Student engagement in the anatomical sciences: What gets in the way?

Active learning has become central to anatomical sciences education, yet its effectiveness largely depends on student engagement. Here we define the anatomical sciences as gross anatomy, surface anatomy, neuroanatomy, embryology, histology, and integrated radiology. Educators dedicate substantial effort to implement flipped classrooms, team-based learning, small-group discussions, and other active learning modalities. Despite these efforts, disengagement persists, with students arriving unprepared, participating minimally, and/or perceiving activities as unrelated to assessment. An engagement-centered perspective clarifies these discrepancies and informs more intentional course design. Here, we examine engagement throughout the entire learning cycle, drawing on self-determination theory, cognitive load perspectives, constructivist and social constructivist views, experiential and transformative learning theories, and constructive alignment theory. Common barriers to pre-class engagement include excessive workload, weak alignment with in-class activities, and low perceived relevance. Suggested responses include concise, goal-directed tasks that are clearly linked to learning objectives and incorporate low-stakes accountability and retrieval practice. During class, psychological safety, calibrated challenge, and structured peer interaction are highlighted as central conditions for participation. After class, brief self-testing, spaced follow-up questions, and structured reflection activities consolidate learning. Assessment is positioned as a primary driver of engagement, with an emphasis on constructive alignment to ensure that objectives, active sessions, and summative tasks all rehearse the same kinds of cognitive work. Overall, effective active learning in the anatomical sciences relies less on instructional format and more on fostering learner engagement.