Student engagement and learning outcomes: an empirical study applying a four-dimensional framework

Figures & data

Table 1. Descriptive statistics.

	Participant characteristics	Mean	SD	Observations
1	Gender (Male)	0.44	0.50	13010
2	Residence (Rural area)	0.45	0.50	13010
3	Father’s education duration	10.73	3.77	13010
4	Mother’s education duration	9.60	4.17	13010
5	Father’s occupation ISEI	33.04	18.89	13010
6	Mother’s occupation ISEI	29.99	17.14	13010
7	Having medical worker(s) in the family	0.27	0.45	13010
8	NCEE result	537.70	52.00	13010
	Independent Variables: Student engagement
	Behavioral engagement	Cronbach’s α: 0.69
B1	Participating in teaching rounds	3.87	1.04	13010
B2	Participating in case-reporting	3.39	1.08	13010
B3	Engaging in clinical operations	3.29	1.11	13010
B4	Doing academic-related presentations	2.68	0.98	13010
B5	Participating in cooperative group learning or discussions	3.28	0.86	13010
	Emotional engagement	Cronbach’s α: 0.79
E1	I am interested in my field of study	3.68	0.79	13010
E2	I want my future career to be closely related to my profession	3.92	0.79	13010
E3	I am passionate about learning	3.55	0.76	13010
	Cognitive engagement	Cronbach’s α: 0.75
C1	When I encounter difficulties in my studies, I can usually think of some solutions to deal with them	3.68	0.72	13010
C2	I have participated as an active learner with responsibility for my own learning	3.54	0.81	13010
C3	I have assessed my own competence	3.58	0.81	13010
	Agentic engagement	Cronbach’s α: 0.78
A1	My feedback has been taken into account in curriculum development	3.39	0.91	13010
A2	I have been involved formally and/or informally in peer teaching (explaining the appropriate knowledge to my peers)	3.49	0.83	13010
A3	I have engaged in peer assessment	3.41	0.88	13010
	Dependent Variables: Learning outcomes
D1	Basic Medical Knowledge Examination	190.64	34.17	13010
D1.1	Memorization	42.39	8.29	13010
D1.2	Comprehension	56.99	9.45	13010
D1.3	Application	91.24	18.34	13010
D2	Basic Clinical Skills Examination	80.32	9.72	13010

Table 2. Student engagement and learning outcomes in the Basic medical Knowledge Examination and in the Basic clinical Skills Examination.

	Dependent variable: Learning outcomes in the Basic Medical Knowledge Examination						Dependent variable: Learning outcomes in the Basic Clinical Skills Examination
	Model 1	Model 2	Model 3	Model 4	Model 5	Model 6	Model 1	Model 2	Model 3	Model 4	Model 5	Model 6
Behavioral clinical engagement	−0.034*** (0.009)					−0.077*** (0.009)	0.014 (0.008)					−0.012 (0.009)
Behavioral classroom engagement		0.023** (0.008)				−0.023** (0.009)		0.047*** (0.008)				0.019* (0.009)
Emotional engagement			0.128*** (0.008)			0.116*** (0.010)			0.084*** (0.008)			0.065*** (0.010)
Cognitive engagement				0.096*** (0.008)		0.098*** (0.014)				0.070*** (0.008)		0.023 (0.014)
Agentic engagement					0.032*** (0.008)	−0.061*** (0.012)					0.051*** (0.008)	0.001 (0.012)
Controls	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
School FE	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
R^2	0.231	0.231	0.246	0.239	0.231	0.254	0.247	0.249	0.254	0.252	0.250	0.255
Adjusted R^2	0.228	0.227	0.242	0.235	0.228	0.250	0.244	0.246	0.250	0.248	0.246	0.251
Observations	13010	13010	13010	13010	13010	13010	13010	13010	13010	13010	13010	13010

Notes: The learning outcomes were standardized among all students who participated in the test and the survey to obtain a mean of zero and a standard deviation of one. Standard errors in parentheses. ***p < 0.001, **0.001<p < 0.01, *0.01<p < 0.05. The controls contain gender, residence, father’s education duration, mother’s education duration, father’s occupation, mother’s occupation, whether having medical worker(s) in the family, and National College Entrance Examination (NCEE) result. Medical school fixed effects are included in all regressions. In the two Model 6, Variance Inflation Factors are all less than 5.

Table 3. Relationship between student engagement and learning outcomes in memorization, comprehension, and application.

	Memorization	Comprehension	Application
	Model 1	Model 2	Model 3
Behavioral clinical engagement	−0.071*** (0.009)	−.067*** (.009)	−.076*** (.009)
Behavioral classroom engagement	−0.018* (0.009)	−.029*** (.009)	−.019* (.009)
Emotional engagement	0.101*** (0.011)	.109*** (.011)	.115*** (.010)
Cognitive engagement	0.098*** (0.014)	.089*** (.014)	.094*** (.014)
Agentic engagement	−0.063*** (0.012)	−.054*** (.012)	−.057*** (.012)
Controls	Yes	Yes	Yes
School FE	Yes	Yes	Yes
R^2	0.210	.225	.249
Adjusted R^2	0.206	.221	.245
Observations	13010	13010	13010

Notes: The learning outcomes were standardized among all students who participated in the test and the survey to obtain a mean of zero and a standard deviation of one. Standard errors in parentheses. ***p < 0.001, **0.001<p < 0.01, *0.01<p < 0.05. The controls contain gender, residence, father’s education duration, mother’s education duration, father’s occupation, mother’s occupation, whether having medical worker(s) in the family, and National College Entrance Examination (NCEE) result. Medical school fixed effects are included in all regressions. In Model 1–3, Variance Inflation Factors are all less than 5.

Table 4. Moderating effects of gender.

	Learning outcomes in the Basic Medical Knowledge Examination					Learning outcomes in the Basic Clinical Skills Examination
	Model 1	Model 2	Model 3	Model 4	Model 5	Model 1	Model 2	Model 3	Model 4	Model 5
Behavioral clinical engagement	−0.078*** (0.011)	−0.077*** (0.009)	−0.077*** (0.009)	−0.077*** (0.009)	−0.077*** (0.009)	−0.008 (0.011)	−0.012 (0.009)	−0.012 (0.009)	−0.012 (0.009)	−0.012 (0.009)
Behavioral classroom engagement	−0.023** (0.009)	−0.027* (0.011)	−0.023** (0.009)	−0.023** (0.009)	−0.022** (0.009)	0.019* (0.009)	0.008 (0.011)	0.019* (0.009)	0.019* (0.009)	0.019* (0.009)
Emotional engagement	0.116*** (0.010)	0.116*** (0.010)	0.103*** (0.013)	0.116*** (0.010)	0.116*** (0.010)	0.066*** (0.010)	0.065*** (0.010)	0.050*** (0.013)	0.065*** (0.010)	0.066*** (0.010)
Cognitive engagement	0.098*** (0.014)	0.098*** (0.014)	0.098*** (0.014)	0.101*** (0.016)	0.098*** (0.014)	0.023 (0.014)	0.023 (0.014)	0.022 (0.014)	0.013 (0.016)	0.023 (0.014)
Agentic engagement	−0.061*** (0.012)	−0.061*** (0.012)	−0.061*** (0.012)	−0.061*** (0.012)	−0.050*** (0.014)	0.001 (0.012)	0.001 (0.012)	0.001 (0.012)	0.001 (0.012)	0.003 (0.014)
Male	−0.225*** (0.015)	−0.225*** (0.015)	−0.225*** (0.015)	−0.225*** (0.015)	−0.225*** (0.015)	−0.365*** (0.015)	−0.365*** (0.015)	−0.365*** (0.015)	−0.366*** (0.015)	−0.366*** (0.015)
Behavioral clinical engagement* Male	0.002 (0.015)					−0.008 (0.015)
Behavioral classroom engagement* Male		0.009 (0.015)					0.024 (0.015)
Emotional engagement *Male			0.028 (0.015)					0.034* (0.015)
Cognitive engagement *Male				−0.006 (0.015)					0.022 (0.015)
Agentic engagement *Male					−0.023 (0.015)					−0.003 (0.015)
Controls	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
School FE	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
R^2	0.254	0.254	0.254	0.254	0.254	0.255	0.255	0.255	0.255	0.255
Adjusted R^2	0.250	0.250	0.250	0.250	0.250	0.251	0.251	0.251	0.251	0.251
Observations	13010	13010	13010	13010	13010	13010	13010	13010	13010	13010

Notes: The controls contain residence, father’s education duration, mother’s education duration, father’s occupation, mother’s occupation, whether having medical worker(s) in the family, and National College Entrance Examination (NCEE) result. *** p < 0.001, ** 0.001<p < 0.01, *0.01<p < 0.05.

Table 5. Moderating effects of NCEE.

	Learning outcomes in the Basic Medical Knowledge Examination					Learning outcomes in the Basic Clinical Skills Examination
	Model 1	Model 2	Model 3	Model 4	Model 5	Model 1	Model 2	Model 3	Model 4	Model 5
Behavioral clinical engagement	−0.077*** (0.009)	−0.076*** (0.009)	−0.076*** (0.009)	−0.076*** (0.009)	−0.076*** (0.009)	−0.012 (0.009)	−0.011 (0.009)	−0.011 (0.009)	−0.011 (0.009)	−0.012 (0.009)
Behavioral classroom engagement	−0.022** (0.009)	−0.023** (0.009)	−0.023** (0.009)	−0.023** (0.009)	−0.023** (0.009)	0.019* (0.009)	0.019* (0.009)	0.019* (0.009)	0.019* (0.009)	0.019* (0.009)
Emotional engagement	0.116*** (0.010)	0.116*** (0.010)	0.115*** (0.010)	0.117*** (0.010)	0.116*** (0.010)	0.065*** (0.010)	0.066*** (0.010)	0.065*** (0.010)	0.066*** (0.010)	0.066*** (0.010)
Cognitive engagement	0.099*** (0.014)	0.098*** (0.014)	0.099*** (0.014)	0.096*** (0.014)	0.098*** (0.014)	0.023 (0.014)	0.022 (0.014)	0.023 (0.014)	0.022 (0.014)	0.023 (0.014)
Agentic engagement	−0.061*** (0.012)	−0.061*** (0.012)	−0.061*** (0.012)	−0.061*** (0.012)	−0.062*** (0.012)	0.001 (0.012)	0.001 (0.012)	0.001 (0.012)	0.001 (0.012)	0.001 (0.012)
NCEE	0.209*** (0.010)	0.209*** (0.010)	0.211*** (0.010)	0.210*** (0.010)	0.209*** (0.010)	0.096*** (0.010)	0.096*** (0.010)	0.097*** (0.010)	0.097*** (0.010)	0.096*** (0.010)
Behavioral clinical engagement* NCEE	0.013 (0.008)					−0.004 (0.008)
Behavioral classroom engagement* NCEE		0.020* (0.008)					0.016* (0.008)
Emotional engagement* NCEE			0.037*** (0.007)					0.018* (0.007)
Cognitive engagement * NCEE				0.028*** (0.007)					0.004 (0.007)
Agentic engagement * NCEE					0.016* (0.007)					0.001 (0.007)
Controls	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
School FE	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
R^2	0.254	0.254	0.255	0.254	0.254	0.255	0.255	0.255	0.255	0.255
Adjusted R^2	0.250	0.250	0.251	0.250	0.250	0.251	0.251	0.251	0.251	0.251
Observations	13010	13010	13010	13010	13010	13010	13010	13010	13010	13010

Notes: The controls contain gender, residence, father’s education duration, mother’s education duration, father’s occupation, mother’s occupation, and whether having medical worker(s) in the family. *** p < 0.001, ** 0.001<p < 0.01, *0.01<p < 0.05.

Figure 1. Post-hoc probing for the moderating effects of NCEE.

Notes: The figure displays the moderating effects of NCEE based on the estimations from Model 3 and Model 4 in Table 5. The x-axis represents the standardized score on NCEE, while the y-axis represents the association between the Basic Medical Knowledge Examination and the two student engagements.