Medical Student Engagement and Intention to Practise Medicine Across Undergraduate Years: A Longitudinal Study

Medical students' declining intention to practise medicine threatens workforce sustainability. Addressing this issue is critical to alleviating workforce shortages and improving healthcare delivery. While previous studies have explored factors influencing students' career intentions, the specific role of multidimensional student engagement, and whether its associations with intention vary across undergraduate years, has not been systematically examined.

We analysed a two-year (2020-2021) longitudinal dataset from the China Medical Student Survey using a cohort-sequential design. Five dimensions of engagement were measured: behavioural classroom, behavioural clinical, emotional, cognitive, and agentic engagement. Multilevel growth models were applied to examine changes in intention to practise medicine and year-specific engagement-intention associations. Bayesian Model Averaging (BMA) was employed to evaluate robustness under model uncertainty using Posterior Inclusion Probabilities (PIPs).

The findings indicated that intention to practise medicine declined through Year 4, with a slight attenuation of the decline in Year 5. Engagement-intention associations varied across years: behavioural classroom engagement showed its largest association in Year 2; behavioural clinical engagement was significant in Years 4-5; cognitive engagement increased across years; and agentic engagement was stronger in Years 4-5 than in earlier years. Emotional engagement was consistently associated with intention across Years 1-5 and accounted for the largest incremental explanatory power; BMA indicated strong evidence for inclusion of emotional and agentic engagement.

Engagement is consistently associated with intention to practise medicine, but the salience of engagement dimensions shifts across undergraduate years. Educational strategies should be year-sensitive and developmentally strategic-supporting emotional and cognitive engagement throughout training and cultivating agentic engagement in early years.