{
  "abstract": "Introduction: As quality improvement in medical education increasingly focuses on the learning processes that students actually experience, it is important to clarify which learning-environment domains are most closely associated with student engagement and how engagement relates to learning gains.\n\nMethods: In this pooled repeated cross-sectional study, we analyzed 11,717 student responses from four administrations (2021–2024) of the National College Student Survey among undergraduate students at a medical university in western China. The learning environment was assessed across five domains: classroom teaching quality, facilities and resources, developmental support, interpersonal support, and teaching administration. Student engagement was measured across behavioral, emotional, and cognitive dimensions. Learning gains were assessed across six domains. Hierarchical multiple linear regression, cross-sectional indirect association analysis, year-stratified analyses, and k-means clustering were used to examine associations among perceived learning environment, engagement, and learning gains and to explore heterogeneity among students.\n\nResults: Survey year and background characteristics explained only 1.5–4.0% of the variance in engagement, whereas the five learning-environment domains explained an additional 22.5–27.6%. Classroom teaching quality showed the largest positive associations with behavioral, emotional, and cognitive engagement, which were statistically significant in every survey wave, and developmental support was also positively associated with all three dimensions. Engagement statistically accounted for 31.93% of the cross-sectional association between perceived learning environment and learning gains (total indirect association = 0.234; total association = 0.734). Person-centered analysis identified a convergent-low profile comprising 37.2% of students, whose scores on perceived learning environment, engagement, and learning gains were all below the sample average; background characteristics were only weakly associated with membership in the three profiles (Cramér’s V ≤ 0.063).\n\nDiscussion: These findings suggest that, in improving educational quality, medical universities should give greater attention to the classroom teaching and developmental support processes that students experience directly in their everyday learning, and should incorporate student engagement and learning experiences into routine, ongoing quality monitoring alongside conventional outcome assessment.",
  "abstract_shown": true,
  "affiliations": [
    "Institute of Higher Education Research, Guangxi Medical University",
    "School of Public Health, Guangxi Medical University",
    "Department of Clinical Laboratory, The First Affiliated Hospital of Guangxi Medical University",
    "Key Laboratory of Clinical Laboratory Medicine of Guangxi Medical University, Department of Education of Guangxi Zhuang Autonomous Region",
    "School of Humanities and Health Management, Guangxi Medical University",
    "Education Evaluation and Faculty Development Center, Guangxi Medical University"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Zhiwen Mo"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Yong Gao"
    },
    {
      "affs": [
        4
      ],
      "name": "Zhuangyu Wei"
    },
    {
      "affs": [
        5
      ],
      "name": "Hua Xu"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/75kfgsh2y3vwv.bib",
  "cited_by": 0,
  "doi": "10.3389/fpubh.2026.1885067",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13724328/?tool=EBI",
  "id": "75kfgsh2y3vwv",
  "issns": [
    "2296-2565"
  ],
  "landing_url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1885067/full",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2739|Innovations in Medical Education"
    ]
  ],
  "openalex": "W7222959668",
  "pdf_url": "https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2026.1885067/pdf",
  "pmcid": "PMC13724328",
  "pmid": "42973450",
  "published": "2026-10-19",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/75kfgsh2y3vwv.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:24Z",
      "native_id": "10.3389/fpubh.2026.1885067",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1885067/full"
    },
    {
      "first_seen": "2026-11-03T15:20:51Z",
      "native_id": "PMC:PMC13724328",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13724328"
    },
    {
      "first_seen": "2026-11-04T12:22:55Z",
      "native_id": "PMC13724328",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fpubh.2026.1885067"
    },
    {
      "first_seen": "2026-11-04T15:20:48Z",
      "native_id": "MED:42973450",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42973450"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Innovations in Medical Education",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Evaluating the associations of learning environment with student engagement and learning gains among undergraduate students at a medical university in western China",
  "title_text": "Evaluating the associations of learning environment with student engagement and learning gains among undergraduate students at a medical university in western China",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:20:51Z",
  "url": "https://research.draconitic.com/paper/75kfgsh2y3vwv",
  "venue": "Frontiers in Public Health",
  "versions": []
}