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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Med Educ . 2026 Mar 3;26:585. doi: 10.1186/s12909-026-08923-3 Search in PMC Search in PubMed View in NLM Catalog Add to search The relationship between socioeconomic status and the career calling of medical students: the chain mediation effect of social support and subjective social status Xiaoguang Wu Xiaoguang Wu 1 Clinical College of Anhui Medical University, Hefei, Anhui China 2 Health Humanities Research Innovation Team, Clinical College of Anhui Medical University, Hefei, Anhui China Find articles by Xiaoguang Wu 1, 2 , Tangwen Wang Tangwen Wang 1 Clinical College of Anhui Medical University, Hefei, Anhui China Find articles by Tangwen Wang 1 , Siyu Di Siyu Di 1 Clinical College of Anhui Medical University, Hefei, Anhui China Find articles by Siyu Di 1, ✉ Author information Article notes Copyright and License information 1 Clinical College of Anhui Medical University, Hefei, Anhui China 2 Health Humanities Research Innovation Team, Clinical College of Anhui Medical University, Hefei, Anhui China ✉ Corresponding author. Received 2025 Sep 3; Accepted 2026 Feb 25; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13067407 PMID: 41772516 Abstract Purpose To improve the career calling of medical students and cultivate high-quality medical workers, this study aimed to investigate the role of socioeconomic status in the career calling of medical students. Methods The questionnaire method was used to distribute the Socioeconomic Status Scale, Perceived Social Support Scale, Subjective Social Status Scale, and Career Calling Scale to 1428 medical students, and the relationship between the variables was analyzed using structural equation modeling. Results (1) Socioeconomic status significantly and positively predicts career calling among medical students, but its direct predictive effect on career calling is not significant. (2) Social support and subjective social status each played a fully mediating role between socioeconomic status and career calling. (3) Social support and subjective social rank serve as statistically significant chain mediators between socioeconomic status and career calling, though the actual effect size of this pathway remains modest. Conclusion A strong correlation exists between medical students’ career calling and socioeconomic status, social support, and subjective social status. Socioeconomic status indirectly influences career calling through the independent mediation and chain mediation of social support and subjective social status. This provides a new way to improve the career calling of medical students. Keywords: Socioeconomic status, Career calling, Social support, Subjective social status Introduction The 21st century has seen a number of international public health emergencies around the globe, from the H1N1 influenza pandemic in 2009 to the monkeypox pandemic in 2024. These epidemics have placed higher demands on public health systems worldwide. As future medical workers, the quality of medical students’ training is a matter of life and health safety of future patients and affects the stability of the public health system. Therefore, improving the quality of medical education and promoting the comprehensive development of medical students is an effective way to meet the new requirements of the public health system. For medical students, high-quality medical talent should not only have high professional skills, but also a sense of identity and significance for professional behavior [ 59 ]. Career calling (CC) refers to an individual’s ability to generate positive emotions and value recognition for professional behaviors and to realize or gain a sense of meaning in life when engaging in a certain career [ 15 ]. Within the context of Chinese culture, career calling is further imbued with the cultural connotations of “responsibility and accountability” and “realization of social value.” It emphasizes the integration of professional conduct with family and societal expectations, rather than focusing solely on individual self-fulfillment [ 55 ]. For individuals with a sense of career calling, engaging in occupational behaviors is no longer just a means of livelihood but a way of realizing the value of their lives (Hall et al., 2005) [ 19 ]. By directly or indirectly helping others at work, they can gain a greater sense of fulfillment and meaning, resulting in positive evaluations and cognitive experiences of their occupation (Dik et al., 2007) [ 14 ]. It has been found that career calling not only helps to increase the learning engagement [ 49 ] and achievement motivation [ 43 ] of medical students, but also helps to combat burnout [ 1 ] and career anxiety [ 9 ]. However, there is still much room for improvement in the career calling of medical students [ 21 , 59 ], and how to further improve the career calling of medical students and promote their overall development has become an urgent issue in the development of medical education. This study analyzes the mechanism through which socioeconomic status influences career calling among medical students by integrating Maslow’s hierarchy of needs theory with Bourdieu’s theory of social capital. These two frameworks establish the theoretical foundation from complementary dimensions: “intra-individual motivation” and “socio-structural externalities.” First, Maslow’s hierarchy of needs theory focuses on the developmental logic of motivation at the individual level, explaining how socioeconomic status affects career calling—a psychological outcome at the “self-actualization” level—by influencing the fulfillment of individual needs. Second, Bourdieu’s social capital theory centers on resource allocation and capital conversion within social structures. It elucidates how socioeconomic status, as an objective structural factor, shapes individuals’ social capital (social support) and subjective class perception (subjective social status), thereby providing external structural conditions for fulfilling individual needs and developing motivation. These two theories form a progressive, integrated logic — “social structure → resource acquisition/class perception → need fulfillment → career calling”—that collectively underpins the hypothesis system of this study. Relationship between socioeconomic status and career calling Socioeconomic status (SES) is an objective social status defined according to the social resources that an individual or a group possesses, and is usually assessed comprehensively based on the individual’s or a group’s economic income, education level, and the type of occupation they are engaged in (Mueller et al., 1981) [ 38 ]. High socioeconomic status not only reduces the negative effects of anxiety, depression, and burnout [ 40 , 52 ] but also enhances the sense of well-being and life satisfaction of individuals ([ 17 ]; Gur et al., 2021) [ 18 ]. Career calling is closely related to the life satisfaction of individuals ([ 23 ]; F. Wang et al., [ 47 ]. Therefore, there may also be an association between socioeconomic status and career calling as external factors. According to Maslow’s Hierarchy of Needs Theory, individuals pursue higher-level “self-actualization needs” [ 35 ] only after satisfying lower-level needs. The need for self-actualization has similar connotations to the sense of value and significance that career calling brings to individuals. Individuals with a higher socioeconomic status can easily satisfy low-level needs, such as physiology and safety, and have more resources to pursue higher-level needs, which means that the occupational goal is shifted from “survival” to “self-actualization”, forming a strong career calling. In contrast, individuals with low socioeconomic status are under pressure to survive for a long time, and maintaining their existence becomes their primary goal. They are unable to pursue higher-level needs and naturally have difficulty developing a sense of career calling. This motivational development logic demonstrates that socioeconomic status, as a key external condition influencing the fulfillment of individuals’ lower-level needs, directly and positively shapes medical students’ career calling through the “hierarchical progression of needs” mechanism articulated by Maslow’s hierarchy of needs theory. Although research on the relationship between socioeconomic status and career calling is currently lacking, [ 45 ]conducted a three-year longitudinal study tracking socioeconomic status and career aspirations among high school students. Their findings revealed that socioeconomic status in the first year of high school positively predicted career aspirations in the third year. Career aspirations, in turn, play a crucial role in establishing a career calling. In summary, based on the individual motivation development perspective of Maslow’s hierarchy of needs theory and the correlation between satisfaction, happiness, and socioeconomic status, Hypothesis 1 is proposed: Socioeconomic status can significantly and positively predict career calling among medical students. Mediating role of social support Social support (SS) refers to general or specific supportive behaviors that individuals perceive from others in their social networks. Such behaviors can increase an individual’s social suitability and insulate them from negative factors (Kerres Malecki et al., 2002) [ 26 ]. According to Bourdieu’s theory of social capital, socioeconomic status essentially reflects the combined manifestation of an individual’s economic capital, cultural capital, and social capital [ 4 ]. Medical students with higher socioeconomic status possess superior social networks. These networks serve as the core vehicle for social capital, providing tangible social support such as emotional and informational resources [ 25 ]. In other words, objective socioeconomic status transforms into tangible social support for individuals through the mediation of social capital. Individuals with lower socioeconomic status are more susceptible to financial stress, negative emotions, and consequently, problematic behaviors leading to strained interpersonal relationships, and are able to receive less social support [ 25 ]. Studies have demonstrated a significant association between socioeconomic status and social support [ 29 , 44 ]. For example, Wangberg et al., [ 50 ], who investigated the relationship between individual socioeconomic status and social support in Europe, found that socioeconomic status was a significant and positive predictor of social support. Furthermore, from Maslow’s hierarchy of needs perspective, the social support individuals receive can compensate for their own resource deficiencies on both material and psychological levels. This support helps them better fulfill lower-level needs such as physiological and safety requirements, thereby freeing up more energy to pursue “self-actualization needs.” Consequently, individuals can develop a career calling(Taormina et al., 2013) [ 46 ]. This view is also supported by existing studies that show a strong link between social support and career calling [ 30 , 32 ]. For example, L. Zhang et al., (2023) [ 57 ], investigated the relationship between social support and career calling among Chinese teachers and found that social support positively predicted career calling. According to social capital theory, individuals with a higher economic status have more social capital and are in higher-quality social networks through which they can easily access social support, such as emotional and informational support [ 20 , 42 ]. This social support further provides individuals with the freedom to choose their careers and promotes career calling. Based on this, drawing upon the logic of capital conversion from Bourdieu’s theory of social capital and the logic of motivation activation from Maslow’s hierarchy of needs theory, Hypothesis 2 is proposed: Social support mediates the relationship between socioeconomic status and medical students’ career calling. Mediating role of subjective social status Subjective social status (SSS) refers to an individual’s subjective perception of their status based on the resources they possess in comparison to other individuals around them [ 2 ]. According to Bourdieu’s field-habitus theory, individuals occupy different social fields where their position is determined by their capital endowment within that field, and this position in turn shapes their habitus (behavioral tendencies and modes of perception) (Bourdieu et al., 1992) [ 6 ]. Medical students with higher socioeconomic status possess greater economic, cultural, and social capital, occupying advantageous positions within core fields such as campus and family. This privileged position directly elevates their subjective perception of social status [ 4 ]. Studies have found a strong association between socioeconomic status and subjective social status [ 27 , 36 ]. For example, Moss et al., [ 37 ] investigated the relationship between subjective social status and socioeconomic status among pregnant women in the UK and found that pregnant women with a higher socioeconomic status also had a higher subjective social status. Furthermore, individuals with high subjective social status perceive themselves as holding a higher social standing than others around them. This positive subjective perception shifts their habitual tendencies toward pursuing “symbolic rewards,” moving beyond mere survival needs. Consequently, they come to view their careers as a mission to realize personal value, fostering a career calling. Although no study has directly investigated the relationship between subjective social status and career calling, Wei et al., [ 51 ] found that the subjective social status of poor Chinese college students was significantly correlated with job willingness and career adaptation, which are all related to career calling (J. Chen et al., 2023) [ 10 ]. According to social capital theory, individuals are in different fields and form different habitus, which are their unique behavioral tendencies, perceptions, and thinking patterns (Bourdieu et al., 1992). Higher socioeconomic status provides individuals with a better field and enhances their subjective social status, which in turn enables them to pursue more “symbolic rewards” instead of only “survival rewards” and to regard their career as a “mission”. Based on this, drawing upon Bourdieu’s theory of social capital and the field-habitus framework’s logic of social structural perception, Hypothesis 3 is proposed: subjective social status mediates the relationship between socioeconomic status and career calling among medical students. Chain mediating role of social support and subjective social status Social support available to an individual is provided by other individuals in their social network. Subjective social status is a subjective judgment of one’s status in comparison to others in the social network. Both are closely related to the social network in which individuals live. From the perspective of Bourdieu’s theory of social capital, social support represents a concrete manifestation of social capital. The greater the social support an individual receives from their social networks, the stronger their stock of social capital and their perception of its value. This perception of capital enables individuals to form more positive class judgments in social comparisons with others, thereby significantly enhancing their subjective social status (Yuning [ 12 , 48 ]). In other words, social support, as the vehicle for social capital, serves as the crucial link connecting objective socioeconomic status with subjective social status. When individuals attain a higher subjective social status, according to Maslow’s hierarchy of needs theory [ 35 ], their lower-level psychological needs (respect, belonging) are satisfied, further stimulating their higher-level motivation to pursue self-actualization. This motivation directly translates into professional value identification and meaning perception—that is, a sense of career calling. Based on the integration of Bourdieu’s external structural transmission logic of social capital theory and Maslow’s internal motivational activation logic of hierarchy theory, Hypothesis 4 is proposed: Social support and subjective social status play a chain mediating role between socioeconomic status and medical students’ career calling. In summary, this study aimed to investigate the relationship between socioeconomic status and career calling of medical students and to learn the role of social support and subjective economic status in the relationship between socioeconomic status and career calling. The present study employed a questionnaire method using the Socioeconomic Status Scale, Perceived Social Support Scale, Subjective Social Status Scale, and Career Calling Scale to survey 1,428 medical students from two medical schools in China and to test the following hypotheses: Hypothesis 1: Socioeconomic status significantly and positively predicts medical students’ career calling. Hypothesis 2: Social support mediates the relationship between medical students’ economic status and career calling. Hypothesis 3: Subjective social status mediates the relationship between socioeconomic status and career calling in medical students. Hypothesis 4: Social support and subjective social status mediate the relationship between socioeconomic status and medical students’ career calling. Materials and methods Participant A convenience sampling method was used to select two undergraduate medical schools in Anhui Province, China, to distribute the electronic questionnaire. The e-questionnaire was developed on an online platform and included demographic information, family socioeconomic status, perceived social support, subjective social status, and career calling. To minimize the impact of social expectation errors, participants were prompted at the beginning of the e-questionnaire to participate anonymously in the study, no personal information was collected throughout the survey, the survey was to be answered according to their own reality, and the results of the survey were to be used only for scientific research. The electronic questionnaire was then distributed to classes by professionally trained personnel, who prompted the students to read the instructions to ensure informed consent. To avoid missing data, all questions were set as mandatory, and the electronic questionnaire could only be submitted after completing all the questions. A total of 1,490 electronic questionnaires were collected for the study, and after excluding the questionnaires that were regularly answered, 1,428 valid questionnaires were obtained, with an effective recovery rate of 95.8%. Among them, 584 (40.9%) were male and 844 (59.1%) were female students. There were 517 (36.2%) freshmen, 371 (26.0%) sophomores, 334 (23.4%) juniors, and 206 (14.4%) seniors. There were 384 (26.9%) only child and 1044 (73.1%) non-only child students. The mean age was (19.91 ± 1.51) years. The study was approved by the ethics committee of the location (approval number: LCYXY00003), and all students provided informed consent. This study complies with the Declaration of Helsinki. Material Socioeconomic status The economic status of medical students’ families was used as an indicator of their socioeconomic status, including items such as monthly household income, parents’ occupations, and educational attainment. Monthly household income is categorized into the following groups: “1,000 RMB or less,” “1,001–2,000 RMB,” “2,001–3,000 RMB,” “3,001–4,000 RMB,” “4,001–5,000 RMB,” “5,001–7,000 RMB,” “7,001–10,000 RMB,” and “over 10,000 RMB,” with corresponding scores of 1–8 points [ 33 ]. Occupational information references Lu [ 34 ]’s classification of China’s ten major occupational strata. This framework centers on the core logic of “social resource endowment, occupational power, and skill thresholds,” aligning with the hierarchical classification principles of the National Classification of Occupations in the People’s Republic of China (2022 Edition). It remains widely validated and applied in recent socioeconomic status research [ 56 ]. The specific classification is as follows: “rural and urban unemployed, underemployed, and semi-unemployed individuals,” “agricultural workers,” “industrial workers,” “commercial and service industry employees (entry-level managers in the commercial and service industry, white-collar employees in the commercial and service industry, blue-collar employees in the commercial and service industry),” “self-employed individuals,” “clerical staff (government and enterprise clerical staff),” “professional and technical personnel (science, education, culture, and health professionals, engineering and technical professionals, commerce and service industry professionals),” “private business owners,” “managers,” and “national and social managers (high-, medium-, and low-level administrative managers, medium- and high-level public institution managers),” with scores assigned from 1 to 10, respectively. Educational attainment was categorized into six items: “elementary school or below,” “junior high school (including those who did not graduate),” “high school/vocational school (including those who did not graduate),” “college,” “bachelor’s degree,” and “master’s degree,” with scores assigned from 1 to 6 points, respectively. When calculating, the parent with the higher occupation or educational attainment was selected as the final score for these two indicators and converted into a standard score(Yanhong [ 11 ]). The standard scores for income, career, and education were then subjected to principal component analysis to obtain their factor loadings, which were incorporated into the formula SES= ( β 1 ∗ Z income + β 2 ∗ Z career + β 3 ∗ Z education ) / εf . Here, β₁, β₂, and β₃ are the factor loadings, and εf is the eigenvalue of the first factor. In this study, the SES scores ranged from − 1.35 to 1.40, with higher scores indicating a higher family socioeconomic status. Social support The ‘Perceived Social Support Scale’ developed by Blumenthal et al., [ 3 ] was translated into Chinese by Jiang [ 24 ] and introduced in China. It has been demonstrated to have better reliability and validity in measuring the perceived social support of college students [ 53 ]. The scale consists of 12 items divided into three dimensions: family support, friend support, and other support, with four items in each dimension. Participants answered each item on a 5-point Likert scale (1 = completely disagree, 5 = completely agree). Higher total scores indicate a higher level of perceived social support. In this study, the questions in the other dimensions of support were modified appropriately with reference to previous studies (replacing “leaders, colleagues” with “teachers, classmates”) to match the actual situation of college students, such as “I can share happiness and sadness with some people(teachers, classmates)” [ 53 ]. The Cronbach’s α of this scale in this study was 0.93, and the validated factor analysis model fit well ( χ 2 /df = 4.23, TLI = 0.98, CFI = 0.99, RMSEA = 0.05, SRMR = 0.02). Subjective social status The scale was developed by Cheng et al., [ 13 ] and consists of seven items: social relationships, academic performance, family background, social practice abilities, artistic talents, satisfaction with romantic relationships or single status, and personal image and demeanor. For example, “Where do your academic grades rank among your peers at university?” Participants answered each item on a 10-point Likert scale (1 = lowest status, 5 = highest status). A higher total score on the scale indicates a higher perceived subjective social status. In this study, Cronbach’s α for this scale was 0.89, and the confirmatory factor analysis model fit well ( χ 2 /df = 3.73, TLI = 0.99, CFI = 0.99, RMSEA = 0.04, SRMR = 0.02). Career calling The ‘Career Calling Scale’ developed by Zhang [ 55 ] in the context of Chinese culture was adopted. The scale consists of 11 items and is divided into three dimensions: Altruism, Guiding Force, and Meaning and Purpose. Participants answered each item on a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Item 3 was reverse scored. A higher total score on the scale indicates a higher career calling. In this study, Cronbach’s α for the scale was 0.89, and the confirmatory factor analysis model fit well ( χ 2 /df = 6.12, TLI = 0.98, CFI = 0.99, RMSEA = 0.06, SRMR = 0.04). Data processing First, data analysis was performed using SPSS version 26.0. Questionnaires with consistent responses (where selected items remained consistent) and those completed in less than 120 s were excluded. All remaining data were standardized, and common method bias tests and descriptive statistical analyses were performed. Finally, Amos 26.0 was used to construct structural equations for chain mediation analysis, with career calling packaged into three latent variable indicators: altruism, guiding force, and meaning and purpose. Social support was grouped into three latent variables: family support, friend support, and other support. Socioeconomic status was divided into three latent variables: income, occupation, and education level. Subjective social status was divided into seven latent variables based on the questions, and age, only child status, and gender were included as covariates in the structural equation model for controlling. Results Common method bias test Harman’s single-factor test was used to perform an unrotated exploratory factor analysis on the 33 items measured. The results showed that there were nine factors with eigenvalues greater than 1 when unrotated, explaining 66.73% of the variance, with the first factor explaining 31.08% of the variance, which was less than 40%. Therefore, the results of this study were less affected by common method bias. Descriptive statistics and correlation analysis The descriptive statistics for socioeconomic status, social support, subjective social status, and career calling are shown in Table 1 . The results of the correlation analysis show that socioeconomic status, social support, subjective social status, and career calling are all significantly positively correlated, as shown in Table 1 . Table 1. Descriptive statistics and correlation analysis M SD 1 2 3 SES 0.00 0.55 SS 3.81 0.67 0.18 ** SSS 5.07 1.53 0.25 ** 0.34 ** CC 3.65 0.59 0.01 ** 0.45 ** 0.28 ** Open in a new tab SES Socioeconomic status, SS Social support, SSS Subjective social status, CC Career calling * p < 0.05, ** p < 0.01, *** p < 0.001, same below Analysis of chain mediation effect Using socioeconomic status as the predictor variable, social support and subjective social status as the mediator variables, and career calling as the dependent variable, a structural equation model was developed. The results indicated that the model fit was optimal ( χ 2 /df = 4.75, TLI = 0.93, CFI = 0.95, RMSEA = 0.05, SRMR = 0.04).Using maximum likelihood estimation to estimate path coefficients, socioeconomic status positively predicted social support ( β = 0.17, p < 0.001) and subjective social status ( β = 0.24, p < 0.001), social support ( β = 0.43, p < 0.001), and subjective social status ( β = 0.17, p < 0.001) positively predicted career calling, and social support positively predicted perceived social status ( β = 0.33, p < 0.001).The direct predictive effect of socioeconomic status on career calling was not significant ( β =-0.02, p > 0.05), indicating that the positive influence of socioeconomic status on career calling is fully mediated by the intervening variables, as shown in Table 2 ; Fig. 1 below. Table 2. Test of the chain mediation model Dependent variable Independent variable Estimate S.E. C. R Lower2.5 Upper2.5 SS SES 0.17 *** 0.04 3.98 0.09 0.24 age 0.03 0.01 -2.48 -0.01 0.03 Only-child 0.03 0.04 -0.60 -0.05 0.14 gender 0.08 ** 0.04 -1.48 0.02 0.17 SSS SES 0.24 *** 0.08 6.96 0.37 0.73 SS 0.33 *** 0.07 11.11 0.58 0.94 age 0.00 0.03 0.05 -0.05 0.05 Only-child 0.02 0.09 0.88 -0.10 0.27 gender -0.06 * 0.08 -2.27 -0.35 -0.02 CC SES -0.02 0.04 -0.70 -0.09 0.04 SS 0.43 *** 0.03 13.65 0.36 0.53 SSS 0.17 *** 0.01 5.21 0.04 0.11 age -0.05 0.01 -1.94 -0.05 0.00 Only-child -0.03 0.04 -1.24 -0.14 0.03 gender 0.02 0.04 0.88 -0.04 0.10 Open in a new tab SES Socioeconomic status, SS Social support, SSS Subjective social status, CC Career calling Fig. 1. Open in a new tab Chain mediation effect of social support and subjective social status. Note: SES: socioeconomic status; SS: social support; SSS: subjective social status; CC: career calling The Bootstrap method was used to test the mediating effect. The sampling frequency is set to 5000.The results indicated that social support exerted a complete mediating effect between socioeconomic status and career calling, with a mediating effect size of 0.07 and a 95% confidence interval (CI) of [0.04, 0.12]. Subjective socioeconomic status fully mediated the relationship between socioeconomic status and career calling, with a mediation effect size of 0.04 and a 95% confidence interval (CI) of [0.02, 0.06]. Social support and socioeconomic status exhibited a significant chain mediation effect between socioeconomic status and career calling, with a mediation effect size of 0.01 and a 95% CI of [0.01, 0.02], as shown in Table 3 . Table 3. Estimates, SE and 95%CI in mediating role Parameter Estimates SE Lower2.5 Upper2.5 SES—SS—CC 0.07 0.02 0.04 0.12 SES—SSS—CC 0.04 0.01 0.02 0.06 SES—SS—SSS—CC 0.01 0.00 0.01 0.02 Open in a new tab SES Socioeconomic status, SS Social support, SSS Subjective social status, CC Career calling Discussion To meet the global demand for high-quality public health services, cultivate highly qualified medical students, and enhance their sense of career calling, this study employed a questionnaire method to validate the independent mediating role of social support and subjective social status in the relationship between socioeconomic status and career calling. Additionally, the research identified a statistically significant chain mediation effect between these two factors (though the effect size was relatively small), providing empirical evidence for medical education reform at the level of operational mechanisms. The relationship between socioeconomic status and career calling among medical students Research findings indicate a significant positive correlation between socioeconomic status and career calling among medical students. Specifically, medical students with higher socioeconomic status exhibit stronger career calling, validating Hypothesis 1. Moreover, the positive influence of socioeconomic status on career calling lacks a direct effect, being fully mediated through subsequent intermediary variables. Individuals with a higher socioeconomic status not only have more material resources but also enjoy better social status and educational backgrounds. On the one hand, this provides them with more opportunities for career choices; on the other hand, it enhances their ability to cope with life risks (Mueller et al., 1981) [ 38 ]. According to Maslow’s hierarchy of needs theory, individuals will only pursue “self-actualization needs” after their lower-level needs are satisfied or partially satisfied [ 35 ]. Medical students from lower socioeconomic backgrounds prioritize meeting their and their families’ basic survival needs after entering the profession. Some students may also face the pressure of repaying student loans, leading them to seek “survival-oriented rewards” (e.g., income and job stability) in their work, thereby reducing their career calling [ 7 , 16 ]. Conversely, medical students from high socioeconomic backgrounds, free from survival pressures, can pursue “symbolic rewards” (e.g., work value, self-realization) in their careers, thereby fostering the development of their career calling [ 41 ]. Therefore, increasing medical students’ learning subsidies and work compensation to alleviate their concerns is an effective approach to enhancing their professional sense of calling and promoting their high-quality development. The mediating role of social support The study findings indicate that social support plays a fully mediating role between socioeconomic status and career calling among medical students, thereby validating Hypothesis 2. This result enriches the existing research on the indirect relationship between socioeconomic status and career calling. The study results indicate that the higher the socioeconomic status of medical students, the greater the social support they can obtain. The social support provided by others around them not only reduces their concerns about survival crises, freeing them from the constraints of survival pressures, but also motivates them to pursue higher professional goals and cultivate a sense of career calling. The reason lies in the fact that individuals with higher socioeconomic status have better income, educational background, and professional status, all of which provide them with more social support. From a professional perspective, individuals engaged in specialized professions or managerial roles frequently interact with others at work. This not only enhances their communication and interpersonal skills but also expands their social networks, helping them secure greater social support [ 22 ]. From an educational perspective, higher education provides individuals with high-quality social networks, such as alumni networks and academic circles, while also enhancing their overall capabilities, such as emotional management and interpersonal skills [ 8 ]. From an income perspective, a higher material foundation can reduce life pressures for individuals on one hand, and on the other hand, it can strengthen social networks by helping others (Pinquart et al., 2000) [ 39 ]. Based on this, a higher socioeconomic status provides medical students with more social support [ 50 ]. As social support increases, medical students can pursue “symbolic rewards” more and establish a career calling. This finding aligns with Bourdieu [ 4 ] perspective, which posits that individuals possess social, cultural, economic, and symbolic capital. Symbolic capital refers to symbolic resources accumulated through social recognition, prestige, and honor, sharing similar connotations with career calling. After acquiring social, cultural, and economic capital, individuals must also obtain social recognition through symbolic practices to convert these into symbolic capital, which is the key to validating the legitimacy of other forms of capital [ 5 ]. This suggests that medical students should be provided with more social support to promote their pursuit of a career calling. The mediating role of subjective social status The study findings indicate that subjective social status plays a fully mediating role between socioeconomic status and career calling among medical students, thereby validating Hypothesis 3. This result enriches research on the indirect relationship between socioeconomic status and career calling. The study results indicate that medical students with a higher socioeconomic status also have a higher subjective social status. Positive evaluations of their own position, on the one hand, enhance their self-efficacy, leading them to believe they can achieve life value through professional behavior, thereby strengthening their sense of career calling [ 58 ]. On the other hand, it enhances their sense of control, leading them to believe that they have greater control over their lives, thereby making them more willing to pursue long-term goals rather than merely meeting short-term survival needs [ 54 ]. The reason lies in the fact that individuals with higher social status possess superior social networks, and these superior social networks can help enhance self-perceived social class identity by fostering a sense of belonging within social circles, thereby reinforcing subjective social status [ 28 ]. As subjective social status increases, individuals are more likely to view their profession as a core component of their self-identity, using professional behavior as a means to achieve their life’s value rather than merely as a means of subsistence, thereby fostering a sense of career calling [ 31 ]. This finding aligns with Bourdieu [ 4 ] perspective that individuals compete in different fields based on the capital they possess. Those with a higher socioeconomic status hold advantageous positions in terms of social, cultural, and economic capital, enabling them to maintain a relatively leading position in competition and thereby elevate their subjective social status. This advantage drives them to pursue symbolic capital to gain societal recognition of their status, thereby fostering a sense of career calling. This suggests that we can help medical students choose appropriate fields to enhance their subjective social status and cultivate a sense of career calling. Chain mediation effect of social support and subjective social status The findings indicate that social support and subjective social status exert a statistically significant chained mediating effect between socioeconomic status and medical students’ career calling, validating Hypothesis 4. However, the magnitude of this chain mediation effect is only 0.01 (95% CI [0.01, 0.02]), suggesting its limited explanatory power for the relationship between socioeconomic status and career calling. Therefore, caution should be exercised when interpreting these findings. From the perspective of the underlying mechanism linking these variables, this study confirms that socioeconomic status influences medical students’ career calling through a dual pathway: “external structural empowerment” and “internal motivation activation.” There was a significant positive correlation between social support and subjective social status, consistent with previous research [ 48 ]. According to Bourdieu’s Social Capital Theory, social capital is a collection of actual or potential resources associated with stable, institutionalized social networks. Social support, as a specific form of social capital, enhances an individual’s “symbolic power” within a field. Individuals with stable, high-quality social support tend to perceive themselves as having a higher social status, thereby enhancing their subjective social status [ 4 ]. This positive subjective perception of social status further enhances an individual’s self-efficacy and belief in control, making them more inclined to pursue the “symbolic rewards” of their profession. This ultimately transforms into a sense of career calling. This chain mechanism demonstrates the existence of a multi-step transmission process: “social structure → resource acquisition/class perception → need fulfillment → career calling.” It theoretically refines the causal pathway linking socioeconomic status and career calling. Limitations and perspectives This study also has some areas for improvement. First, this study only selected medical students from two universities in China. This may result in insufficient sample representativeness, affecting the external validity of the study’s findings. In the future, the sampling scope can be further expanded using multilevel sampling to cover medical student populations from multiple countries, thereby enhancing the external validity of the study’s findings. Second, this study relied solely on self-reporting as an observational indicator, which is susceptible to social desirability effects. Therefore, future studies should collect data from multiple perspectives, including evaluations from individuals, parents, and teachers, or incorporate more objective indicator data. Third, this study employed a cross-sectional design, which prevented us from further clarifying the causal relationships among the variables. Future research could incorporate longitudinal designs to investigate the directionality and developmental trends of each variable. Finally, the chain mediation effect between social support and subjective social status in this study was relatively small. While it confirmed the existence of the transmission mechanism, its explanatory power for practical issues remains limited. Future research could further explore the core factors influencing medical students’ subjective social status (such as academic performance and professional identity) to optimize the structure of the chain mediation model. Conclusion The findings of this study validate the complementary nature of Maslow’s hierarchy of needs theory and Bourdieu’s social capital theory in research on career calling. Together, they provide a comprehensive theoretical framework for analyzing the mechanisms through which socioeconomic status influences medical students’ professional psychology, addressing both individual and social structural dimensions. Socioeconomic status significantly and positively predicts medical students’ career calling, but its direct predictive effect on this career calling is not significant. Social support and subjective social status each fully mediate the relationship between socioeconomic status and medical students’ career calling. Social support and subjective social status exhibit statistically significant chain mediation between socioeconomic status and medical students’ career calling, though the actual effect size of this pathway is relatively small. Authors’ contributions XW and SD designed the experiment, prepared the manuscript and made data analysis. TW collected data, gave technique supports and valuable suggestions in experiment designing. All authors contributed to the article and approved the submitted version. Funding This research was supported by the Provincial Quality Engineering Program for Higher Education Institutions in Anhui Province, China (2023jyxm0978), the Health Humanities Research Center, Clinical college of Anhui Medical University (Project No. 2025PT002), the study on the relationship between medical students’ career calling and medical humanities competency (2025XJKY026) and the Health Humanities Research Innovation Team, Clinical college of Anhui Medical University (Project No. XJTD001), Anhui, China. Data availability All scales used in this study were mature scales. And all of them are labeled with the literature referenced in the Materials section of the article. The data presented in this study are available on request. The data are not publicly available due to concerns about privacy and ethics in personal decision-making. Declarations Ethics approval and consent to participate The studies involving human participants were reviewed and approved by The Academic Ethics Committee, Clinical College of Anhui Medical University. Clinical trial number: not applicable. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin. Written informed consent was obtained from the individual (s, and minor(s)’ legal guardian/next of kin, for the publication of any potentially identifiable images or data included in this article. Consent for publication Not applicable. The article does not contain any information or images that could lead to the identification of participants. 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. References 1. 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