Medical university students were divided into 5 types according to the process they used to decide on a course when entering a university, and the relationship between the decision-making process and occupational identity after entering the university was examined. The largest number of students, approximately 50%, were of the “meeting” type, followed in descending order by the “early decision” type, the “changing during 4 years” type, the “deciding at the last moment” type, and the “avoidance” type. There were differences in the frequency of decision-making types among departments, including the nursing department, which showed a large number of students of the “early decision” type. We examined the relationship between the decision-making process and occupational identity after entering the university and found that students of the “early decision” type were stable after entering the university, whereas students of the “avoidance” type had the lowest scores on all 4 subscales of occupational identity. This tendency was seen during the 4 years of university, and the importance of deciding on a course when entering the university was indicated.