Abstract
Student engagement is a key contributor to educational programme quality. It is a complex construct often defined with the focus on student behaviors. However, a broader, more organizational approach takes into account the institutional context and how this can be structured to encourage and support students’ willingness and ability to become engaged. This paper includes suggestions for a student engagement system using key elements recognized in the literature and concrete examples from medical schools that achieved recognition in the ASPIRE-to-Excellence student engagement initiative. The examples from the ASPIRE participants demonstrate that the presence of certain key features creates a mutually beneficial collaborative approach between students and their institutions. This includes opportunities for students to formally engage in four domains touching on the breadth of student life, including institutional governance and policy-making, educational programme development and evaluation, participation in activities in the academic community, and participation in local community and international outreach. Based on an in-depth review of the information from three medical schools that recently received an ASPIRE-to-Excellence award in student engagement, it was possible to identify certain specific practices that individually and taken together allow an institution to demonstrate excellence in this complex construct. As an overarching concept, it was clear that student participation in each of these domain areas benefitted from a supportive institutional culture characterized by specific formal attributes and activities. Examples included codifying student involvement in governance through institutional policies; maximizing communication routes among students and between students and school administrators and faculty; and formalizing a participatory environment through missions statements or strategic plans. For programme planning, a helpful conceptualization is that a successful student engagement programme occurs when change is championed by all stakeholders within an institution and the organization supports a collaborative culture that includes students as active participants and partners.
Practice points
Students engagement is a key contributor to educational program quality.
Student engagement is a process where formal organizational commitment facilitates and supports active student participation in all areas that affect student life.
As exemplified by the ASPIRE-to-Excellence components of student engagement, a successful programme involves formal opportunities for students individually and as an organized group to participate in policy and organizational decision-making; in activities related to the educational programme, including curriculum evaluation, active learning, and peer teaching/mentoring; in activities based in the academic community, including mentored research and attendance at and participation in local/regional meetings; and in community support and student-generated extracurricular and volunteer healthcare delivery options.
A successful student engagement programme requires a supportive organizational culture and learning environment where students are treated as partners.
Introduction
The construct of student engagement has generated growing interest as a contributor to educational programme quality and institutional excellence [Citation1,Citation2]. There are different definitions of student engagement, use of which would lead to different approaches to and means of planning, implementing, and evaluating the presence of the construct at a given institution. For example, Kahu [Citation3] presented a conceptual framework for understanding engagement through the lens of academic success and engagement with learning and defined student engagement as a “psycho-social process, influenced by institutional and personal factors, and embedded within a wider social context.” Kassab et al. [Citation4] considered student engagement to be “student investment of time and energy in academic and non-academic experiences that include learning, teaching, research, governance, and community activities.”
The ASPIRE-to-Excellence initiative was created to stimulate and recognize excellence in medical, dental, and veterinary programmes in a variety of domains [Citation5], including student engagement. In a review of programmes recognized by ASPIRE for excellence in student engagement, Freitas et al. [Citation6] identified a range of institutional conditions that resulted in student engagement. In these institutions, important contributors to success in student engagement included a collaborative organizational culture that valued students as equals and created functional and visible student engagement opportunities. These authors found that examples of student engagement permeated these schools based on participatory practices that resulted in benefits for students, faculty, and the institution as a whole. Contextual factors internal and external to the school affected the degrees of engagement at the personal and student cohort levels. Importantly, however, the core values of the schools helped them mitigate barriers to engagement.
Those findings support previous research that identified the importance of organizational, faculty, and student commitment [Citation7–10]. Organizational values and intrinsic motivations are key drivers of participatory activities, corroborating the need for institutions to make engagement strategies visible and accessible for students [Citation7,Citation11,Citation12]. While the support of academic staff has been described as one of the more significant drivers of student engagement [Citation8,Citation10], other results suggest that engagement becomes more successful when change is championed by both students and staff and, when given the opportunity, students have the capacity to enhance their own learning environment [Citation12]. Research confirms that students who are valued as partners by staff develop self-confidence, motivation to contribute to their school, and show commitment to institutional and individual success [Citation8,Citation10,Citation13]. This aligns with conceptualization of student engagement through a participatory lens: students as partners with faculty across all domains of academic work including research, teaching, governance and their local community [Citation2]. This aligns with the concept that student engagement develops from a reciprocal investment between students and institutions, with mutual benefits [Citation9].
In summary, previous studies have found that student engagement is enhanced by: (1) participatory values that are made explicit to institutional stakeholders and actively reinforced by senior leadership, (2) engagement activities that are driven by both students and staff, (3) engagement strategies that provide reciprocal benefits for all stakeholders, and (4) contextualized strategies that are enabling, empowering, and inclusive.
Domains of student engagement in health professions education with examples
When taken together, the domains that constitute excellence in student engagement should reflect the breadth of the construct. Individually, they should be recognizable, clear, and easy to implement. While the literature provides many examples as noted above, the overall framework followed in this paper aligns with that of the AMEE ASPIRE-to-Excellence awards.
The examples provided here are from three medical schools that received the ASPIRE award for excellence in student engagement in 2021 or 2022. They were selected as demonstrating how specific components of student engagement can be successfully operationalized within schools with varying characteristics and contexts. School 1 is a fairly-new graduate-entry medical school in the UK with a total of over 700 students in its four-year curriculum. School 2 is a university-hospital partnership in south-central Asia with 200 students enrolled in each of the six years of the curriculum. School 3 is a medical school with about 1300 students located in the middle east that has a six-year curriculum and is organizationally located in a large institution responsible for graduate (PhD) and residency (postgraduate) training.
There are four large domains that together cover the areas included in the definitions of student engagement from Kasab and colleagues (2023) as described above. Each of these domains includes elements that together describe specific areas for institutional and student action within the domain. To qualify for the ASPIRE award for excellence in student engagement, schools must provide substantial evidence that the required actions occur in each of the four domain areas and that appropriate outcomes are achieved, including evidence of student participation and changes being made based on student input. As such, the ASPIRE award winners provide useful examples that can be built upon and adapted by other institutions based on their own local contexts.
The following examples from the ASPIRE award winners illustrate concrete actions that schools can take to support student engagement at their own institutions.
Domain 1: Student engagement in policy and decision-making activities
Participation in school governance
Participation in educational programme planning
Participation in decisions related to faculty
School 1
Students have a formal role in governance and policy-making. For example, students have codified voting rights in a number of committees. A formal student-staff liaison committee with 15 students and 15 faculty operates as a conduit between the student body and institutional representatives. Processes exist for the student committee members to collect input from the student body as a whole and such a committee provides opportunities for institutional-level communication. The presence of students in the Medical Education Committee and committees for each of the phases of the curriculum and formal student participation in panels for new teaching-only faculty appointments allow students to have input in important areas related to the medical education programme.
School 2
The Medical Student Council and its subcommittees engage about 75% of the students in each curriculum year. Through the Student Council, students serve as representatives on the majority of the school’s educational governing committees and subcommittees, the Faculty’s Well-being committee, and the Programmatic Assessment Committee. The Student Council Executive Board participates in school policy development activities and provides input to policies that are being considered. This input comes from collecting the perceptions of the student body at large. Importantly, student feedback on teaching is used in faculty promotion.
School 3
Medical students have formal representation on some decision-making committees and are invited as guests to curriculum-related committees. They are invited to respond to policy statements and provide input to the institutional strategic plan. While governmental regulations do not permit students to participate in hiring decisions, students evaluate faculty teaching, and the data are used in promotion and retention actions.
In summary, in the three examples student input in institutional decision-making was both formally sought by the institution and provided by students as individuals and as representatives of formal student groups. This is enhanced if the opportunity for student engagement is codified in institutional policies and operationalized through formal student structures, such as student councils, and institutional structures (such as student-staff liaison committees). Importantly, demonstrating success in student engagement requires evidence that student participation leads to defined outcomes. For example, successful schools provided information that student-proposed policies were adopted by the institution and student input into other policies was included in decision-making.
Domain 2: Student engagement in education and programme evaluation
Students evaluate their courses and teaching staff
Student feedback is considered in curriculum development and evaluation
Students take responsibility for their own learning
Students support the learning of other students
School 1
Students are expected to evaluate courses and clerkships and this feedback is taken into account at various curriculum governance levels, including at curriculum phase management meetings where students are participants. There is an innovative student “mystery shopper” programme which provides more in-depth detail on teaching sessions than what is available in standard course evaluations. The use of case-based small group learning provides opportunities for students to take responsibility for their own learning. Students are active in teaching, mentoring, and supporting their peers through formal activities and are formally trained to carry out these responsibilities.
School 2
Student evaluations of courses and teachers have a response rate of over 80%. Mid-course surveys precede mid-course discussions with faculty to allow students to reflect on course characteristics and teaching quality. Student course evaluations are provided to course directors and department chairs and reported to the Faculty Curriculum Evaluation Subcommittee. Active learning formats occupy over 50% of curriculum time. Through the Student Council, students are organized and prepared to support their peers in areas related to academic assistance, mental health support, and peer mentoring. Each of these activities is linked to the outcome-based objectives of the specific Student Council subcommittee responsible for the activity.
School 3
There are anonymous and mandatory course evaluations that have a high response rate. The results of evaluations are communicated to students, teaching staff, and department chairs. Active learning formats where students take responsibility for their own learnings, such as problem-based learning, are widely used. Students have access to leadership training and are prepared to serve as tutors and mentors for their peers.
In summary, student engagement is facilitated by a reciprocal process where student participation is sought, as in the expectation for completion of course evaluations, and occurs, as in a high course evaluation response rate. The utilization of such feedback in bringing about change closes the loop in that it stimulates student willingness to engage in this activity in the future. Active participation by students in their education, such as inclusion of active learning formats, and volunteer opportunities for peer teaching and peer mentoring also enhance engagement by supporting learning and the student experience.
Domain 3: Student engagement in the academic community
Students engage in research
Students participate in local, regional, and/or international academic activities
School 1
Students are required to participate in research and can develop an original idea or select from school-provided options. Students receive mentoring for research project development and implementation. Funding is available for summer research and for students to attend conferences and present their research. Follow-up surveys showed that one-quarter of respondents had presented their research at regional meetings.
School 2
Research is a required subject linked to a specific course in each year of the curriculum. This sequence builds to the student creating and conducting a research project with a mentor. Students also can pursue more in-depth research through an extracurricular research programme that is school-funded and can participate in a Research Club that helps students explore different research methodologies. Some students have presented their research at national conferences. Students also have the opportunity to become involved with various national and international organizations, such as the Asian Medical Students’ Association.
School 3
Approximately 20-30% of students participate in research every year. The school provides logistical and financial support to students participating in local, national, and international medical and scientific meetings. The school supports students to travel abroad for electives during the summer.
In summary, research is made available to students through education in research methodologies, participation by mentors, and financial support for stipends, travel and the time of mentors. Similarly, institutional funding allows students to participate in local and external scientific and medical meetings.
Domain 4 – student engagement in supporting the community, participating in extracurricular activities, and engaging in service delivery
Students engage with the local community and participate in student-generated extracurricular activities
Student engage in healthcare delivery locally and/or internationally during volunteer activities or electives
School 1
There is a student organization (MedSoc) which serves as an umbrella for 54 student-lead societies, including medical specialty interest groups, sports teams, student support/well-being groups, and groups for specific focus areas, such as women in medicine. Students are introduced to the various opportunities through a MedSoc “fair.” There are volunteer student projects that support the needs of groups within the local community, such as the homeless, and various other community-focused initiatives are directed at specific groups such as youth, children facing hospitalization, and refugees. Students have a self-selected elective as part of the curriculum that might be local, national, or international and can include clinical experiences and health education.
School 2
As part of the curriculum, there are community medicine courses where students conduct community-based health promotion projects, for example doing quality improvement projects related to community needs. Extracurricular activities are under the direction of the Medical Student Council and student clubs. Examples of local projects involve teaching primary school students and providing social services in nursing homes. A large number of students participate in and receive funding for clinical electives within the country and internationally. There is funding for international exchange programs.
School 3
Students are engaged in healthcare delivery locally and internationally during volunteer activities and electives. Extracurricular activities often are student generated and students play a major role in community health promotion initiatives and health campaigns.
In summary, students have choices for activities outside the formal curriculum or in required areas where options, such as the selection of a research topic or a community-support activity, are available. Many activities, such as the creation of electives or student interest groups, are student-generated. Student engagement is facilitated by the provision of institutional resources, such as staff to help organize activities and funding.
In considering the information provided by applicants for the ASPIRE award that successfully met the stated expectations and those that did not, it became clear that excellence in student engagement is more likely to occur where there is a supportive institutional culture that is demonstrated by specific institutional attributes and activities. For example, In School 1, such a culture was reflected in formal aspirational value statements about the importance of student engagement that are linked to concrete methods of implementation. The institutional commitment to student engagement also can be demonstrated by specific inclusion of the concept in mission statements and/or strategic plans, ideally developed with student input. For example, School 2 created an institutional strategic initiative for student engagement, which is formally aligned with the goals of the Medical Student Council. Operationally, this partnership supported the ability of students to bring their plans for strategic initiatives into institutional policy-making discussions. Another award winner not included in this article created the position of Deputy Dean for Student Engagement as a way to formalize and ensure the sustainability of its commitment to promote student engagement.
Discussion
Based on an in-depth review of the information from three medical schools that recently received an ASPIRE-to-Excellence award in student engagement, it was possible to identify certain practices that individually and taken together demonstrate excellence in this complex construct. This illustrates the operational components of student engagement and provides direction for schools wishing to implement or enhance a student engagement programme. Advice for institutions also is available in a paper devoted to student engagement from Peters et al. [Citation2] in the “Twelve Tips” series in Medical Teacher. To create this paper, the past winners of the ASPIRE-to-Excellence award in student engagement award came together to produce a comprehensive set of recommendations for implementing student engagement. The paper concludes with the advice that success in student engagement requires attention to empowering the “student voice,” creating a “framework” describing the “relationship between students and faculty,” and implementing effective “communication frameworks” in the student to student and student to faculty dimensions.
These and other recommendations specify the breadth of things that contribute to an effective student engagement system within an institution. What also is needed is guidance on how to create such a system and overcome any institutional and other barriers to implementation. Freitas et al. [Citation6] reviewed the submissions of ASPIRE-to-Excellence winners of the student engagement award between 2013 and 2016 and, in addition to the analyses of the applications’ content, interviewed five faculty and four students from five award-winning institutions. Among other questions, the participants were asked to reflect on the “drivers, optimal processes, challenges, and outcomes” for implementing student engagement programming. The results, in part, highlighted the importance of the following: 1) the involvement of multiple stakeholders, including administration, leadership, faculty, and students in a “bottom-up” and “top-down” model of implementing a student engagement system; 2) the demonstration of reciprocal benefits of student engagement to institutions, faculty, and students, which can offset additional costs of student engagement activities in such things as faculty time, student time, and institutional funding; and 3) the ability to overcome resistance, for example faculty reluctance to student-led initiatives. The authors concluded that “core drivers” require an institutional culture that “values students as equals” and creates meaningful student engagement opportunities. However, research to date does not provide a simple solution to overcoming some barriers, such as those imposed by regulatory prohibitions for student engagement at the institutional or national levels and institutional culture. Likely overcoming barriers requires strategies that need to be created locally in the context of the internal and external institutional environment.
Conclusion
Despite their differences in many areas, such as size and location, there was noticeable commonality in how the three institutions responded to and the evidence they provided for their activities related to the key elements of student engagement. This is likely due to the need to respond to a defined set of requirements in the ASPIRE-to-Excellence award criteria. In looking across these institutions and at the literature, it became clear that the definition of student engagement needs to go beyond a focus solely on what the student does to a broader view of the engagement of the total institution and the interactions among the groups within it. In summary, student engagement is a process where formal organizational commitments, policies, and procedures facilitate and support active student participation in areas that affect student life. On the part of institutions, evidence for an organizational commitment to student engagement is based in formal policies and defined actions by institutional members, including the availability of concrete support for activities and avenues for students to contribute to institutional decision-making. Students demonstrate their willingness to be engaged through their actions as an organized body (for example, student organizations/informal student groups) and as individuals (for example, in responding to course evaluations and serving as peer tutors/mentors). Finally, as a way to sustain institutional commitment, it would be important to communicate the benefits of a student engagement programme to the different stakeholder groups, including students, faculty, and the institution as a whole.
Acknowledgements
The authors wish to acknowledge the work and commitment of the ASPIRE panel on Student Engagement. The panel for the 2023-2024 academic year includes the following: Co-chair: Barbara Barzansky, PhD, MHPE (USA); Co-chair: Carmen Fuentealba, DVM, MSc, PhD, (F)AMEE (USA); Khalid Bin Abdulrahman (Saudi Arabia); Maria Rosa Fenoll-Brunet (Spain); Kulsoom Ghias (Pakistan); Madalena Patricio (Portugal); Celine Marmion (Ireland); Marietjie Van Rooyen (South Africa); Danai Wangsaturaka (Thailand); Marko Zdravkovic (Slovenia); Gladys Zugwai Ibrahim (Nigeria), Student Member.
Disclosure statement
The authors report no conflicts of interest. The authors alone are responsible for the ideas, content, and writing of this article.
Additional information
Funding
Notes on contributors
Barbara Barzansky
Barbara Barzansky, PhD, MHPE, Liaison Committee on Medical Education (LCME) Co-Secretary, American Medical Association, Co-Chair, ASPIRE Student Engagement Panel.
Carmen Fuentealba
Carmen Fuentealba, DVM, MSc, PhD, (F)AMEE, Professor and Dean, Long Island University College of Veterinary Medicine, Co-Chair, ASPIRE Student Engagement Panel.
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