, while the association between career self-efficacy and primary care employment intention was non-significant. For Reasoning-Oriented students, career self-efficacy played a more critical mediating role, with the strongest association with primary care employment intention among the three profiles. The Balanced profile exhibited relatively equal contributions from both pathways. These findings provide empirical evidence suggesting that SCCT-based pathways may vary as a function of individual competence characteristics, contributing to the person-centered perspective in career development research. The results suggest that medical education institutions should implement differentiated career guidance interventions tailored to students’ competence profiles to strengthen the primary care workforce.