Academic Engagement and Contextual Factors Associated with Academic Performance in First-Year Medical Students: A Cross-Sectional Study

Purpose: Academic performance in medical education reflects interactions among student background, academic engagement, and assessment context, particularly during the transition into medical training. This study examined associations among sociodemographic factors, academic engagement, and academic performance in first-year medical students. Methods: A cross-sectional study was conducted among first-year medical students at the University of Buenos Aires. Academic engagement was assessed using the Utrecht Work Engagement Scale (UWES-9S), focusing on vigor. Sociodemographic variables included age, gender, nationality, living arrangements, and parental education. Performance was evaluated using partial and final examination scores and pass/fail outcomes across oral, written multiple-choice, and written open-ended examinations. Students contributed repeated subject-level performance observations across partial examinations; therefore, mixed-effects models with random intercepts for students were used, alongside linear and logistic regression models. Results: Among 257 students, partial examination data were available for 227. Final examination data were available for a selectively progressed subset of 124 students and were analyzed secondarily. Higher vigor was associated with a greater probability of passing partial examinations (OR = 1.15, 95% CI 1.01 to 1.32), although it was not clearly associated with continuous examination scores. In the main mixed-effects model, cross-border/international students obtained modestly lower partial examination scores than Argentine students (β = -0.74, 95% CI -1.45 to -0.04), and students living with a partner and/or own children scored lower than those living alone (β = -1.06, 95% CI -1.97 to -0.15). An exploratory interaction suggested that performance differences between cross-border/international and Argentine students varied across assessment contexts; however, assessment context was structurally confounded with subject content and curricular timing. Conclusion: Academic vigor and contextual factors, including nationality and living arrangements, were associated with early academic progression. Exploratory assessment-context findings require confirmation in longitudinal studies with controlled assessment designs before informing institutional policy.