From motivation to meaning in medical humanities: a mixed-methods study of Chinese medical students’ value internalization

Background Medical humanities are expected to strengthen humanistic values in future physicians, yet how students internalize such values across learning contexts is not fully understood. This study examined how different types of motivation relate to engagement, and how emotions and clinical experiences may support value internalization. Methods We conducted a mixed-methods study at a Chinese medical university. Survey data from 161 students were analyzed with structural equation modeling (SEM), and semi-structured interviews with 30 students provided qualitative insights. Results Developmental motivation predicted both course satisfaction and professional identity (β = 0.47, p < 0.001). Avoidant motivation reduced affective satisfaction (β=-0.18, p = 0.021). Clinical internship appeared to strengthen the pathway from satisfaction to professional identity (Δβ=+0.14, p = 0.012). Qualitative themes highlighted emotional engagement as a turning point for reflection. Clinical settings appeared to act as catalysts, reinforcing or sometimes challenging how classroom knowledge was translated into professional practice. Conclusions Motivation alone does not fully explain how values are internalized. Our findings suggest that emotions and clinical context may serve as important bridges, supporting the translation of humanities learning into professional commitments. These results highlight the potential value of curricula that integrate experiential teaching with supportive clinical environments, although causal effects cannot be confirmed in this observational study.