A systematic review of engagement in medical education

Introduction Ask any educator, and they will respond that engagement is an important factor in their teaching. However, engagement is a complex, multidimensional construct comprising behavioural, cognitive, emotional, and agentic dimensions. Despite growing interest in this area, the conceptualisation and measurement of engagement in medical education remain inconsistent. This systematic review aims to examine how engagement is defined, conceptualised, and measured in studies involving medical students. Methods A systematic literature search was conducted in February 2025 across five databases for peer-reviewed studies published within the last decade. Studies were included if they focused on medical students, collected original data, and measured engagement within the context of a medical curriculum. Data extraction and screening were performed independently by two reviewers following PRISMA guidelines. Studies were analysed for their conceptual framework, dimensions of engagement measured, data collection methods, and study design. Results A total of 26 studies that met the eligibility criteria were included in this systematic review. Most studies measured behavioural (n = 21), cognitive (n = 19), and emotional engagement (n = 17), while agentic engagement was least frequently measured (n = 4). Most studies employed a quantitative approach, using survey instruments (n = 14) and engagement metrics (n = 5) to measure engagement, while a small number of studies adopted a qualitative approach, including interviews (n = 4) and observations (n = 4) to measure engagement. Engagement was mainly measured as a multidimensional construct, but some studies treated it as a unidimensional construct. Discussion Engagement remains inconsistently and often poorly defined, as evidenced by the exclusion of more than half of initially screened studies for lacking rigorous measurement of engagement. The rise of technology-driven interventions has led to an increasing interest in ensuring that students are engaged in learning to achieve the desired learning outcomes successfully. Future research should systematically incorporate behavioural, cognitive, emotional, and agentic engagement dimensions to advance understanding and enhance educational practices.