{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:53:59Z","timestamp":1791287639011,"version":"4.1.0"},"reference-count":72,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Perspect Med Educ"],"abstract":"<jats:p>Introduction: Medical students\u2019 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\u2019 career intentions, the specific role of multidimensional student engagement, and whether its associations with intention vary across undergraduate years, has not been systematically examined.\nMethod: We analysed a two-year (2020\u20132021) 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).\nResults: 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\u20135; cognitive engagement increased across years; and agentic engagement was stronger in Years 4\u20135 than in earlier years. Emotional engagement was consistently associated with intention across Years 1\u20135 and accounted for the largest incremental explanatory power; BMA indicated strong evidence for inclusion of emotional and agentic engagement.\nConclusion: 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\u2014supporting emotional and cognitive engagement throughout training and cultivating agentic engagement in early years.<\/jats:p>","DOI":"10.5334\/pme.2157","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T10:57:32Z","timestamp":1791284252000},"page":"1058-1072","source":"Crossref","is-referenced-by-count":0,"title":["Medical Student Engagement and Intention to Practise Medicine Across Undergraduate Years: A Longitudinal Study"],"prefix":"10.5334","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9605-6361","authenticated-orcid":false,"given":"Zehua","family":"Shi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4425-9845","authenticated-orcid":false,"given":"Hongbin","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4669-336X","authenticated-orcid":false,"given":"Jie","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"issue":"11","key":"key20261006105727_B1","doi-asserted-by":"crossref","first-page":"853","DOI":"10.2471\/BLT.13.118729","article-title":"Human resources for health and universal health coverage: Fostering equity and effective coverage","volume":"91","year":"2013","journal-title":"Bull World Health Organ"},{"issue":"1","key":"key20261006105727_B2","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1186\/s12909-022-03819-4","article-title":"Preparing students to deal with the consequences of the workforce shortage among health professionals: A qualitative approach","volume":"22","year":"2022","journal-title":"BMC Med Educ"},{"key":"key20261006105727_B3","volume-title":"Global strategy on human resources for health: Workforce 2030","author":"World Health Organization","year":"2016"},{"issue":"1","key":"key20261006105727_B4","first-page":"1","article-title":"Medical school attrition\u2014Beyond the statistics: A ten year retrospective study","volume":"13","year":"2013","journal-title":"BMC Med Educ"},{"issue":"9","key":"key20261006105727_B5","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1001\/jamainternmed.2022.2194","article-title":"Association of sociodemographic characteristics with US medical student attrition","volume":"182","year":"2022","journal-title":"JAMA Intern Med"},{"issue":"1","key":"key20261006105727_B6","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1097\/PTS.0000000000000222","article-title":"Poor physician performance in the Netherlands: Characteristics, causes, and prevalence","volume":"16","year":"2020","journal-title":"J Patient Saf"},{"key":"key20261006105727_B7","doi-asserted-by":"crossref","first-page":"892","DOI":"10.2471\/BLT.13.118927","article-title":"A comprehensive health labour market framework for universal health coverage","volume":"91","year":"2013","journal-title":"Bull World Health Organ"},{"issue":"4","key":"key20261006105727_B8","doi-asserted-by":"crossref","first-page":"366","DOI":"10.5582\/bst.2017.01198","article-title":"New medical education reform in China: Towards healthy China 2030","volume":"11","year":"2017","journal-title":"Biosci Trends"},{"issue":"1","key":"key20261006105727_B9","first-page":"1","article-title":"A rapid review of the rate of attrition from the health workforce","volume":"15","year":"2017","journal-title":"Hum Resour Health"},{"issue":"9","key":"key20261006105727_B10","article-title":"Career intentions of medical students in the UK: A national, cross-sectional study (AIMS study)","volume":"13","year":"2023","journal-title":"BMJ Open"},{"key":"key20261006105727_B11","first-page":"2103","article-title":"A third of medical students plan to leave the NHS within two years of graduating, survey suggests","volume":"382","year":"2023","journal-title":"BMJ"},{"issue":"1","key":"key20261006105727_B12","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1186\/s12909-022-03313-x","article-title":"Attractiveness of medical disciplines amongst Swiss first-year medical students allocated to different medical education tracks: Cross-sectional study","volume":"22","year":"2022","journal-title":"BMC Med Educ"},{"key":"key20261006105727_B13","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.jebo.2021.12.034","article-title":"Still want to be a doctor? 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