Career clarity and demand for structured career counselling among medical students: a multicentre cross-sectional study and implementation framework

Background Structured institutional career counselling is not routinely integrated into undergraduate medical education in India, despite increasing complexity in postgraduate specialty pathways. Social Cognitive Career Theory (SCCT) emphasises contextual supports in translating self-efficacy and outcome expectations into stable career goals. We examined career clarity and perceived need for structured institutional career counselling among undergraduate medical students and developed a theory-grounded implementation framework and developed a staged implementation framework (India–Seed–Sprout–Sapling; I3S). Methods A multicentre cross-sectional survey was conducted between January and April 2024 among 295 MBBS students from four urban medical colleges (two government and two private). The primary outcome was perceived need for structured institutional career counselling (Yes vs No/Not sure). Predictor variables included gender, academic year, doctor in family, independent MBBS choice, awareness of aptitude assessment tools, and high career clarity. Associations were analysed using chi-square tests and multivariable logistic regression. Career clarity (four-level ordinal variable) was examined using ordinal logistic regression adjusting for gender and doctor in family. The I3S framework underwent expert content validation using item- and scale-level Content Validity Indices (CVI), Wilson 95% confidence intervals, and modified kappa statistics. Results Of 295 participants, 223 (75.6%) perceived a need for structured institutional counselling. Only 53 students (18.0%) reported high career clarity, indicating limited decisional confidence during undergraduate training and 67 (22.7%) were aware of aptitude assessment tools. Career clarity demonstrated a positive trend across advancing academic years (adjusted OR 1.16, 95% CI 1.05–1.28; p < 0.01). No variable was significantly associated with perceived counselling need. The regression model explained minimal variance (Nagelkerke R²=0.03). I-CVI ranged from 0.889 to 1.00, with S-CVI/Ave 0.975 and modified kappa ≥ 0.887, indicating excellent agreement. Conclusion Three-fourths of undergraduate medical students perceived a need for structured institutional career counselling irrespective of background. Although career clarity improved with progression, demand for institutional guidance remained high across institutions. The I3S framework offers a theory-grounded, curriculum-integrated model to support implementation within existing mentorship structures.