This study was the first to examine the value systems of medical students and instructors in Thailand. The analysis has confirmed the existence of a difference in personal values between students and instructors. The difference can be viewed as a product of generation-wide societal phenomena on one hand, and of accumulated personal experience and personality development through progression of life cycle on the other. Students rated significantly higher on Universalism & Benevolence, which included values on family, friends, social tolerance, contribution to own institution, and contribution to the world. This implies that students require more time and depth in social life than their seniors. The higher inclination toward friends and intimate significant others could be the manifestation of psychosocial developmental stage [33]. Attachment, reliance, and subsequent valuing of family could have also been affected by generational changes in parenting style, which not only included an increase in democratic elements, but also greater degrees of overprotection and overindulgence [34, 35]. The practices nonetheless offered closer relationship opportunities for children when compared to the authoritarian style of the past. One explanation of the rise in overprotective and overindulgent behaviors is that these parents are from the recently expanded middle class [36]. Their life struggle, combined with absorbed Western values, caused their parenting practices to deviate from those of the previous generation [37,38,39]. These, combined with the ease of living from technological advancements, could have produced an increase in inclination toward hedonistic ways of life [40]. Early exposure and ease of access to mobile entertainment can also prime them toward hedonism [41]. All of these could be intensified by students’ psychosocial developmental stages of late adolescence and early adulthood, in which the foci are directed relatively inward to the self [33]. Hedonism is a value incompatible with altruistic traits owing to its self-centered aspects [12]. Despite the observed difference being marginal, the incompatibility holds the potential to hinder meaning making in the profession and create relationship strains with seniors and instructors, contributing to disruptions of student’s mental wellbeing as well. Hence, future studies verifying the trend of change in hedonism in the context is still warranted.

The lower rating on religious values among students could be a reflection of the increase in religiosity in Thai society [34, 42]. This could be a result of the rise of social consciousness following easy and widespread access to media, disillusionment with current religious institutions, and incompatibility with modern consumerist ways of life [43,44,45,46,47]. Rise in irreligiosity is also an evolving trend in Western countries as well [48].

Nevertheless, ratings on the other two sets of values, Self-Direction and Achievement & Power, were similar between the groups. Both students and instructors valued the ability to be in charge of their lives and valued career-related achievements all the same. Though the specific foci may differ by developmental stages, basic psychological desires toward self-realization [49] and exertion of control over one’s immediate environment [50] appear to operate regardless of age.

Studies in Western societies have noted that values related to personal growth and self-transcendence were associated with positive affectivity and wellbeing, but replication in Asia has been scarce [51]. This study analyzed the effect of endorsing different values on the mental wellbeing of medical students. Consistent with a previous study in the West, the measure on Self-Direction predicted better mental wellbeing [52]. This category of value implies the ability to redirect attention toward one’s well-being in the face of adversity and results in better self-care behaviors. The ratings on Universalism & Benevolence also predicted better mental health. The value partly concerned the person’s investment in social circles and subsequent supports, which are protective against mental difficulties [53]. The value also concerned institutional and world contributions, which are natural elements of healthcare work and can serve as a guide to students’ life directions. Consistent with the concept of Logotherapy, by seeing meaning in their routine studies and patient care responsibilities, students become buffered from the adverse mental effects of medical school lives [54]. In contrast with speculations from liberal perspectives that view traditions as restricting, the present study observed similar findings to another study in a conservative society that the valuing Tradition predicts better mental wellbeing [51, 55]. Religion, although in decline, can exert protective effects on one’s mental wellbeing, such as by providing mental respite in prayer and meditation [42]. It also adds to meaning where there is nothing to be seen. In the context of Buddhism, adverse events in life are commonly attributed to “bad karma” committed in past lives. Following such philosophical consciousness, people let things go so as not to perpetuate karma.

Valuing Achievement & Power is associated with self-expansion and growth and, as discussed, has been linked with positive affectivity. In contrast, the results from the whole sample did not reveal an association between this value and mental wellbeing. It is possible that the stressful learning environment and intensive norm-referenced assessment deprived students of the sense of academic accomplishment. As Thai medical students typically had backgrounds as accomplished high schoolers and were primed to the glory of academic achievement, the interaction between this value and the inevitable deprivation of success could serve to injure their self-esteem. Moreover, the result from stratified analysis showed that adherence to this value appeared to predict poorer mental wellbeing exclusively in females. Interaction analysis between this value with gender, however, showed only a trend toward significance, suggesting a potentially small effect size for the interaction that is underpowered to detect with the current sample size. Given the potential influences from gender differences in achievement perception, trait emotionality, and societal pressure on female students’ wellbeing, the observed trend necessitates further exploration to inform the creation of inclusive and equity-focused educational environment [56,57,58].

Hedonism, as studied in the Western context, has been viewed as a part of modern values and has been positively associated with mental health [51]. However, the present study observed the opposite. The value, which may be on its early course of rising, pertains to the inclination toward pleasurable activities and pastime. Hedonism is philosophically antagonistic to Altruism, potentially impeding students’ meaning making of the hardship of healthcare work. Students who endorse highly in Hedonistic lifestyle could be frustrated by the limiting nature of medical school environment. A trend toward magnification of the negative effect was noted among male students; however, the observed effect size could have been small, potentially contributing to the lack of statistical significance. The added vulnerability, if present, could be attributed to societal expectations of emotion regulation behaviors. Like many other cultures, social norms dictate that Thai males display little depressive emotion both in public and close circles, in contrast to females, who typically can express sadness while confiding in peers or family [59]. Reliance on hedonistic behaviors can be seen as one of the few available outlets and the deprivation of such coping consequently affects males more. Another possibility lies in the engagement in harmful hedonistic behaviors such as alcohol, gambling, or substance misuse, which can be seen more frequently in males and adversely affect their mental health in the long run [60]. Hedonism can also be viewed negatively be senior members of the medical community, who may derogate the trait as indolence or intolerance, and feel compelled against forming workable relationship with these younger members of the community. As the trait is yet to pervade into normalcy of the community, seeking middle ground between adaptation and acceptance appears to be a viable option.

Owing to the dynamic nature of human society, differences in values among members of the medical community appear inevitable. For now, some differences such as in the Hedonism values may still be subtle, the study of which would require sample size large enough to achieve sufficient statistical power. The shifts in personal values would subsequently alter manifest behaviors and attributes of medical students and future candidates. Recognition must be made that baseline attributes of candidates have started to shift, and medical education curriculum needs to adapt to address the issue. Whether to accommodate or assimilate is still the question. The authors believe that the judgement should be made on whether the values ultimately affect the desirable characteristics of medical students and professionals. Along with this, the definition of what is considered desirable should evolve as well, incorporating views from younger members of the medical communities and the expectations from the wider society. Indeed, some changes brought about by the younger members such as the directness in communication and desire for transparency could be for the better of the community [61]. Supposed that the rise in Hedonism is confirmed in subsequent studies, medical school may opt to accommodate the trait by allowing for more forgiving study and work hours as long as the desired threshold of knowledge, skills, and attitude can be reached. However, should any traits appear to deteriorate the student’s desirable characteristics or mental wellbeing, the decision whether to intervene must be contemplated by the curriculum designers, who should be informed by empirical evidence and engagement of stakeholders, including students themselves. As the manifestation of two competing values into behaviors can be affected by its personally assigned order of importance, achievement of desirable professional characteristics and behaviors could partially be met through interventions targeting student’s values within the process of medical education. The breadths and scopes of educational processes already in place, such as feedback, reflection, and clinical exposure, can be adjusted to cover the issues of values as well.

As there may exist gender-related differences in the manifestations and consequences of values, actions should be taken to ensure that perspectives are heard from diverse and representative cast before relevant administrative decisions are made.

The observed difference in values cannot be attributed to the effect of generations alone, as respondents were from various psychosocial developmental stages. The cross-sectional nature of the survey limits the strength of the conclusions on directionality. Relatively small numbers of gender minority participants were recruited, and whether their adherence to values affects mental wellbeing differently from other genders still require further studies. For medical schools in different cultures, the exact findings may possess limited generalizability but should nonetheless prompt investigations and actions. Furthermore, as the long-term effects of values, and changes thereof, among medical students and new professionals are not known, longitudinal studies, such as those exploring graduate’s adjustment to the professions or the long-term mental wellbeing outcome, could invaluably inform practices in the field of medical education.