Two-Factor Study Process Questionnaire Research Articles

Critical thinking disposition and learning approach as predictors of mathematics performance

In the Philippines, improving pre-service math teachers’ critical thinking is receiving increasing attention, emphasizing the importance of tailoring instructional methods to students’ learning approaches for a more equitable environment and enhanced mathematics performance. Thus, this study aimed to determine if the critical thinking disposition subscales (reflective, attentiveness, open-mindedness, organization, perseverance, and intrinsic motivation) and learning approach (deep approach and surface approach) predict the mathematics performance of pre-service math teachers. This study employed a descriptive-correlational research design to randomly selected 125 pre-service math teachers from Central Luzon, Philippines. The survey instruments are administered through the student-educator negotiated CTDs scale, the revised two-factor study process questionnaire, and the 40- item validated test. Using descriptive analysis, findings revealed that preservice mathematics teachers have moderate levels of CTD, most of which use a deep approach and have average mathematics performance. Regression analysis showed that CTD and the deep approach were predictors. Therefore, pre-service mathematics teachers with a higher CTD and a deep approach are likelier to perform better in mathematics. These findings provide valuable insights into enhancing mathematics teacher education.

Engagement and learning approaches among medical students in an online surgical teaching programme: A cross-sectional study

BackgroundThe COVID-19 pandemic prompted the transition of all teaching and learning of final-year General Surgery students to an online platform. Despite the utility of online methods, challenges exist such as a sense of impersonal learning, and poor student engagement. Student engagement with course content is important for deep learning. An Online Student Engagement Scale (OSE) and a revised Biggs Two-Factor Study Process Questionnaire (R-SPQ-2F) were used to evaluate student engagement and learning approaches respectively. MethodsA cross-sectional study was conducted in 2021 at a South African university. The OSE and R-SPQ-2F online survey tools were administered to all final-year students (n = 325) enrolled in the surgical online module. Quantitative data was collected, and the data was analysed statistically using R-Statistical computing software. Results are presented in the form of descriptive and inferential statistics. The reliability of the tools was evaluated by Cronbach's alpha. ResultsThe survey response rate was 35.4 % (115/325). Students were engaged at a high level, and the median (IQR) scores of the OSE tool were 71.0 (63.0–78.0). Overall, students adopted a deep approach (DA) to learning, with median (IQR) scores of 34.0 (30.0–39.0) on the R-SPQ-2F tool. There was a moderate positive correlation between the total OSE score and DA (0.53, p < 0.001). Both the OSE and R-SPQ-2F tools showed an acceptable level of internal consistency of 0.893 and 0.806 respectively. ConclusionsStudent engagement was associated with deep learning approaches. The OSE and R-SPQ-2F tools were reliable tools to measure student engagement and learning approaches among medical students.

Surface and deep learning: a blended learning approach in preclinical years of medical school

BackgroundSignificant challenges are arising around how to best enable peer communities, broaden educational reach, and innovate in pedagogy. While digital education can address these challenges, digital elements alone do not guarantee effective learning. This study reports a blended learning approach integrating online and face-to-face components, guided by the Student Approaches to Learning framework.MethodsThis study was carried out investigating learning in first and second year medical students over two academic years, 2019/20 and 2020/21. We evaluated: (1) comparison of students engaged with blended learning and traditional learning; and (2) student learning engaged with blended learning approach over a two-year preclinical curriculum. A revised two-factor study process questionnaire (R-SPQ-2F) evaluated students’ surface/deep learning before and after an academic year. Learning experience (LE) questionnaire was administered over the domains of learning engagement, and outcomes of learning approach. In-depth interviews were carried out to understand the context of students’ responses to the R-SPQ-2F and LE questionnaires.ResultsThe R-SPQ-2F analysis indicated first year students maintained deep learning but second year students became neutral across the academic year, regardless of learning approach, with workload contributing to this outcome. R-SPQ-2F sub-scales showed that students engaged with blended learning maintained an intrinsic interest to learning, as compared to traditional learning which led to surface learning motives. The LE questionnaire showed students engaged with blended learning had deeper subject interest, and more positive perceptions of workload, feedback, and effectively developed skills and knowledge. However, peer interactions from blended learning were significantly lacking. In-depth interviews revealed that the flexibility and multi-modality of blended learning enabled learning, but the best use of these features require teacher support. Online interactions could be cultivated through intentional institutional efforts.ConclusionsThis study highlights the importance of designing blended learning that leverages technology-enabled flexibility while prioritising collaborative, learner-centred spaces for deep engagement and knowledge construction.

Learning approach and learning effect of undergraduates in blended learning of business courses: Evidence from China

Research on implementing blended learning in higher education has been extensive, but there is limited research on the relationship between students' entry characteristics, learning approaches, and learning effects, particularly in business education. This study was conducted during the COVID-19 pandemic in a blended teaching environment, surveying undergraduate students in Shanghai who were enrolled in business courses in the same semester. The study analyzed the connection between learning approaches and learning effects using the Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) and students’ exam scores. The research findings revealed that students with deep learning approaches achieved higher average scores than those with surface learning approaches. Students' gender, age, academic year, academic background, and whether a course was mandatory or elective were found to have a significant relationship with their learning approaches. Furthermore, students' gender, age and academic year were significantly related to their final exam scores. However, there was no significant difference in the academic performance of students with different learning approaches, and certain exam formats and scopes may not influence quantitative learning effects. Based on these findings, curriculum developers in business education can consider offering general courses to underclassmen to help them gain a comprehensive understanding of their chosen field, encouraging upperclassmen to take cross-disciplinary courses, and urging instructors to utilize blended teaching methods to enhance teaching effectiveness.

A partially flipped physiology classroom improves the deep learning approach of medical students.

This study aimed to compare the impact of the partially flipped physiology classroom (PFC) and the traditional lecture-based classroom (TLC) on students' learning approaches. The study was conducted over 5 mo at Xiangya School of Medicine from February to July 2022 and comprised 71 students majoring in clinical medicine. The experimental group (n = 32) received PFC teaching, whereas the control group (n = 39) received TLC. The Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) was used to assess the impact of different teaching methods on students' learning approaches. After the PFC, students got significantly higher scores on deep learning approach (Z = -3.133, P < 0.05). Conversely, after the TLC students showed significantly higher scores on surface learning approach (Z = -2.259, P < 0.05). After the course, students in the PFC group scored significantly higher in deep learning strategy than those in the TLC group (Z = -2.196, P < 0.05). The PFC model had a positive impact on deep learning motive and strategy, leading to an improvement in the deep approach, which is beneficial for the long-term development of students. In contrast, the TLC model only improved the surface learning approach. The study implies that educators should consider implementing PFC to enhance students' learning approaches.NEW & NOTEWORTHY In this article, we compare the impact of the partially flipped classroom (PFC) and the traditional lecture classroom (TLC) in a physiology course on medical students' learning approaches. We found that the PFC benefited students by significantly enhancing their deep learning motive, strategy, and approach, which was good for them. However, the TLC model only improved the surface learning motive and approach.

A comparison of two learning approach inventories and their utility in predicting examination performance and study habits.

The revised two-factor Study Process Questionnaire and the Approaches and Study Skills Inventory for Students are two instruments commonly used to measure student learning approach. Although they are designed to measure similar constructs, it is unclear whether the metrics they provide differ in terms of their real-world classification of learning approach. The purpose of this study is to compare outcomes of these two inventories in a study population from an undergraduate (baccalaureate) human anatomy course. The three central goals of this study are to compare the inventories in terms of 1) how students are classified, 2) the relationship between examination performance, time spent studying, and learning approach, and 3) instrument reliability. Results demonstrate that student classifications of corresponding scales of each inventory are significantly correlated, suggesting they measure similar constructs. Although the inventories had similar reliability, neither was consistently strong in predicting examination performance or study habits. Overall, these results suggest that the two inventories are comparable in terms of how they measure learning approach, but the lack of correspondence between learning approach scores and measurement outcomes questions their validity as tools that can be used universally in classrooms.NEW & NOTEWORTHY Although learning approach inventories have been used extensively in education research, there has been no direct comparison of how student classification differs between instruments or how classification influences the interpretation of how learning approach impacts student performance. This is especially relevant in light of recent research questioning the validity of the Study Process Questionnaire (LoGiudice AB, Norman GR, Manzoor S, Monteiro S. Adv Health Sci Educ Theory Pract 28: 47-63, 2023; Johnson SN, Gallagher ED, Vagnozzi AM. PLoS One 16: e0250600, 2021).

Gender Difference in Learning Approaches Among Education Students of Sule Lamido University Kafin Hausa, Jigawa State, North-West, Nigeria

This study investigated gender difference in learning approaches among education students of Sule Lamido University Kafin Hausa, Jigawa State, North-West, Nigeria. Ex-post facto design was used. The study used 101 students as samples drawn from the university. The Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) was adopted to measure learning approaches. Cronbach Alpha, Pearson Product Moment Correlation Coefficient values of Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) were .77, and .62 respectively. The statistic used to analyze the data was t-test for independent sample. One hypothesis was formulated and tested. The study did not find any significant difference in learning approaches between female learners and male learners was not significant (p&gt;0.05). It was recommended that teachers should orient their students about learning approaches to studies as well as use of essay and objective test items as assessment tools throughout their programme.

The Impact of Changing Step 1 to Pass/Fail Reporting on Anxiety, Learning Approaches, and Curiosity.

Given the significance of the US Medical Licensing Exam (USMLE) Step 1 score moving from a 3-digit value to pass/fail, the authors investigated the impact of the change on students' anxiety, approach to learning, and curiosity. Two cohorts of pre-clerkship medical students at three medical schools completed a composite of four instruments: the State-Trait Anxiety Inventory, the revised two-factor Study Process Questionnaire, the Interest/Deprivation Type Epistemic Curiosity Scale, and the Short Grit Scale prior to taking the last 3-digit scored Step 1 in 2021 or taking the first pass/fail scored Step 1 in 2022.Responses of 3-digit and pass/fail exam takers were compared (Mann-Whitney U) and multiple regression path analysis was performed to determine the factors that significantly impacted learning strategies. There was no difference between 3-digit (n = 86) and pass/fail exam takers (n = 154) in anxiety (STA-I scores, 50 vs. 49, p = 0.85), shallow learning strategies (22 vs. 23, p = 0.84), or interest curiosity scores (median scores 15 vs. 15, p = 0.07). However, pass/fail exam takers had lower deprivation curiosity scores (median 12 vs. 11, p = 0.03) and showed a decline in deep learning strategies (30 vs. 27, p = 0.0012). Path analysis indicated the decline in deep learning strategies was due to the change in exam scoring (β = - 2.0428, p < 0.05). Counter to the stated hypothesis and intentions, the initial impact of the change to pass/fail grading for USMLE Step 1 failed to reduce learner anxiety, and reduced curiosity and deep learning strategies. The online version contains supplementary material available at 10.1007/s40670-023-01878-w.

Changes in engineering students’ surface and deep approaches to learning in first- and second-year university courses

The aim of this study is to investigate how students’ approaches to learning change during early years of university studies in classes where assessments have been designed to increase students’ engagement and ownership. The revised two-factor Study Process Questionnaire (R-SPQ-2F), a self-reporting survey, was used to measure students’ deep and surface approaches. Two first-year and one second-year cohorts of engineering students completed the questionnaire at the beginning and at the end of their modules. The majority of the assessment questions activated the first three levels of Bloom’s revised taxonomy, possibly encouraging a more surface approach to learning. However, the learning environment made use of peer assessment and online quizzes to provide prompt feedback to students and opportunities for self-reflection, thus possibly inducing a deeper level of engagement with the material. Data analysis of the R-SPQ-2F questionnaire scores showed that the deep approach score did not change while the surface approach score increased. The findings align with those of previous studies: the relationship between assessment and learning is complex, and surface approaches might have to be expected and accepted in the early years at university, in preparation for deeper approaches to learning which should be developed in later university years, when the more cognitive demanding levels of Bloom’s taxonomy, such as evaluating and creating, are required.

Relationship between Learning Approaches and Students’ Preferences for Online Learning

Objectives: The objective of this study is to enhance the quality of medical education by exploring the learning approaches of students and their relationship with the student’s preference for online learning in a Problem-Based Learning (PBL) Program. Subjects and Methods: The study was a descriptive, cross-sectional one; the target population included a random sample of students in the 1st, 2nd and 3rd years (n = 300). The study was conducted at the Faculty of Medicine, Suez Canal University in Ismailia, Egypt during the academic year 2021-2022. The instrument used for data collection is named “a Two-Factor Study Process Questionnaire (R-SPQ-2F)” (Arabic Version). Results: In this study, the students mostly adopt deep learning strategies (72.3%) compared to superficial learning strategies (27.7%). The current study shows that females mostly adopt deep learning strategies (75.8%) compared to males who adopted deep learning strategies (68.7%). The results of the correlation test in the current study show that learning approaches significantly correlated with gender and skills, also only computer skills and year were significantly correlated with the preferences of the students of distance learning. We conducted a correlation analysis with the subscales of the questionnaire with the preference of the students of distance learning. The only significant one is the first item of the questionnaire. Conclusion: In conclusion, the results of this research show that students in a PBL school adopt a deep learning approach. Older students with good computer skills prefer online learning to face-to-face learning more than younger ones do. In addition, students prefer online learning to increase their satisfaction in their time of studying, and there is a significant relationship between their computer skills and the learning approach.

Assessment of Learning Approaches of Saudi Dental Students Using the Revised Two-Factor Study Process Questionnaire: A Cross-Sectional Study

Purpose: The aim of this study was to assess the learning approaches of undergraduate dental students in Saudi Arabia. Methods: This was a cross-sectional study in which an electronic questionnaire using the Biggs Revised two-factor Study Process Questionnaire (R-SPQ-2F) was completed by 222 undergraduate dental students from 1st year to 5th year. R-SPQ-2F contains 20 items to measure learning approaches through a structural model contrasting deep and surface learning. Results: The mean value of the deep approach was higher among 4th- and 5th-year students than among 1st-, 2nd-, and 3rd-year students. The mean values of the surface approach in male subjects and subjects with lower grade point averages were statistically significantly higher than those of the deep approach. Conclusion: This study highlights that dental students have a greater tendency to adopt the surface approach in their preclinical years and in the 3rd year when they experience a transition to clinical training. A deep approach to learning was mostly adopted among 4th- and 5th-year dental students. The surface approach was higher among male than female students. Students who used a deep approach had higher academic achievement than students who used a surface approach.

The Impact of English Language Proficiency on Academic Performance with the Mediating Effect of Choice of Learning Approaches: The Case of a Management Faculty of a Sri Lankan University

The purpose of this paper is to examine the impact of English language proficiency (ELP) on academic performance with the mediating effect of the choice of learning approaches of students. The study is based on the final year students of a management faculty of a Sri Lankan university. In the study, ELP was measured using the grades for both G.C.E. Advanced Level General English Examination and Business Communication Examination of the first year, first semester at degree level. The choice of learning approaches was divided into two as the Surface Learning Approach (SLA) and the Deep Learning Approach (DLA), which were measured by 20 indicators of the revised two-factor study process questionnaire (R-SPQ-2F). The academic performance was measured using the GPA of students. The relationships among these variables were examined using the Partial Least Squares Structural Equation Modelling (PLS-SEM) analysis. The study found that most students prefer SLA than DLA in their academic studies at the university. Further, the study showed a significant positive relationship between the ELP and academic performance with a partial mediation effect of choice of learning approach on this relationship. The findings of the study are useful for university administrators and academics in educational reforms and the undergraduates to understand the impact of ELP on their learning approach and academic performance.

Short form of revised two-factor study process questionnaire: Development, validation, and cross-validation in two European countries

The utility of students’ approaches to learning (AL) has evolved from a simple act of academic monitoring to a systemic process of continuous improvement of teaching and learning in higher education. Research on the careful development of measures for AL is consequently crucial. The purpose of this research is to develop and validate a brief measure of AL that is theoretically sound with good psychometric properties. To achieve this purpose, we combined three rounds of studies in two European countries consisting of 253, 196, and 440 undergraduate students. Multiple tests of validity and reliability unveil a new measure of AL with two correlated dimensions of deep (four items) and surface (four items) approaches. The psychometric analyses of the new 8-item measure of AL provide promising results, both in validity and reliability demonstrating its possible use in academic contexts.

Does a deep learning inventory predict knowledge transfer? Linking student perceptions to transfer outcomes.

Students are often encouraged to learn 'deeply' by abstracting generalizable principles from course content rather than memorizing details. So widespread is this perspective that Likert-style inventories are now routinely administered to students to quantify how much a given course or curriculum evokes deep learning. The predictive validity of these inventories, however, has been criticized based on sparse empirical support and ambiguity in what specific outcome measures indicate whether deep learning has occurred. Here we further tested the predictive validity of a prevalent deep learning inventory, the Revised Two-Factor Study Process Questionnaire, by selectively analyzing outcome measures that reflect a major goal of medical education-i.e., knowledge transfer. Students from two undergraduate health sciences courses completed the deep learning inventory before their course's final exam. Shortly after, a random subset of students rated how much each final exam item aligned with three task demands associated with transfer: (1) application of general principles, (2) integration of multiple ideas or examples, and (3) contextual novelty. Wethen used these ratings from studentsto examine performance on a subset of exam items that were collectively perceived to demand transfer. Despite good reliability, the resulting transfer outcomes were not substantively predicted by the deep learning inventory. These findings challenge the validity of this tooland others like it.

Seamless Learning Model with Enhanced Web-Quizzing in the Higher Education Setting

The research studied the effectiveness of a three-stage Seamless Learning Model with Enhanced Web-Quizzing based on the intensive use of sets of quizzes created in different web-based quiz generators. The findings revealed that continuous testing using diagnostic, formative, benchmark and summative quizzes, administered at the three stages - familiarisation, formation and assessment, applying such features of seamless learning as learning in various contexts, ubiquitous access to digital learning resources and quizzes, combination of teacher-guided learning, self-directed and collaborative learning, and switching between various learning activities can be an efficient teaching technique in higher education having positive effect on academic performance, motivation, learners’ approaches to studying and course engagement. The testing effect was investigated on the summative tests taken at the end of the three different academic courses. The results showed that online quizzes applied primarily as learning tools with the emphasis on information retrieval and retention resulted in the higher achievements of the experimental group students. The survey conducted with Biggs’s Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) showed the changes in the learners’ motives and approaches to studying revealed in students’ active participation in in-class and out-of-class activities, mastering of the material through understanding rather than mechanical memorizing, the search for additional information and increased attendance. The engagement of the experimental group students in the new quiz-enhanced settings was examined focusing on emotional, skills, participation and performance engagement aspects.

How did changes in medical education during the COVID-19 pandemic affect students’ learning and study approaches?

Aim: Medical education is undergoing a transformation with the COVID-19 pandemic. The aim of this study is to examine the levels of adaptation and flexibility of medical students within an educational system changing due to the pandemic. Material and Methods: This descriptive cross-sectional study was conducted in the Duzce University Faculty of Medicine. Students were asked to complete the VARK (V: Visual, A: Aural, R: Read-write, K: Kinesthetic) learning preferences inventory and the Two-Factor Study Process Questionnaire (R-SPQ2F). Results: In this study, 671 students, with 318 (47.39%) male students and 353 (52.61%) female students, were included. It was found that 25.04% (n=168) of these students participated in lessons via distance learning, while 43.67% (n=293) of them stated that they preferred face-to-face learning and 31.30% (n=210) stated that they preferred mixed learning. The mean visual score of the students who attended lessons via distance learning was found to be higher compared to those who attended face-to-face lessons and those engaged in mixed learning (p=0.0001), while the mean visual score of the mixed learning group was higher compared to the face-to-face group (p=0.002). Discussion: The blended education model, which allows students to choose the most suitable model according to their own learning style, seems to be helpful in challenging periods like the COVID-19 pandemic.

Investigating how students approach learning using generalizability theory

ABSTRACT Investigating how students approach learning is important for designing effective teaching programmes and to ensure better retention and application of information learned. The Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) is a widely used instrument for assessing approaches to students’ learning, but its ability to distinguish between dynamic and stable aspects of students’ learning has not been examined using an appropriate methodology. Generalisability theory (G-theory) is a robust method to differentiate between stable and dynamic patterns and establishing reliability in psychometric measurement. G-theory was applied to longitudinal data of 123 medical students who completed the R-SPQ-2F at three time points with 6-month intervals. Temporal reliability of the full scale was higher (Gr = 0.76) compared to individual subscales, suggesting that there is an overarching trait of optimised learning that involves shifting between deep and surface approaches to achieve the best academic outcome. Accordingly, deep and surface motivation and surface strategy facets displayed characteristics of a reliable state measure and can be used to evaluate the degree of applying these dynamic aspects of learning.

Students’ approach to learning: evidence regarding the importance of the interest-to-effort ratio

ABSTRACT Existing science evidence sustained that students’ preferences for a learning approach (i.e., deep or surface learning) depend on several contextual variables. In this study, we used the network psychometrics perspective to investigate the interactions between the elements that define students’ learning preferences. We aimed to understand which are the central elements of the students’ behavior patterns used when they decide to adopt one specific learning approach. We used the Revised Two-Factor Study Process Questionnaire to collect responses from a large sample of university students (5357 students, 73% female). The results indicated that the interest-to-effort ratio is central to students’ preference for deep or surface learning. Also, we found that the estimated network is stable across different groups defined by the academic disciplines, students’ gender, and year of study. These results are presented as arguments for using the workload and students’ interest as topics in pedagogical programs dedicated to academics.

Incorporating higher order thinking and deep learning in a large, lecture-based human physiology course: can we do it?

Large classes taught with didactic lectures and assessed with multiple-choice tests are commonly reported to promote lower order (LO) thinking and a surface approach (SA) to learning. Using a case study design, we hypothesized that incorporating instructional scaffolding of core physiology principles and assessing students exclusively with long-answer written tests would encourage higher order (HO) thinking and promote a deep approach (DA) to learning in a two-course physiology sequence (Phys I and II), despite their large size. Test questions were categorized as LO or HO according to the Blooming Biology Tool, and students' LO and HO performance was determined for each of six tests across the two courses. The validated Revised Two-Factor Study Process Questionnaire survey tool was administered at the beginning and end of each course to measure student approach to learning. HO performance was maintained across Phys I (72.9 ± 19.4 vs. 74.8 ± 20.7%, P = 0.37) and significantly improved across Phys II (69.9 ± 18.4 vs. 79.4 ± 14.8%, P < 0.001). Unexpectedly, students' LO performance declined from the beginning to end of Phys I (78.5 ± 20.6 vs. 69.4 ± 17.9%, P < 0.001) and Phys II (80.5 ± 19.6 vs. 72.2 ± 24.3%, P < 0.001). Students' approach to learning did not change throughout Phys I or II, but at each time point students preferred a DA over a SA. Taken together, these results indicate that an intentionally designed large lecture class can support a DA to learning and suggests that this teaching and assessment structure may be particularly well suited to promote HO thinking, albeit possibly at the expense of LO thinking.

Patterns of Change in Approaches to Learning and Their Impact on Academic Performance Among Medical Students: Longitudinal Analysis

Theory Several medical education studies suggest that deep approaches to learning (DA) are associated with better academic performance, whereas surface approaches (SA) are associated with worse academic performance. However, no study has assessed how these approaches change at the individual level during undergraduate medical training and how these trajectories contribute to academic performance. We assessed individual patterns of change in learning approaches throughout five years of medical training to determine whether and how DA and SA evolve during the curriculum and whether initial levels and rates of change predict performance in Year 5. Hypotheses: We hypothesized that (1) medical students have a higher preference for DA in comparison with SA; (2) these preferences change along the medical curriculum; and (3) DA predicts better academic performance. Method: Participants were 268 Geneva medical students (59% female) who completed the revised two-factor study process questionnaire in Years 1, 2, 3, and 5 of their 6-year curriculum. Student academic performance was registered in Year 5. Multivariate latent growth modeling was used to assess individual trajectories in learning approaches and test their associations with performance in Year 5. Results: Medical students were inclined to use DA rather than SA. Nevertheless, from Year 2 onward their use of DA decreased while their use of SA increased. Students with higher initial levels of DA tended to have lower initial levels of SA. Moreover, increases in SA were significantly associated with decreases in DA. However, only initial levels of DA and non-repeater status in Year 1 were positive and significant predictors of academic performance in Year 5. Conclusions: Although students tended to use DA rather than SA when entering medical school, their preferences for DA tended to decline throughout medical training while increasing for SA. Learning approaches during early study years, characterized by engagement and meaningful learning, predicted later academic performance. DA should be promoted during the early years of medical studies to foster student learning and to improve academic performance.