TITLE:
Beyond Instructional Labels: A Realist Review of Active-Learning Variation in Medical Education
AUTHORS:
Anatoli Em. Argyrou, Andreas C. Lazaris
KEYWORDS:
Medical Education, Active Learning, Realist Review, ICAP Framework, Cognitive Engagement
JOURNAL NAME:
Creative Education,
Vol.17 No.11,
November
3,
2026
ABSTRACT: Introduction: A realist review examined how learning mechanisms explain variation across teaching approaches in undergraduate medical education (UME). Methods: PubMed/MEDLINE, Scopus, Web of Science, and ERIC were searched through August 2026. Of 2383 records, 27 met inclusion criteria. Evidence was synthesized using context-mechanism-outcome configurations, with Interactive, Constructive, Active, Passive (ICAP) characterizing engagement. Results: Three mechanism-level demi-regularities were identified. Mechanism activation, cognitive engagement, constructive alignment, and implementation fidelity explained variation, while instructional labels showed heterogeneity. Conclusion: Instructional labels are family indicators rather than interventions. Mechanism-ICAP profiles and implementation fidelity provide analytical units for understanding outcomes across UME contexts.