Evaluation of a systematic career coaching program for medical students in Korea using the Career Readiness Inventory

Purpose The purpose of this study was to implement a systematic career coaching program for medical students and to evaluate its effectiveness. Methods First-year medical students of Konyang University College of Medicine took part in the FLEX Mentoring II: Career Coaching Program from September to December in 2016 and 2017. This program included 16 weekly sessions, comprising a total of 32 hours. The students took the Career Readiness Inventory before and after the program, as a pre- and post-test of the program. Data from 100 students were used (46 students in 2016, 54 students in 2017) for the evaluation. Results Medical students’ career readiness pre-test was rated as medium. In particular, many students were at a low level in terms of ‘support from colleagues and peers’ (53.0%), ‘career decision’ (48.0%), and ‘efforts for job preparation’ (60.0%). After 16 sessions of a systematic career coaching program, their career readiness level showed a significant increase except for ‘career decision’ (t= 4.242, P= 0.001) and ‘independence’ (t= 0.731, P= 0.466), a sub-factor of ‘career maturity.’ Conclusion The career readiness level of medical students was not sufficiently high. However, a semester of educational training in a systematic career coaching program helped the students to be better prepared for their career. In particular, the significant reduction in the ‘career decision’ variable after the program can be interpreted as indicating that the students changed their behavior to explore and approach their career more seriously and carefully, which also underscores the need for the implementation of career coaching programs in medical schools.


Introduction
The need for career guidance in medical education is not only about the student him/herself, but can be also considered a social problem. Proper career decision leads health care providers to be personally satisfied with the quality of their work life and helps them optimize their performance, which eventually improves the quality of health care. This demonstrates the importance of career guidance in medical education. However, no systematic career coaching pro-gram (SCCP) has yet been developed for medical students [1]. In the past, many medical schools have planned career development initiatives for students in which faculty advisors are assigned to individual students. One-on-one career counseling initiatives have been reported to lead to significant levels of unmet needs [2]. Therefore, we developed a SCCP for medical students in each academic year based on the career coaching model [3,4]. In this study, we applied an SCCP to career guidance in medical education as a pilot course and examined the effect of the program by analyzing changes in career readiness level. Career readiness refers to an individual's competence in managing the problems related to his or her career in each developmental stage. The subject of this research can be specified as follows: (1) What are the levels and characteristics of career readiness among first-year undergraduate medical students?; (2) How does a career coaching program change the level of career readiness?
These two overarching themes will be used as a framework for eISSN: 1975-5937 Open Access Evaluation of a systematic career coaching program for medical students in Korea using the Career Readiness Inventory

Subjects
First-year medical students from September to December in 2016 and 2017 of Konyang University College of Medicine participated in our newly developed systemic career coaching program called the 'FLEX Mentoring II: Career Coaching Course.' There were 56 and 60 students in 2016 and 2017, respectively. Among them, we analyzed data from 100 students, including 54 (male= 24, female= 30) and 46 (male= 26, female= 20) students from each year, respectively. The course contained 16 weekly sessions, for a total of 32 hours. The students took the CRI before and after the program as a preand post-evaluation of the program.

Career Readiness Inventory
The effects of the career coaching program were examined in terms of the level of career readiness. The CRI for college students assesses general developmental characteristics related to their preparation for employment. It also measures the level of employment preparation behaviors from various angles using each sub-factor and provides an objective view of career readiness [5]. This inventory is administered by the Korean Ministry of Employment and Labor and Korean Employment Information Service, and can be filled out online in Worknet, a Korean employment information website [6]. The CRI usually takes about 20 minutes, but there is no time limitation. It is divided into 2 major sections: career development (Section 1) and employment preparation behavior (Section 2). The sections have 48 and 40 questions, respectively, for a total of 88 questions (Appendix 1). Participants mark their answers to each question on a 6-point Likert scale (strongly disagree, disagree, somewhat disagree, somewhat agree, agree, strongly agree). The results of the inventory were interpreted using T scores, which were obtained by converting the raw scores for an appropriate comparison. The mean score is 50, and the standard variation is 10. The medium level is defined as T scores ranging from 41 to 60, while the low level corresponds to scores of 40 or less, and the high level is defined as scores of 60 and above. As the reliability coefficients of the sub-factors were 0.87 (career maturity), 0.92 (career search behavior), 0.74 (career decision), and 0.96 (employment preparation behavior), the item internal consistency (Cronbach alpha) of the CRI was determined to be high. Additionally, a correlation analysis showed statistically significant results, which verified the validity of the inventory. The specific details of the CRI are described in Supplement 1, and the raw data of this study are shown in Supplement 2.

Technical information
The FLEX Mentoring II: Career Coaching Course was run from September 5 to December 12 in both 2016 and 2017. There were 16 weekly 2-hour sessions in the course. It was a required course for every student at Konyang University College of Medicine and was graded as pass or non-pass. To characterize the effects of the career coaching program, we performed a pre-and post-test of CRI before and after the program. The pre-test was done after the first session, and a full explanation of the purpose and methods of this study was provided to students in writing and orally. The post-test was done after the end of program (16th session) with the same tool.

Statistics
The quantitative data collected from this study were analyzed using IBM SPSS ver. 21.0 (IBM Corp., Armonk, NY, USA). First, the level of career readiness was verified using descriptive statistics and cross-correlation analyses. Second, differences in the career readiness level between male and female students were assessed via the t-test for independent samples. Third, the effects of the career coaching program were analyzed in terms of differences between the pre-and post-test CRI scores through the t-test for matching samples. All results were verified by 2-tailed tests, and P-values < 0.05 were interpreted as indicating statistical significance.

Career readiness level: pre-test
Before implementing the SCCP, all the T scores of each sub-factor of CRI were at a medium level (Table 1). However, students showed low T scores for 'support from colleagues and peers' (53.0%), 'career decision' (48.0%), and 'employment preparation behavior' (60.0%).

Career readiness level: post-test after systematic career coaching program
The SCCP, titled 'FLEX Mentoring II: Career Coaching Course,' was a compulsory course for first-year medical students to help them experience a more practical and specific process of career exploration. It was based on our previous study and carried out as shown in Table  2. In Session 1, students received a class on the concepts of career and job and the importance of their career decision. Next, career decision and career readiness levels were measured in a counseling prohttps://jeehp.org J Educ Eval Health Prof 2018; 15: 10 • https://doi.org/10.3352/jeehp.2018.15.10 gram in Session 2 and 3. This verified the baseline career readiness/ preparation level of the medical students, and we used an interpersonal relations inventory, a vocational value searching activity, and a psycho-geometry personality test to help them to understand themselves and others and to set directions for their path.
In the Bridge component of the program (Sessions 4-7), there were classes about strategies for exploring career information. Afterwards, students identified candidate careers using data collected from senior mentoring, career pedigree, and searching work/job list activities. Groups were then organized by similar career path and took part in a speed dating program. Speed dating is a rapid information interviewing program in which students obtain specific career information through interviewing professionals in their field of interest. It uses a semi-structured interview sheet including job specifications, work environment, required character traits, mandatory competencies, education and training, future prospects, the timing and rationale of the career decision stage, and career contentment.
The following Educational component of the program (Session 8 and 9) consisted of classes on career planning, decision making, and SMART (specific, measurable, attainable, relevant, and timely) goal setting. These activities helped the students to make a 'career goal tree' and to establish practical and realistic career goals. Students also took a vocational aptitude test and learned the required capabilities to make their way into their field of interest.
The next 3 sessions, Sessions 10-12, were the mentoring component of the program, which helped students specify their career goals through mentoring with academic advisors. Furthermore, each group of students presented their portfolio from the career coaching program and shared all the information they gathered. This evaluation program was run from Sessions 13-15, and the students received written feedback on their presentations from their colleagues as well as from the professor. Finally, a post-test of career readiness was conducted in Session 16 to evaluate the effects of our career coaching course.
Significant differences were found in many of the factors of the CRI (Fig. 1). In particular, all the sub-factors in the 'career search behavior' category showed significant and positive differences before and after the SCCP. Also, 6 of the 7 sub-factors in the 'employment preparation behavior' category showed significant and positive differences before and after the SCCP. In contrast, it was very interesting to see students' 'career decision' level drop instead of rising after the SCCP (pre-test= 59.13, post-test= 53.26, P= 0.001). As shown in Fig. 1, the other survey item for which students' post-survey score dropped after the course was 'independence' in the 'career maturity' category (pre-test= 51.42, post-test= 50.73, P= 0.466). The full results are available in Supplement 3.

Discussion
In this study, the results of the pre-test carried out before the SCCP showed that the level of career readiness of the medical students was medium. Moreover, the score for 'independence,' a sub-factor of 'ca-  Goal of the course 1. Students perform tests and curricular activities as part of 4 types of coaching that help self-understanding in terms of character, interests, abilities, and values. 2. Students set their vision and purpose and complete a lifelong roadmap via a mentoring program with academic advisors. 3. Students set their short-term goals for career coaching during the frst semester of academic year 1 in medical school and carry out projects to explore and collect information on their career of interests Instructional method Types of courses: team-teaching, workshops, lectures (L). Types of active learning: individual activity (IA), group/pair discussion (TA), team-based learning, presentation, quiz, interviews, group project, jigsaw, online and offline tests. Assessment (%) 1. Attendance (20%) 2. Presentation (30%): individual/group presentation (assessed based on presentation skill and submitted materials in terms of originality, organization of the content and structure, delivery skills, and teamwork), peer assessment, professor assessment 3. Report (50%): individual report, group report (including mentoring portfolio) Session 1 Orientation Career concept, the importance of deciding upon a career, strategies for career coaching (L); pre-test of CRI, investigation of preferable majors (IA) 2 Counseling program Understanding of 'self' and others (1)  reer maturity,' was the lowest; this variable assesses the degree to which individuals explore options autonomously and make their own decisions about career preparation. This demonstrates that many students rely on other people, such as parents, to make decisions about their career. In other words, even though their own career is at stake, they try to shift their responsibilities onto others. Furthermore, the scores for 'experience of career activity' and 'experience of an academic career-planning program' were the lowest in the category of 'career search behavior.' This indicates a deficiency in experiences of career exploration and career decision. Many Korean medical schools have been struggling with a significant problem in career guidance because of the lack of self-exploration by students on an individual level and the presence of insufficient career information. Thus, more opportunities for those experiences should be provided to medical students in the future. Strikingly, the score for 'support from colleagues and peers' was the lowest among all the sub-factors. This demonstrates insufficient human support from colleagues and peers who could help students explore their future career. Moreover, many students showed a low level of career readiness in terms of 'career decision.' This demonstrates that medical students try to put off choosing a career because of uncertainties about their careers and future paths. In addition, 'employment preparation behavior' measured the level of practical performance based on the 3 items in the corresponding CRI sub-inventory.
However, since we analyzed students in their freshman year who are not at the immediate time of choosing a career, the results should be interpreted properly. Therefore, considering the career readiness of medical students as shown on the pre-test, our career coaching program (SCCP) seems appropriate as a way to help students take initiative in exploring various aspects of career information in order to develop their own career path plan. Since the SCCP helped the students understand their capabilities to deal with their career problems, it provided not only self-understanding but also an analysis of factors that could influence their choice of career.
This study proved that our coaching program (SCCP) had significant effects through the results of the post-test. Almost every item of the CRI showed a statistically significant increase. In particular, the sub-factor 'support from colleagues and peers' within 'career search behavior' showed a highly significant change from a low levelamong the overall scores-to a high level. This demonstrates that the activities carried out in the SCCP, including 'faculty and senior career mentoring' and 'speed-dating with professionals' in their field of interest, served as a meaningful and valuable tool.
However, in contrast with the previous study of Yoo et al. [7], the 'career decision' score significantly decreased after the program. This difference can be explained in terms of the different characteristics of each subject group. In the study of Yoo et al. [7], the participants in the career coaching course were students in academic year 2 in a post-graduate medical school. Although their study used a different evaluation tool, the sub-factor 'career decision' in 'career maturity' improved compared to the control group. The students in that study were in a post-graduate medical school, meaning that they had already graduated college and re-entered medical school to become a clinical doctor. Thus, it is quite predictable that the direction of their career path would be clearer than the case for our subjects, who were undergraduate students in their freshman year in medical college. Therefore, we suggest that the decrease in the 'career decision' score after SCCP in our study may have been due to the characteristics of students who entered medical college based on good grades without sufficient career exploration. They experienced a systematic career exploration program, which led them to consider various career paths and become cautious about their own career decisions. This also indicates that the program accomplished its goal of encouraging students to take initiative in exploring their career and to acquire a positive and active attitude.
Medical education has long been in need of career guidance programs for medical students. For that reason, some countries have recommended structuring and formalizing a career advising system by including it in accreditation standards and national guidelines, and some medical schools are attempting to integrate a career advising system into the formal curriculum [8]. Our study documents a successful case of integrating a career coaching system into the formal curriculum for medical students.
There are some limitations in our study. First, the SCCP and CRI were only conducted in the first year of medical college, making it difficult to generalize our results to encompass career guidance throughout the scope of medical education. Second, the effects of a career coaching program can be assessed via various frameworks, such as career decision self-efficacy and career maturity, whereas we only evaluated the career readiness level. However, we have developed a SCCP [3] and suggested more specific programs for each grade [4]. To conclude, we confirmed the effect of our SCCP by running a 1-semester program in a medical college as a follow-up study. Therefore, a wider range of career coaching programs should be developed and it is expected that studies about experiences in applying such programs will be derived from our research.