Active learning strategies and student engagement in undergraduate medical education: A systematic review (2015–2025)

Active learning strategies (ALS) are increasingly employed in undergraduate medical education to promote student engagement across behavioral, emotional, and cognitive dimensions; however, there remains limited integrative understanding of the pedagogical mechanisms through which ALS activate engagement and the contextual conditions shaping this process. This systematic review synthesized empirical studies published between 2015 and June 2025 to examine how ALS activate multidimensional student engagement and to develop an integrative, mechanism-oriented framework for engagement activation in undergraduate medical education. Following PRISMA 2020 guidelines, six academic databases were systematically searched for quantitative, qualitative, and mixed-methods studies involving undergraduate medical students, yielding 22 eligible studies. Thematic synthesis indicated that strategies such as gamification, scenario-based learning, team-based learning, and audience response systems demonstrated robust engagement activation when instructional designs integrated authentic tasks, structured collaboration, and timely feedback, rather than through instructional format alone. Across studies, discrepancies were frequently observed between perceived engagement and actual learning outcomes, highlighting the limitations of relying on self-report measures. Contextual moderators, including instructional culture, facilitation practices, and learning environments, further shaped how engagement was activated, expressed, and sustained across settings. These findings informed the development of the Active Learning Engagement Activation model, which conceptualizes engagement as a dynamic, context-sensitive process arising from interactions among instructional design features, learner-interface mechanisms, and contextual moderators, providing a mechanism-oriented framework to support engagement-informed curriculum design and future research in undergraduate medical education.