Student Engagement from the Medical Trainees' Perspective and Associated Factors: A Nationwide Cross-Sectional Study

Hirohisa Fujikawa; Hidetaka Tamune; Yuji Nishizaki; Hirotake Mori; Sho Fukui; Kiyoshi Shikino; Taro Shimizu; Yu Yamamoto; Hiroyuki Kobayashi; Toshio Naito; Yasuharu Tokuda

doi:10.31662/jmaj.2025-0448

Student Engagement from the Medical Trainees' Perspective and Associated Factors: A Nationwide Cross-Sectional Study

JMA J. 2026 Mar 16;9(2):486-494. doi: 10.31662/jmaj.2025-0448. Epub 2026 Feb 20.

Authors

Hirohisa Fujikawa^{1

2

3}, Hidetaka Tamune⁴, Yuji Nishizaki⁵, Hirotake Mori¹, Sho Fukui^{6

7}, Kiyoshi Shikino⁸, Taro Shimizu⁹, Yu Yamamoto¹⁰, Hiroyuki Kobayashi¹¹, Toshio Naito¹, Yasuharu Tokuda^{12

13}

Affiliations

¹ Department of General Medicine, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan.
² Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
³ Center for General Medicine Education, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan.
⁴ Department of Psychiatry and Behavioral Science, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.
⁵ Division of Medical Education, Juntendo University School of Medicine, Bunkyo-ku, Tokyo, Japan.
⁶ Department of Emergency and General Medicine, Kyorin University, Mitaka, Tokyo, Japan.
⁷ Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁸ Department of Community-Oriented Medical Education, Graduate School of Medicine, Chiba University, Chiba, Chiba, Japan.
⁹ Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Shimotsuga-gun, Tochigi, Japan.
¹⁰ Division of General Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.
¹¹ Department of Internal Medicine, Mito Kyodo General Hospital, University of Tsukuba, Mito, Ibaraki, Japan.
¹² Muribushi Okinawa for Teaching Hospitals, Urasoe, Okinawa, Japan.
¹³ Tokyo Foundation for Policy Research, Minato-ku, Tokyo, Japan.

Abstract

Introduction: Despite mounting recognition of the importance of student engagement in curriculum development, the current status of student engagement from medical trainees' perspectives has yet to be elucidated. Particularly in Japan, where the educational system places strong emphasis on teacher authority, it is possible that medical student engagement is not promoted as effectively as it could be, and that engagement is not fully perceived by medical students. Thus, we aimed to elucidate the current status of student engagement in curriculum development from the perspective of medical trainees, and to explore factors associated with medical trainees' perceptions of student engagement.

Methods: We performed a nationwide cross-sectional study in Japan from April to May 2025. Participants were newly entered medical residents who took the General Medicine In-Training Examination postgraduate "Year-0." They completed an anonymous online self-administered questionnaire. We analyzed the closed-ended questions using descriptive statistics and linear mixed-effects models, and applied inductive content analysis to the open-ended questions.

Results: Of 748 examinees, 428 (57.2%) were included in the analysis. A total of 105 (24.5%) did not perceive that there were student engagement initiatives at their medical school. Only 38 (8.9%) reported participation. The trainees' overall perceptions of how well their opinions were reflected in the medical curriculum were moderate, with a mean score of 5.41 out of 10. This result was supported by the content analysis findings, which identified four themes, including "desire to see more of medical students' opinions reflected" and "disappointment that medical students' opinions are not reflected." Multilevel analysis demonstrated that females had significantly more favorable perceptions than males.

Conclusions: Our findings indicated that awareness, implementation, and perceived value of student engagement remain limited from the perspectives of medical trainees in Japan. Medical educators should implement structural and cultural reforms and develop effective strategies tailored to diverse institutional environments.

Keywords: medical curriculum; medical trainee; student engagement; student involvement; undergraduate medical education.