Student Engagement in Undergraduate Medical Education: A Longitudinal Study of Medical Students in China.

Purpose: Understanding the changing patterns of student engagement in undergraduate medical education is crucial for effective learning outcomes and overall academic success as well as for improving the quality of medical education. This study examines the dynamics of student engagement in 4 dimensions-behavioral, emotional, cognitive, and agentic engagement-within the context of undergraduate medical education in China.

Method: This longitudinal study uses data from the 2020 and 2021 China Medical Student Survey. The study comprises 4 cohorts spanning all 5 grades of undergraduate medical education in China. Student IDs were matched to track the same students across years, yielding a sample size of 67,439 from 94 medical schools. The multilevel growth curve model and Latent Markov Model were used for data analysis based on a cohort-sequential design.

Results: While emotional, cognitive, and agentic engagement show a similar tendency to decline with grade level until they rebound slightly between grades 4 and 5, behavioral clinical engagement increased significantly as students' progress through grade levels. High-, moderate-, and low-engagement statuses were defined using Bayesian Information Criterion, and the initial probabilities of medical students in grade 1 being in the low-, moderate-, and high-engagement status were 15.34%, 13.47%, and 71.19%, respectively. Transition matrices show that high-engagement students usually maintain their high-engagement status (range: 80.33%-99.92%), moderate-engagement individuals fluctuate though most remain in this status (range: 53.96%-81.81%) or move to the low-engagement status (range: 14.85%-45.42%), and low-engagement students demonstrate a limited propensity for transitioning to a high-engagement status (range: 0.18%-7.53%).

Conclusions: This study demonstrates changing patterns of student engagement in the Chinese undergraduate medical education context. Identifying these patterns offers valuable insights for educators and policymakers to enhance student engagement.