The relationship between honesty-credit, specialty identity, career Identity and performance intention among rural-Oriented tuition-waived medical students of China in the context of COVID-19: a cross-sectional study

Abstract Background: Whether the rural-oriented tuition-waived medical students fulfil the contract to work in rural medical institutions after graduation is directly related to the improvement of rural health quality. This study not only quantitatively measured the direct impact of honesty-credit, specialty identity, career identity on RTMSs' performance intention, but also quantifies the intermediary role of specialty identity and career identity between honesty-credit and performance intention. The research results provide recommendations for the RTME program to achieve its goal of training rural primary health care personnel. Methods: From March to May 2022, a total of 1162 RTMSs were selected as the research objects, honesty-credit, specialty identity, career identity and performance intention were quantitated by self-completed questionnaire. Person correlation analysis and Structural Equation Modelling (SEM) were used for statistical analysis and mediating effect evaluation. Results: 455 (42.3%) of RTMSs had high performance intention, and honesty-credit had a significant direct positive effect on performance intention (β=0.198, p<0.001), specialty identity (β=0.653, p<0.001) and career identity (β=0.180, p<0.001). Specialty identity has a direct positive effect on career identity (β=0.777, p<0.001), and the latter also has a direct positive effect on performance intention (β=0.321, p<0.001). In the intermediary path between honesty-credit and performance intention, career identity 95%CI:( 0.007)– (0.051) had significant mediating effects. Career Identity 95%CI:( 0.030)– (0.149) also had significant mediating effects between specialty identity and performance intention, and specialty identity had significant mediating effects between honesty-credit and career Identity, 95%CI:( 0.465)– (0.760). These results strongly confirm that honesty-credit, specialty identity, career identity are early and powerful predicators of RTMSs' performance intention. Conclusion: Medical universities need to strengthen the sense of honesty-credit and performance of RTMSs, and make clear their important contribution and significance of their role to the country, society, and realize the national expectation and individual win-win development.