Abstract
Background
The effects of mindfulness on personal development and positive self-related outcomes in learning and professional contexts have been studied extensively. However, the associations of positive psychology instruction with embedded mindfulness exercises with professional calling and self-concept clarity remain underexplored among medical students.
Methods
The present study examined whether participation in such instruction was associated with changes in professional calling and self-concept clarity among 105 medical students at Shandong Xiehe University. The participants were divided into two groups: a training group (n = 51) and a control group (n = 54). Both groups completed the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R), the Calling and Vocation Questionnaire (CVQ), and the Self-Concept Clarity Scale (SCCS). Over 16 weeks of study, the training group received a course that incorporated positive psychology and mindfulness exercises, while the control group received no training or intervention in these areas.
Results
The results indicated that the training group showed greater increases in mindfulness, professional calling, and self-concept clarity compared to the control group.
Conclusions
These findings indicate that integrating mindfulness-related practices into positive psychology instruction was associated with higher levels of mindfulness, professional calling, and self-concept clarity among medical students in this study.
Supplementary Information
The online version contains supplementary material available at https://doi.org/10.1186/s40359-026-05245-3.
Keywords: Mindfulness, Self-Concept Clarity, Professional Calling, Medical Students, Quasi-Experimental Study
Introduction
Mindfulness has gained increasing attention in educational and health psychology as a personal resource associated with adaptive functioning, emotional regulation, self-awareness, and psychological adjustment among university students and healthcare trainees [5, 25, 42]. It is conceptually defined as receptive and sustained attention to present-moment experiences with openness and without judgment [6, 26]. As a regulatory process, mindfulness allows individuals to observe internal and external experiences with reduced reactivity, which may support attentional regulation, emotional awareness, and intentional cognitive processing [30, 31, 42]. Empirical studies have shown that mindfulness practices are associated with positive psychological outcomes, including meaning in life, life satisfaction, emotional adjustment, and psychological resilience, particularly among university students facing intensive academic demands [24, 25, 31, 34].
In medical education, the development of mindfulness skills is particularly relevant because medical students are frequently exposed to sustained academic and emotional demands that may affect psychological adjustment and identity development [5, 25]. Medical education involves sustained academic and professional demands that may influence students’ psychological adjustment and identity development. Studies conducted among Chinese medical students have reported that structured mindfulness-based interventions improve psychological functioning, including enhanced meaning in life and other indicators of positive psychological development [5, 25, 31, 42]. These findings suggest that mindfulness-related practices may be associated with broader self-related and vocational outcomes among medical students.
Self-concept clarity is a central construct in explaining identity development and psychological adjustment among students in professional training contexts [32, 44]. It refers to the extent to which individuals’ beliefs about themselves are clearly defined, internally consistent, and stable over time [10, 32, 44]. Individuals with higher self-concept clarity display more coherent identity structures and greater stability when making personal or academic decisions, while lower clarity reflects fragmented or inconsistent self-beliefs. Prior theoretical and recent empirical work suggest that self-concept clarity may fluctuate during periods of developmental transition and adaptation to new academic or professional roles, particularly in higher education contexts where identity-related demands become more salient [13, 41]. Prior research has also demonstrated that self-concept clarity is positively associated with learning engagement, identity formation, and emotional adjustment [32, 44]. Recent empirical work among Chinese medical students further showed that self-concept clarity mediated the association between mindfulness and academic engagement [3], indicating that engaging in mindfulness may help individuals organize self-beliefs more clearly, which in turn facilitates adaptive functioning in demanding learning environments.
The association between mindfulness and self-concept clarity has been discussed within models of metacognitive awareness. The reperceiving model [40] and the monitor-and-acceptance theory [30], together with more recent mindfulness research in educational and health contexts [5, 42], suggest that mindfulness may facilitate a shift from automatic cognitive processing toward more reflective and non-reactive awareness. Within these frameworks, mindfulness has been theoretically linked to greater coherence and stability in self-related beliefs, although the mechanisms underlying changes in self-concept clarity remain insufficiently established empirically. Recent theoretical work has also emphasized that self-concept clarity should be understood as a dynamic aspect of identity organization that may vary across contextual and developmental experiences rather than solely as a stable individual characteristic [22].
Professional calling represents a psychological construct relevant to vocational development among students in professional training contexts. In the present study, professional calling refers to a perceived sense of meaningful engagement and purpose related to one’s future profession, consistent with the broader conceptual framework underlying the Calling and Vocation Questionnaire (CVQ; [16]). The CVQ remains relevant in contemporary vocational research, as recent psychometric studies have continued to examine and support its use among university students and working populations [14, 15, 37]. Professional calling may become increasingly relevant during early professional training as students begin to connect personal values, future occupational goals, and emerging professional roles. Research among medical students and university populations has shown that professional calling is associated with vocational identity development, career decidedness, and professional meaning [18].
Recent studies suggest that mindfulness is positively associated with professional calling, vocational meaning, and career-related purpose among university students [4, 33]. Mindfulness has been found to predict higher levels of calling, likely because it encourages reflective awareness, value clarification, and emotional regulation [7, 17, 33]. In addition, theoretical and empirical literature has suggested that self-concept clarity may represent an important identity-related process linking mindfulness with vocational development, as coherent and stable self-beliefs may support the articulation of professional goals, vocational meaning, and consistent evaluation of career decisions [8, 29]. However, despite growing evidence linking mindfulness with self-concept clarity, vocational meaning, and professional identity-related processes, experimental research simultaneously examining professional calling and self-concept clarity within structured mindfulness-related educational interventions remains limited, particularly among medical students undergoing intensive professional training [29, 33]. The present study addresses this gap by simultaneously examining mindfulness, professional calling, and self-concept clarity within a structured instructional intervention designed to support reflective awareness, vocational orientation, and identity-related development among medical students. Although previous studies have reported associations among mindfulness, self-concept clarity, and vocational development, limited experimental research has examined how these constructs may operate together within structured educational interventions in medical education contexts [27, 29, 33]. Existing quasi-experimental studies have primarily focused on stress reduction and general well-being outcomes following mindfulness-related interventions, while comparatively limited attention has been directed toward vocational development and self-concept clarity within medical education contexts [12, 42].
The present quasi-experimental study addresses this gap by examining mindfulness, self-concept clarity, and professional calling as theoretically interconnected aspects of psychological and vocational development among medical students participating in a structured instructional intervention. The instructional program was designed to enhance awareness, reflective thinking, and identification of professional values through positive psychology instruction with embedded mindfulness-related practices.
Previous research has emphasized mindfulness as a psychological resource associated with identity development and professional purpose among university students. Although correlational studies have consistently demonstrated positive associations among mindfulness, professional calling, and self-concept clarity, limited experimental evidence has examined whether these constructs can be enhanced through structured educational interventions in medical education contexts.
Accordingly, the present study examined whether participation in the instructional intervention would be associated with changes in mindfulness, professional calling, and self-concept clarity among medical students. Based on the theoretical and empirical literature reviewed, the following hypotheses were proposed.
Based on this gap in the literature, the present study examined whether participation in positive psychology instruction with embedded mindfulness exercises would be associated with changes in mindfulness, professional calling, and self-concept clarity among medical students. Based on the theoretical and empirical literature reviewed, the following hypotheses were proposed.
H1: Students who participated in the instructional intervention would demonstrate greater increases in mindfulness compared with students in the control group.
H2: Students who participated in the instructional intervention would demonstrate greater increases in professional calling compared with students in the control group.
H3: Students who participated in the instructional intervention would demonstrate greater increases in self-concept clarity compared with students in the control group.
Method
A quasi-experimental pre-test/post-test design with a control group was employed to examine whether participation in positive psychology instruction with embedded mindfulness exercises was associated with changes in professional calling and self-concept clarity among medical students. This design is commonly used in educational and field-based intervention research when random assignment is not practically feasible, while still allowing comparison of change over time between intervention and comparison groups [9, 11, 38].
The study was conducted during the 2025 academic semester at Shandong Xiehe University in China. The intervention was implemented using two intact academic classes within a naturally occurring educational setting where individual random assignment was not feasible. One class was assigned to the training condition, whereas the other served as the control group. This classroom-based approach preserved continuity of instruction and minimized disruption to the academic schedule; however, it may also have introduced unmeasured differences between groups and potential selection bias. Despite these limitations, quasi-experimental classroom-based designs continue to be widely employed in contemporary educational intervention research when random assignment is not practically feasible in naturally occurring instructional settings [5, 42].
Participants
A total of 110 undergraduate students enrolled in medical sciences at Shandong Xiehe University in China were recruited voluntarily to participate in the study. The participants were drawn from two intact classes within the same institutional and academic context, reflecting a relatively homogeneous educational setting. Two intact classes were selected, and each initially consisted of 55 students. One class was assigned to the intervention condition, whereas the other served as the control group. The assignment was based on pre-selection of comparable classes rather than individual randomization, consistent with a quasi-experimental classroom-based design. The class designated as the intervention group was the course section taught by the researcher, who delivered positive psychology instruction with embedded mindfulness exercises as part of regular coursework. The control class was selected from the same academic college based on similarity to the intervention class in age range, academic major, and level of study.
Eligibility criteria required that participants had no previous experience with mindfulness training or related contemplative practices, including Tai Chi, Qigong, or yoga. All participants completed informed consent forms and were assured that their responses would remain confidential. During the intervention period, four students from the training class and one student from the control class did not complete the post-test measures and were excluded from analysis. The final sample, therefore, comprised 51 students in the training group and 54 students in the control group. Participants’ ages ranged from 18 to 21 years (Mage = 19.8, SD = 1.84).
Procedures
The study followed a quasi-experimental design using two intact classes from the same academic college. After obtaining institutional approval and informed consent from all participants, the pre-test questionnaires were administered simultaneously to both classes. The purpose of this initial assessment was to establish baseline levels of mindfulness, professional calling, and self-concept clarity and to examine baseline comparability between the two classes before the intervention.
Following the baseline assessment, one intact class—the class taught by the researcher—was designated as the training group. This class received a structured instructional program that integrated positive psychology content with embedded mindfulness exercises across a 16-week semester. The program consisted of weekly sessions that combined conceptual instruction, guided discussions, and in-class mindfulness practice. Each session included approximately 30 min of mindfulness exercises, and students were encouraged to complete additional brief meditation practices as homework.
The control class did not receive any form of psychological training or mindfulness-related instruction during the study period and continued with their regular coursework. No elements of the intervention were introduced to the control group during the study period. However, because the control condition did not include an alternative activity or active comparison program, the observed differences may partly reflect non-specific instructional factors, including instructor attention and general classroom engagement, rather than the specific effects of mindfulness-related practices alone.
At the end of the 16-week intervention period, both classes completed the post-test questionnaire under the same conditions as the pre-test. Although the instructor supervised the intervention activities as part of regular coursework, students completed the questionnaires independently and were reminded that all responses would remain confidential and would be analyzed only in aggregated form. Participation in all phases of data collection was voluntary. Students who did not complete the post-test were excluded from the final analysis. The final sample included 51 students in the training group and 54 students in the control group.
Measurements
Mindfulness
The Cognitive and Affective Mindfulness Scale–Revised (CAMS-R) in its Chinese adaptation includes 12 items [20] and has been validated as a reliable tool for use in Chinese settings [43]. Each item is rated on a 4-point Likert scale, ranging from 1 (never) to 4 (always). In the present study, the scale demonstrated acceptable internal consistency, with a Cronbach’s α of 0.79.
Professional calling
The Chinese version of the Calling and Vocation Questionnaire (CVQ), consisting of 24 items [16], has been validated and demonstrated as a reliable instrument within Chinese contexts [23]. Each item is rated on a 4-point Likert scale, ranging from 1 (strongly disagree) to 4 (strongly agree). The present study utilized the overall composite score of the CVQ to assess professional calling rather than analyzing specific calling dimensions separately. This approach was appropriate because the present study focused on overall professional calling as a broad vocational orientation, rather than on testing dimension-specific differences. The use of a composite score is also consistent with the broader conceptualization of calling as a multidimensional but integrated vocational construct involving meaningful work, purpose, prosocial orientation, and perceived summons [14–16, 37]. The scale demonstrated acceptable internal consistency in the present study, with a Cronbach’s α of 0.88.
Self-concept clarity
The Chinese version of the Self-Concept Clarity Scale (SCCS; [10]) was employed to assess the degree of clarity and consistency in participants’ self-concepts. The scale consists of 12 items rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree) and has demonstrated reliability in Chinese populations [45]. In the present study, the internal consistency was satisfactory, with a Cronbach’s α of 0.82.
The training program
The training program was developed as an instructional intervention grounded in positive psychology and supported by the mindfulness practices conceptually adapted from principles commonly used in mindfulness-based approaches such as Mindfulness-Based Stress Reduction (MBSR), including breathing awareness, body scan, mindful walking, and present-moment attention [26, 27]. The intervention was not intended to replicate a standardized clinical mindfulness protocol but rather to integrate mindfulness-related educational practices within a semester-long instructional context. Rather than functioning as a standardized clinical stress-reduction protocol, the program was implemented as part of a semester-long course in positive psychology and was designed to enhance students’ self-understanding, reflective awareness, and professional calling. This distinction is important because recent mindfulness-based intervention studies in medical education have largely examined stress, burnout, psychological distress, and well-being outcomes rather than vocational or identity-related outcomes [12, 42]. The program combined conceptual instruction with structured experiential activities to strengthen mindfulness skills in ways relevant to self-concept clarity and vocational purpose.
Each weekly session integrated short theoretical components with guided group-based exercises. The instructional content addressed themes such as awareness of personal values, identification of strengths, and reflection on professional goals. These components were followed by mindfulness practice aimed at cultivating focused attention, breath regulation, emotional awareness, and intentional engagement with present-moment experience. The integration of these elements sought to help students connect mindfulness skills with outcomes related to identity formation and professional orientation.
A central component of the instructional activities involved a breathing-based coloring exercise adapted from mindfulness-related attentional and breathing practices previously described in related educational intervention studies [1, 2]. During the exercise, students synchronized slow inhalation and exhalation with repetitive coloring movements while focusing attention on the present task. The activity was implemented as part of the broader instructional program rather than as a standalone clinical mindfulness protocol. During the exercise, students inhaled slowly while coloring the ascending line for approximately four seconds, paused for two seconds, and exhaled slowly while coloring the descending line for an additional four seconds. Each session required students to complete approximately 140 such shapes, resulting in 25 to 30 min of continuous meditative practice.
In addition to in-class breathing meditation, students were assigned complementary mindfulness practices as weekly homework to reinforce continuity of training. These included body scan meditation, mindful eating, and mindful walking. At the beginning of each weekly session, the instructor reviewed students’ reflections on their home practice to ensure adherence, address challenges, and connect their experiences to the course content. This combination of in-class guided practice and home-based exercises was intended to strengthen the internalization of mindfulness skills and sustain their application beyond the classroom.
The program was delivered by the course instructor (1st author), who has academic expertise in positive psychology and experience in implementing mindfulness-based educational practices. Students were informed that the instructional activities formed part of a research project examining psychological development in educational settings. To reduce response pressure, participation in questionnaire completion was voluntary, responses were anonymized, and students were informed that their responses would not influence academic evaluation. All sessions were conducted during regular class meetings across the 16-week semester. Figure 1 presents a sample of the repeated coloring shape used in the breathing-meditation component of the program.
Fig. 1.
Repeated breathing-based coloring shape used during the mindfulness exercise (Author-created figure)
Intervention fidelity
Intervention fidelity was ensured through adherence to a structured session plan developed specifically for the training program. The instructor followed a detailed weekly manual outlining the theoretical content, discussion prompts, and mindfulness exercises to be delivered in each session. To maintain consistency, the instructor completed a fidelity checklist after every class session, documenting the extent to which the planned components were implemented. In addition, brief reflections were recorded regarding student engagement, timing of activities, and any deviations from the planned structure.
Since the intervention was delivered by the course instructor—a faculty member with academic expertise in positive psychology and experience in mindfulness-based educational practices—consistency in delivery was further supported by the instructor’s familiarity with the program’s objectives and procedures. The control group did not receive any form of mindfulness or positive psychology training during the study period, ensuring a clear distinction between instructional conditions.
Data analysis
Data were analyzed using IBM SPSS Statistics version 31.0.0 to examine the effects of the 16-week instructional intervention on mindfulness, professional calling, and self-concept clarity. Before conducting inferential analyses, the dataset was screened for completeness, and only participants who completed both pre- and post-test measures were included in the final analysis. Descriptive statistics (means and standard deviations) were computed for all variables across the two measurement points.
The normality of the distributions was assessed using Shapiro–Wilk tests, following the original procedure proposed by Shapiro and Wilk [39]. All results were non-significant, indicating no substantial deviations from normality and supporting the use of parametric analyses. Detailed normality statistics are presented in Supplementary Table S1. In addition, Levene’s tests indicated no significant violations of the assumption of homogeneity of variances.
Baseline equivalence between the training and control groups was examined using independent samples t-tests on pre-test scores for mindfulness, professional calling, and self-concept clarity. This step was intended to assess baseline comparability between groups before the intervention, although it does not eliminate the possibility of unmeasured differences.
To evaluate the effects of the intervention, a series of mixed-design analyses of variance (mixed ANOVAs) was conducted, with Time (pre-test, post-test) as the within-subjects factor and Group (training, control) as the between-subjects factor. Mixed-design ANOVA is appropriate for examining whether changes across repeated measurements differ between independent groups in pre-test/post-test intervention designs [28, 35]. For each outcome variable, the main effects of Time and Group, as well as the Group × Time interaction, were examined. Significant interaction effects were interpreted as evidence that changes over time differed between groups, consistent with a differential pattern associated with the intervention.
To provide additional estimates of intervention-related differences while accounting for baseline variability, separate analyses of covariance (ANCOVAs) were conducted for each outcome variable. ANCOVA is commonly used in intervention and quasi-experimental research to compare post-test outcomes between groups while statistically adjusting for corresponding baseline scores [21, 35, 38]. In these analyses, post-test scores served as dependent variables, group was entered as the fixed factor, and corresponding pre-test scores were included as covariates.
These procedures remain consistent with contemporary quantitative practice in educational, psychological, and medical education intervention research, where assumption testing, mixed-design analyses, and baseline-adjusted group comparisons continue to be used to evaluate intervention-related changes over time [12, 27, 42].
In addition, 95% confidence intervals were reported for key intervention-related estimates to improve interpretability and align with current reporting recommendations. Effect sizes were reported using partial eta squared (ηp²) to quantify the magnitude of observed effects. Statistical significance was evaluated using a conventional alpha level of 0.05.
Results
Table 1 shows that the control and training groups were comparable at baseline on mindfulness, professional calling, and self-concept clarity. As presented in Table 2, no statistically significant differences were observed in pre-test scores across the study variables. Post-intervention scores showed increases in the training group across all measures (CAMS-R: 15.75 to 19.50; CVQ: 60.00 to 63.30; SCCS: 21.00 to 26.00), whereas the control group showed negligible changes, with scores remaining largely stable from pre- to post-test (CAMS-R: 16.06 to 16.00; CVQ: 60.01 to 60.00; SCCS: 22.11 to 22.00). These patterns indicate that the intervention group showed greater improvements in mindfulness, professional calling, and self-concept clarity than the control group during the study period.
Table 1.
Descriptive Statistics
| Measure | Group | N | Mean | SD |
|---|---|---|---|---|
| CAMS-R Pre | Control | 54 | 16.06 | 4.07 |
| Experimental | 51 | 15.75 | 4.34 | |
| CAMS-R Post | Control | 54 | 16.00 | 4.21 |
| Experimental | 51 | 19.50 | 3.44 | |
| CVQ Pre | Control | 54 | 60.01 | 3.63 |
| Experimental | 51 | 60.00 | 3.95 | |
| CVQ Post | Control | 54 | 60.00 | 4.07 |
| Experimental | 51 | 63.30 | 4.06 | |
| SCCS Pre | Control | 54 | 22.11 | 5.49 |
| Experimental | 51 | 21.00 | 5.82 | |
| SCCS Post | Control | 54 | 22.00 | 5.56 |
| Experimental | 51 | 26.00 | 4.37 |
CAMS-R Mindfulness scale, CVQ Professional Calling scale, and SCCS Self-Concept Clarity scale
Table 2.
Independent Samples t-tests
| Measure | t | df | p |
|---|---|---|---|
| CAMS-R Pre | 0.377 | 103 | 0.707 |
| CVQ Pre | 0.135 | 103 | 0.893 |
| SCCS Pre | 1.004 | 103 | 0.318 |
Table 2 presents the independent samples t-test results, which indicate no significant baseline differences between the control and training groups on mindfulness (CAMS-R Pre, p = .707), professional calling (CVQ Pre, p = .893), or self-concept clarity (SCCS Pre, p = .318).
Table 3 shows significant main effects of time and significant Group × Time interactions across the three study variables, while the main effect of group was non-significant for all outcomes. For mindfulness (CAMS-R), there was a significant effect of time (p = .001) and a significant Group × Time interaction (p = .001), but no significant main effect of group (p = .420), indicating that while scores changed over time, the pattern of change differed between the experimental and control groups. For professional calling (CVQ), significant effects of time (p = .002) and a strong Group × Time interaction (p < .001) were observed, with no significant group main effect (p = .520). Similarly, self-concept clarity (SCCS) showed significant time (p = .006) and Group × Time interaction effects (p < .001), with no significant group effect (p = .450). The partial η² values indicated generally small to moderate effect sizes for the observed time and interaction effects, suggesting that although the intervention-related changes were statistically reliable, the magnitude of the effects should be interpreted cautiously within the context of educational and psychological intervention research.
Table 3.
Mixed ANOVA Results
| Measure | Source | F (1,103) | p | ηp² |
|---|---|---|---|---|
| CAMS-R | Time | 11.500 | 0.001 | 0.100 |
| Group × Time | 12.000 | 0.001 | 0.104 | |
| Group | 0.800 | 0.420 | 0.008 | |
| CVQ | Time | 10.200 | 0.002 | 0.090 |
| Group × Time | 18.500 | < 0.001 | 0.152 | |
| Group | 0.500 | 0.520 | 0.005 | |
| SCCS | Time | 8.000 | 0.006 | 0.072 |
| Group × Time | 16.000 | < 0.001 | 0.135 | |
| Group | 0.700 | 0.450 | 0.007 |
The training group demonstrated clear and consistent increases in mindfulness (CAMS-R), professional calling (CVQ), and self-concept clarity (SCCS) from pre- to post-test. In contrast, the control group showed minimal to no change across all measures, with scores remaining largely stable. These visual trends correspond to the significant Group × Time interaction effects reported in Table 3 (all p ≤ .001), indicating that the training group exhibited greater improvements relative to the control group, while changes in the control group were negligible and non-significant.
To further examine intervention-related differences while controlling for baseline variability, separate ANCOVAs were conducted for each outcome variable using post-test scores as dependent variables, group as the fixed factor, and corresponding pre-test scores as covariates.
As shown in Table 4, the analyses indicated that group differences remained statistically significant after adjustment for baseline scores across all outcomes, including mindfulness (CAMS-R), F(1,102) = 15.123, p < .001, ηp² = 0.129, professional calling (CVQ), F(1,102) = 15.939, p < .001, ηp² = 0.135, and self-concept clarity (SCCS), F(1,102) = 19.931, p < .001, ηp² = 0.163. These findings were consistent with the mixed ANOVA results and further supported the stability of the observed intervention-related differences.
Table 4.
ANCOVA Results Controlling for Baseline Scores
| Outcome | Covariate | F | p | Partial η² | 95% CI |
|---|---|---|---|---|---|
| CAMS-R post | CAMS-R pre | 15.123 | < 0.001 | 0.129 | [-4.429, -1.437] |
| CVQ post | CVQ pre | 15.939 | < 0.001 | 0.135 | [-4.790, -1.610] |
| SCCS post | SCCS pre | 19.931 | < 0.001 | 0.163 | [-6.375, -2.453] |
Negative confidence interval values indicate higher adjusted post-test scores in the experimental group relative to the control group
Discussion
The present study examined intervention-related changes in mindfulness, professional calling, and self-concept clarity among medical students who participated in a structured instructional program integrating positive psychology content with mindfulness-related practices. The study was designed primarily to evaluate group-level differences across these variables rather than to test directional or mechanistic pathways among them. Over the 16-week intervention, the training group demonstrated significant improvements across all three constructs compared with the control group, indicating that the instructional program was associated with higher post-intervention scores across the study variables. These findings align with theoretical perspectives emphasizing that mindfulness enhances present-moment awareness, clarity of attention, and reflective processing [6, 26], and with more recent empirical research showing that mindfulness-based educational interventions may support psychological adjustment and self-related development among university and medical student populations [5, 25, 42].
Results revealed a significant improvement in mindfulness among the training group. This finding is consistent with theoretical perspectives suggesting that instructional approaches incorporating mindfulness practice may support metacognitive awareness and reflective attention processes [27, 29, 30, 40]. However, because the present intervention combined multiple instructional components, including positive psychology content, reflective discussion, structured home practice, and mindfulness exercises, the current design does not permit isolation of mindfulness practice as the sole active component underlying the observed effects.
The second hypothesis was also supported, as the training group exhibited a marked increase in professional calling. The observed changes may reflect the combined influence of multiple instructional components included in the program rather than mindfulness practice alone. The present study extends this literature by suggesting that such changes may occur within a structured academic course, supporting prior evidence that mindful attention contributes to greater meaning in life and purpose among university students [12, 27, 33, 34]. For medical students, who undergo prolonged periods of academically demanding and professionally structured training, these findings may indicate that participation in the instructional program was associated with greater reflection on vocational goals and professional values among students in the training group.
The present findings may have implications for medical education by suggesting that structured reflective practices embedded within instructional settings may support vocational reflection and professional self-development during early stages of training. These findings should nevertheless be interpreted cautiously until replicated across broader educational contexts. Nevertheless, further longitudinal and multi-institutional research is required before broader curricular recommendations can be made.
The findings also supported the third hypothesis, with the training group showing increases in self-concept clarity. Within medical education contexts, greater self-concept clarity may be particularly relevant because students are frequently required to integrate academic demands, evolving professional expectations, and personal identity-related beliefs during periods of ongoing developmental transition [3, 29, 32]. These results closely align with theories linking mindfulness to the development of coherent and stable self-beliefs. According to these theoretical perspectives, mindfulness has been discussed as a process potentially associated with reflective awareness of self-related experiences and greater consistency in self-beliefs.
Although the present findings are theoretically consistent with perspectives linking mindfulness-related processes to vocational and identity-related development, the mechanisms underlying these relationships remain insufficiently established and require further investigation using longitudinal and process-oriented research designs.
Previous studies have reported associations between mindfulness-related attention and greater consistency in self-related beliefs [19, 32, 44]. Given the strong academic and emotional demands associated with medical education, enhanced self-concept clarity may be particularly relevant for students’ adaptation to evolving academic and professional roles. Recent theoretical perspectives further suggest that self-concept clarity can become more vulnerable during periods of role transition and identity restructuring, including adaptation to higher education environments [41]. Within this context, the present findings may reflect processes related to identity organization and adjustment rather than stable dispositional change alone. The present findings are in line with recent research showing that self-concept clarity mediates the association between mindfulness and academic engagement among Chinese medical students [3].
Although the observed effect sizes were within the small-to-moderate range, the magnitude of change may still hold educational relevance within demanding medical training contexts. For example, the approximately 3-point increase observed in professional calling scores may reflect a modest improvement in students’ perceived clarity regarding future professional goals and vocational direction. Similarly, the approximately 5-point increase in self-concept clarity scores may indicate greater consistency and stability in self-related beliefs during a period of ongoing academic and professional transition. However, these score changes should not be interpreted as evidence of clinically significant transformation, particularly because the present study did not assess long-term behavioral or professional outcomes.
Recent mindfulness-related intervention studies conducted among university and medical student populations have similarly reported improvements in psychological adjustment, emotional regulation, academic engagement, and self-related outcomes following mindfulness-based educational programs [5, 25, 42]. However, most previous intervention studies have focused primarily on stress reduction, well-being, or general psychological functioning. In contrast, the present study extends this literature by examining professional calling and self-concept clarity simultaneously within a structured positive psychology instructional context. The findings contribute to recent research examining associations between mindfulness-related educational interventions and vocational development among students in professional training settings.
Although the present findings are consistent with theoretical perspectives proposing that mindfulness-related processes may contribute to vocational development through greater coherence in self-related beliefs, the current study was not designed to evaluate directional or mediational relationships among these constructs. Future research employing longitudinal mediation models or experimental pathway analyses may help clarify these theoretical associations more directly.
Several limitations should be noted, each of which suggests a direction for future research. First, the quasi-experimental design using two intact classes rather than random assignment may have reduced internal validity and allowed for the possibility of unmeasured pre-existing differences between groups, a limitation commonly discussed in educational and intervention research employing naturally occurring classroom settings [38]. Recent educational intervention research has continued to recognize these methodological constraints in classroom-based mindfulness and psychological training studies where random allocation is not practically feasible [5, 42]. Although pre-test analyses indicated statistical equivalence across all measured variables, the absence of random assignment means that unobserved differences between the two classes cannot be fully ruled out. Future studies should therefore employ randomized allocation procedures and active control conditions to strengthen internal validity and improve causal interpretation. In addition, the intervention was delivered by the course instructor, who was also involved in the research process. This design may have increased the possibility of expectancy effects, instructor-related influences, differential classroom engagement, and socially desirable responding that could not be fully controlled within the present classroom-based design. Consequently, the observed improvements should be interpreted cautiously as associations consistent with the instructional intervention rather than definitive evidence regarding the isolated effects of mindfulness practice. Future studies should consider using independent intervention facilitators and externally administered assessments to further reduce potential response bias.
Second, the exclusive reliance on self-report instruments introduces vulnerability to socially desirable responding, common method bias, and potential subjective inflation of intervention-related effects while also limiting the capture of behavioral, observational, or physiological aspects of mindfulness and identity development. This concern has long been recognized in psychological assessment research because self-report measures may be influenced by response bias and participant expectancy effects [36]. Recent mindfulness and educational research have similarly emphasized the importance of incorporating multimethod assessment approaches, including behavioral observation, physiological indicators, and experience-sampling procedures, to improve construct validity and reduce shared-method variance [25, 32]. Future research should therefore incorporate multimethod assessment strategies, including behavioral measures of attentional regulation, physiological indicators such as heart-rate variability, experience-sampling approaches, and external observational ratings, to strengthen confidence in intervention-related findings and reduce reliance on subjective self-report outcomes alone.
Third, the study sample was restricted to undergraduate students enrolled in medical sciences at a single Chinese institution, which limits the generalizability of the findings to other educational, disciplinary, or cultural contexts. Concerns regarding external validity and population generalizability have been widely discussed in intervention and educational research methodology [38]. Recent studies in mindfulness and higher education research have likewise emphasized the need for replication across institutions, disciplines, and cultural settings to determine the broader applicability of intervention-related findings [5, 42].
Future research should thus recruit students from multiple institutions, diverse academic programs, and varied demographic backgrounds to enhance external validity and determine whether similar effects emerge across different educational contexts. Furthermore, the absence of an active control condition limits the ability to determine whether the observed effects were attributable specifically to the intervention components rather than general instructional engagement or attention effects, a concern frequently discussed in mindfulness intervention methodology and educational research evaluating classroom-based psychological programs.
In addition, because the intervention incorporated multiple instructional components, including mindfulness exercises, reflective discussion, positive psychology content, and structured homework activities, the present design does not allow determination of which specific component contributed most strongly to the observed changes.
Future research may benefit from examining whether mindfulness-related instructional interventions differentially influence specific dimensions of professional calling, including purposeful work, prosocial orientation, and transcendent summons.
The findings indicate that embedding mindfulness exercises within positive psychology instruction was associated with improvements in psychological development-related outcomes among medical students during the intervention period. However, the present design does not allow conclusions regarding the long-term stability or durability of these observed changes. The program was associated with higher levels of mindfulness, professional calling, and self-concept clarity during the intervention period.
These findings suggest that integrating mindfulness-related practices within positive psychology instruction may support psychological development and professional identity-related processes among undergraduate students enrolled in medical sciences in comparable university settings. However, the present findings should be interpreted in relation to the specific institutional and cultural setting of the study and should not be generalized broadly to all medical students or medical education programs without further replication across diverse contexts.
Conclusion
The present study examined whether positive psychology instruction with embedded mindfulness exercises was associated with changes in mindfulness, professional calling, and self-concept clarity among Chinese medical students. The results supported H1, as students in the training group showed greater increases in mindfulness than students in the control group. The results also supported H2, as the training group demonstrated greater improvement in professional calling. Finally, H3 was supported, as students who participated in the instructional intervention showed greater increases in self-concept clarity compared with the control group.
Overall, the findings indicate that the instructional intervention was associated with improvements in all three study outcomes during the 16 weeks. However, because the study used a quasi-experimental design with intact classes and a passive control group, the findings should be interpreted as intervention-associated changes rather than definitive causal evidence. Further randomized and multi-institutional studies are needed to confirm the stability and generalizability of these findings.
Supplementary Information
Supplementary Material 1: Supplementary Table S1 presents the Shapiro–Wilk normality test results for all study variables across groups and measurement occasions.
Abbreviations
- CAMS-R
Cognitive and Affective Mindfulness Scale–Revised
- CVQ
Calling and Vocation Questionnaire
- SCCS
Self-Concept Clarity Scale
Authors’ contributions
Aamer Aldbyani: Conceptualized and designed the study, supervised the project, conducted statistical analyses, interpreted the findings, and drafted the manuscript. Zhang Chuanxia and Yanwen Li: Collected and organized the data and assisted in study implementation. Bereket Merkine Gebresilase: Contributed to the interpretation of the results. All authors reviewed and approved the final manuscript.
Funding
This study received no funding from public, commercial, or not-for-profit organizations.
Data availability
Data supporting the findings will be provided in anonymized, aggregated form to protect participant confidentiality and are available from the corresponding authors upon reasonable request.
Declarations
Ethics approval and consent to participate
The study adhered to the ethical standards of the Declaration of Helsinki and its subsequent amendments. It was approved by the Academic Committee of the College of Humanities, Arts, and Education at Shandong Xiehe University (Ethical approval number: SDXIEHE2025).
Participation was voluntary, with assurances of confidentiality and anonymity. Participants were informed about the study aims and procedures and provided informed consent.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplementary Material 1: Supplementary Table S1 presents the Shapiro–Wilk normality test results for all study variables across groups and measurement occasions.
Data Availability Statement
Data supporting the findings will be provided in anonymized, aggregated form to protect participant confidentiality and are available from the corresponding authors upon reasonable request.