Abstract: Objective This study aims at exploring influences of medical students' learning outcomes based on the theory of student engagement.Methods A questionnaire was distributed to 174 students majoring in clinical medicine in grade 2014 at Peking University Health Science Center in June 2019. A multilevel model was applied to analyze the results.Results For student inputs variables, the metacognitive strategy (β = 0.058, P <0.01), emotional input (β = 0.040, P = 0.013), extracurricular learning input (β = 0.006, P<0.01) influence grade point average (GPA), and the effects have no change with academic stage. The influence of scientific research input time on GPA is moderated by academic stage. Effects of scientific research input change from negative to positive along with the change of academic stage (e.g., from the pre-medical, basic medicine and clinical stages). For school inputs variables, only equipment and facilities have a significant influence on GPA, and a positive relationship is only found in clinical medical stage.Conclusions Students' metacognitive strategies and emotional input play the greatest role in improving their learning outcomes. The physical environment alone does not necessarily promote students' learning.

Key words: Students engagement, Academic achievement, Multilevel model, Clinical medicine