One example of successful student contribution to the curriculum is the implementation of the Integrated Clinical Case Discussions (ICCD) at the TUM [21]. They are a peer-organized series of case-based tutorials that track an interdisciplinary lecture on internal medicine, pathology, and surgery. There are twelve sessions per semester in the first and second years of students’ clinical training.

The project demonstrates the importance of a faculty’s collaborative organizational culture as an antecedent of meaningful SE (Fig. 1). The impetus for the project was provided by three undergraduate student representatives who, in response to poor ratings of emergency remote teaching, sought a way to offer additional learning opportunities while also alleviating pressure on faculty staff. In the school’s council on curricular development, the student representatives connected with staff from the TUM Medical Education Center, who guided the development of the didactic concept and helped secure funding for the project. The school continued to cover the administrative aspects of contracting tutors while the student representatives decided on financial expenses.

Case study of ICCD through Kassab’s theoretical framework of SE [8]. Green: sociocultural context, dark blue: components of SE, light blue: explanation of each component in the context of ICCD from the perspective of a participating student (tutee), orange: antecedents of SE for organizing students, gray: items not further discussed in this paper

We have described the antecedents of engagement from the perspective of the incentivizing student representatives, but to understand the extent of SE, we must also analyze the ICCD through the perspective of participating tutees. Since the ICCD were implemented against the background of the emergency remote teaching during the COVID-19-crisis [22], many students missed meaningful interactions with instructors and patients and reported a loss in educational quality [23]. ICCD were therefore aimed at (a) providing additional learning opportunities by teaching clinical reasoning skills through interactive case studies and (b) improving the student-school relationships.

Case studies are a useful format for positively mediating engagement in higher education [24]. Since most emergency remote lectures were restricted to teaching facts and declarative knowledge, ICCD stimulated students’ intrinsic motivation by discussing patient cases. At the same time, ICCD considered tutees’ self-efficacy and feeling of competence by gradually increasing the level of interaction and difficulty (e.g., from taking the patient history to integrating the findings into a final diagnosis). At the end of each session, there was also time for reflection through an evaluation. In the definition of Kassab et al., belonging comprises of a feeling of being “valued, accepted, included, and encouraged by staff and peers “ [8]. In our study, this was reflected by a composite score for the category “educational atmosphere” of 1.35 on a 5-point Likert scale from 1 to 5 (n = 107) [21]. The exact study design can be cross-referenced.

ICCD also sought to improve the student-school relationships. In some ICCD sessions, both lecturers and students could meet and discuss cases together, moderated by a student tutor. In the end-of-class evaluations, we saw that this made teachers more approachable and afforded psychological safety for students.

We observed positive effects of ICCDs on participants’ engagement in all dimensions. The behavioral dimension can be quantified through participation rates in educational activities [8, 25]. With 44.5% of all eligible students having attended at least one session in the first semester and 71.0% in the second semester, we infer that ICCD gained significant traction in the student body. We also required tutors to employ cognitive learning theory and constructivist teaching, by asking stimulating questions to activate prior knowledge to engage participants cognitively. A self-report questionnaire was developed based on literature findings to capture students` learning experience from the psychological perspective. Participants also rated the tutors as excellent (average score of 1.26 on a 5-point Likert scale from 1 to 5; n = 121). In a qualitative analysis of student commentaries (n = 123), we also saw that students felt grateful for the tutorial and praised them. In 54.4% of evaluations, tutees felt emotionally connected to their tutors and identified them as inspiring role models. The role of different sociocultural backgrounds was acknowledged in the project but was not explicitly addressed [21].

As for learning outcomes, we observed significantly better subjective ratings of cognitive skills training and knowledge retention in the ICCDs in comparison to the lecture (p < 0.01). In fact, in a comparative self-assessment (CSA) [26], tutees reported up to 70.31% (n = 114) increase in the ability to interpret diagnostic findings after the tutorial. After the tutorial, students rated ICCDs as more motivational than the corresponding lecture and also said they felt more comfortable with peer instruction after the tutorial (CSA gain = 69.57%, n = 111). The study design did not allow for a long-term follow-up of engagement outcomes [21].

ICCD further showcase SE through partnership with the university. Not only did tutors deliver educational opportunities, but the student representatives also carried out a study of the tutorials, guided by the school’s staff. The results were presented to the council on curricular development and to the faculty board. In fact, ICCD and the two projects described below catalyzed the inception of a special student engagement fund by the faculty to financially support student initiatives.

Studying medicine can be very demanding for students. Excessive workload, work-life balance conflicts, and system-level factors such as administrative failures contribute to the stress experienced by medical students [27, 28]. It has been shown that symptoms of burnout, depression, and anxiety, but also somatic complaints and alcohol misuse, are elevated in medical students compared to the general population [28,29,30,31,32]. Struggling with such problems can lead to a decrease in academic performance [33, 34]. However, many medical students are hesitant to seek professional help for mental health problems, mainly due to fear of stigmatization [29].

To mitigate this situation, MIND Your Health! was founded in 2019. The starting point for this initiative was concerns voiced by representatives of the School of Medicine student council, who called for actions to destigmatize mental health problems (Fig. 2). Initially, the board of faculty development commissioned an interdisciplinary task force on mental health, which soon evolved into the project MIND Your Health! It comprised members of the student council, faculty members, and specialists from the Department of Psychosomatic Medicine and Psychotherapy at the Klinikum rechts der Isar and the TUM Medical Education Center. Working in conjunction with these institutions has played an instrumental role in providing critical resources, both structurally and psychosocially.

Case study of MIND your Health! through Kassab’s theoretical framework of SE [8]. Green: sociocultural context, dark blue: components of SE, light blue: explanation of each component in the context of MIND your Health! from the perspective of a participating student, orange: antecedents of SE for organizing students, gray: items not further discussed in this paper

During their first meeting, the members decided on the aims of MIND Your Health! These are fourfold: (1) to raise awareness about mental health problems; (2) to provide information about mental health; (3) to incorporate the topic of mental health in teaching courses; and (4) to offer basic psychological support for medical students in need. While the academic and clinical staff are responsible for the last two goals, members of the student council have been very enthusiastic about the development of innovative formats to pursue the first two goals. These actions were supported and supervised by the faculty members of MIND Your Health!

To enable low-threshold access to the topic of mental health, MIND your Health! offers events, workshops, and a contact point for students. Each term, the working group organizes an event that reaches about 200 medical students. Examples include a poetry slam, a TedTalk, and a panel discussion. For instance, physicians talked about emotional closeness and distance in the medical profession or discussed how to deal with physical and mental illness while being a doctor. Also, a podcast called Speak your MIND was started in 2022. Here, speakers examine topics such as suffering from eating disorders or struggling with finding a fulfilling career. MIND your Health! has also aimed to improve physical and mental well-being. As low to moderate-intensity workouts seem to reduce stress and depressive symptoms [35], a running group and a yoga class were founded. Moreover, a peer-led facultative course called “Psychological First Aid” is offered for medical students who are interested in learning, in a simulated environment, how to help others who are experiencing acute stress after a critical event.

To successfully implement these projects, especially motivation and belonging, play an important role by mediating between institutional and student-level antecedents and the actual engagement. Projects are generally intended to extend a sense of appreciation and understanding towards students (belonging) while also addressing topics that students can relate to (motivation).

What is more, student engagement in this initiative manifests across various dimensions. Regarding Kassab et al. (2022), student engagement includes different dimensions [8]. For instance, students engaged in the “Psychological First Aid” workshop actively study the theory beforehand, take on leading roles, and navigate between fellow students, acting patients, psychologists, and the faculty. The organizing students create a hands-on project that combines the transfer of theoretical and practical knowledge on how to help reduce acute distress after a traumatic situation (behavioral); through their participation, fellow students confront sensitive topics around mental health (emotional); the integration of knowledge from medical school, personal experiences, and input from other professions requires an interdisciplinary approach to developing and applying psychological coping strategies (cognitive); students take on leadership roles, provide constructive feedback to peers, and practice teamwork (agentic); mental health awareness, being a broad and complex topic, concerns people from all backgrounds which requires openness and freedom of judgment (sociocultural). A vital aspect of the project is the students’ proactive involvement in their own learning. Students must engage in self-study to familiarize themselves with the relevant mental health topics. This preparation enhances their ability to effectively educate others, and their engagement deepens as they share knowledge and collaborate with fellow students. Partnerships with the Medical Education Center, the Department of Psychosomatic Medicine and Psychotherapy, and the student council ensured professional oversight and financial and logistic support.

MED ME is a peer-organized mentoring program that connects students with peers, doctors, and researchers.

Four to six first-year clinical students are matched with a senior peer and a physician-mentor based on specialty interest. At TUM, all first-year clinical students are new to the campus and have completed their preclinical training at a different university.

During the semester, three meetings take place. The first one is scheduled right after the semester starts, allowing the group members to get to know each other and discuss potential lab visits or clinical internships. Additionally, the administrative questions on the clinical studies, e.g. the exams, are addressed by the peer. The second meeting is scheduled in the middle of the semester and can be held in a more personal atmosphere. Topics are learning strategies and the group’s individual focus, e.g., on the dissertation, internships, training practical skills, and studying abroad. The third meeting at the end of the semester is used to evaluate the process and to discuss the semester. After three sessions, the groups can be continued if the students, peers, and mentor wish to do so. However, the official structure of MED ME ends at this point.

The matching process of MED ME is crucial to the success of the project and is genuinely guided by the psychological mediators of SE (Fig. 3). It is aimed at fostering participants’ intrinsic motivation and sense of belonging by considering different interests in specializations, interest in research versus clinical work, and sympathy towards mentors and peers. In the semester’s final meeting, the project provides time for a thorough reflection and evaluation.

Case study of MED ME through Kassab’s theoretical framework of SE [8]. Green: sociocultural context, dark blue: components of SE, light blue: explanation of each component in the context of MED ME from the perspective of a participating student (mentee), gray: items not further discussed in this paper

In well-functioning mentoring groups, multiple dimensions of SE are addressed throughout the program (Fig. 3). MED ME empowers mentees to actively shape their experience by deciding on the frequency of the meetings and suggesting discussion points and activities (feeling of agency). Mentees can exchange views and expand their perspectives, especially in the scheduled conversations with the mentors. At the same time, MED ME provides a supportive platform where mentees can share feelings and obstacles they face in their immediate studies, fostering a sense of understanding and support. From a behavioral perspective, we noticed great interest in the project, with approximately 50% of newly enrolled students participating as a mentee (145 out of approx. 300). It is important to consider that MED ME was implemented amidst the COVID-19 pandemic. In the subsequent semesters, we noted a slightly declining interest; however, the number of participants remained above 100 in the following semester.

Regarding the institutional antecedents for facilitating SE, our school helped develop the mentoring program through the TUM Hackathon, a program during which students can research and develop different ideas from computer science to medical students. The mentoring project used this program to create the website for the booking process. Every semester, new mentors from different specializations are recruited. This is key to a successful continuance of the project. To do so, the mentoring project is presented and advertised in various committees of the clinic and medical faculty, as well as at welcoming events for new students at the university. Staff also supports MED ME by organizing a lecture on non-classic career paths in medicine with, for example, doctors without borders, doctors in mountain rescue, or prison doctors.

Summative evaluations were administered to measure the outcomes of the first three mentoring cohorts. They show that more than 83% of all mentees (n = 71) recommend the program to other students. We believe this underscores and corroborates our conceptual approach to mentoring and the matching of groups. Most students say they have profited a lot or well from the program. Only around 6.4% claim to have had no profit, while around half of the mentees can imagine themselves becoming a peer the following semester. This suggests a potential long-term outcome on personal development: that students participate first as mentees, later as peers, and eventually as doctors or researchers.