From Quiet Quitting to Open Dialogue in Medical Education: Longitudinal Student Perspectives on the Factors Shaping...

A healthy work-life balance and an environment where students feel valued are goals of increasing importance in medical education. When these essential elements are absent or lacking, educators run the risk of losing their trainees, either physically or mentally, via a silent "check out," referred to as "quiet quitting." This study examined the maturation of value-based student engagement and students' tendency to disengage from academic tasks during their first year of college and shortly before graduation.

This longitudinal mixed methods study was conducted at the 6-year Doctor of Medicine program at the Radboud University Medical Center, Nijmegen, the Netherlands, 2017-2023. Scales for the Assessment of Learning and Performance in Students questionnaire data were connected with qualitative insights from focus group interviews from 10 student participants at 3 key points in their academic progression: the beginning and end of their first academic year and shortly before graduation. Through concurrent, exploratory, inductive analysis, the authors examined patterns, relationships, and discrepancies among the data, comparing and contrasting to ultimately draw overarching conclusions.

Data analysis revealed a transformation in students' learning and performance motivation, becoming more intrinsically driven and connected to personal values. The willingness to invest effort was not a constant, varied among individual students over time, and became less pronounced when considering future employment prospects. Intellectual analysis on desired future work-life balance prompted students to consider a plan B for their career choice. Work-life balance concerns were mainly discussed within close-knit social circles.

Student engagement or disengagement appeared to be a dynamic construct. Workplace learning seemed to trigger committed action. However, healthy work-life balance concerns grew stronger as students got closer to graduation. When drivers and barriers of engagement are not discussed, potential talent could be lost, quietly or openly.