Pre-qualifications, learning strategies, and study satisfaction among medical students: insights from a multicenter German study

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INTRODUCTION: Although medical students with pre-medical qualifications (e.g., paramedic training) may enhance diversity within the student body, they have received little attention in international research. Their prior experience may influence study satisfaction through different learning strategies or working alongside their studies. This study investigates how pre-qualifications relate to three dimensions of study satisfaction (content, conditions, and coping with study load) and examines whether deep-processing learning strategies (elaboration and critical thinking) and part-time employment help explain these associations. METHOD: The authors conducted a cross-sectional survey at five German medical schools across different stages of study (3rd, 6th and 10th semester, final year). A structural equation model tested (a) whether pre-qualifications (i.e., academic degree, vocational training in the medical field) moderated the relationship between deep-processing strategies and study satisfaction and (b) whether part-time employment mediated the relationship between pre-qualifications and study satisfaction, controlling for age, gender, undergraduate GPA, semester, and medical school. RESULTS: Associations between deep-processing strategies and satisfaction did not differ by pre-qualifications. Regardless of students' pre-qualifications, elaboration was positively (ß = .51) and critical thinking negatively (ß = -.31) associated with satisfaction with study contents. Students with vocational training or prior academic degree more often worked part-time to finance studies; part-time employment was associated with lower satisfaction with study conditions (ß = -.07) but higher satisfaction with coping with study load (ß = .08). Indirect effects via part-time employment were significant but small. DISCUSSION: The findings suggest that elaboration may be a particularly relevant learning strategy for satisfaction with study contents, regardless of students' prior professional or academic qualifications. The negative association between critical thinking and satisfaction highlights the complexity of students' perceptions of study contents. Although associations involving part-time employment were small, the findings contribute to a better understanding of students with professional and academic pre-qualifications and may inform efforts to support increasingly diverse medical student populations.