Opening doors together: Agentic engagement as a relational practice in medical education

Agentic engagement is a practice describing students' constructive and influencing behaviours toward optimising their learning processes. Agentic engagement relies on students' interaction with their educators, study materials and/or each other. This study seeks a better understanding of the factors stimulating medical students' engagement in small-group learning settings. Findings may help educators to more effectively support students' agentic engagement and help students prepare for unforeseen, demanding (clinical) healthcare settings.

We conducted 12 semi-structured interviews to explore factors stimulating and hindering medical students' agentic engagement in small-group pre-clinical classes. We analysed interview transcripts using template analysis, a form of thematic analysis.

We identified four main themes of factors influencing student agentic engagement: the bold and the timid, navigating the (PBL) curriculum, paradoxes of collective learning, and tutors as gatekeepers. Students also described how engaging agentically to achieve their own learning expectations could collide with and hinder their peers' learning experiences.

Medical students' agentic engagement is stimulated by individual qualities, social dynamics, emotional engagement and near-clinical exposure, while hindered by controlling teaching styles and curriculum ambiguities. Tutors' responses to students' agentic attempts prove crucial in either sustaining or suppressing such behaviours. To foster agentic engagement, educators should aim to create autonomy-supportive learning environments, involve students in curriculum dissemination, and integrate meaningful clinical experiences that empower students to tailor their learning trajectories. Such approaches may prepare them for navigating the complexities of clinical practice and lifelong learning.