How can academic engagement and flow of medical students be promoted? The roles of perceived autonomy and teacher support

IntroductionDue to the increasing demand from universities to enhance their educational quality, there is a growing emphasis on monitoring not only the progress and academic success of medical students but also their essential contributing factors.It is now more important than ever for medical science universities to seriously consider how to promote their students' academic engagement and flow and implement appropriate plans for its improvement.One of the key effective factors in academic progress is academic engagement (1), which refers to students' active participation in academic activities (2).Academic engagement is a multifaceted construct consisting of behavioral, cognitive, emotional, and agentic components (3).Behavioral engagement refers to students' behaviors towards classroom topics, effort and persistence in learning, classroom attendance, and homework completion (4).Cognitive engagement is known as students' use of cognitive strategies (e.g., acquisition, maintenance, and application of information) and metacognitive strategies (e.g., monitoring, self-regulation, evaluation, and planning) (5).Emotional engagement encompasses interest or disinterest in university, professors, and academic assignments, as well as positive emotions such as pleasure, curiosity, anxiety, anger, and fatigue (6).Agentic engagement involves constructive participation of learners in their learning processes, causing them to actively strive to personalize and optimize their learning conditions (3).Active engagement is essential for development and progress in education since high levels of academic engagement can contribute to academic progress, reduce behavioral problems, and prevent student dropout.Conversely, students with lower