Matric or Mirror? Exploring Cognitive and Institutional Drivers of Student Course Evaluations: A Mixed-Methods Study in Medical Education.

BACKGROUND: Student evaluation of Courses (SECs) is widely used for educational quality assurance in medical education, yet their purpose to serve as a formative tool for development or a summative reflection of opinion is a subject of ongoing debate. This study examined how medical students and faculty perceive, navigate, and use teaching evaluation data, systematically identifying the procedural constraints and cognitive barriers that drive student evaluation decline across training years. MATERIALS AND METHODS: This mixed-methods triangulation study integrated quantitative student survey data (N = 263; 70% response rate; 22% female, 77% male) across all four medical training years (years 1-4) with qualitative semi-structured faculty interviews (N=6) to cross-validate and enrich understanding of the cognitive and institutional drivers shaping the evaluation ecosystem. The validated 26-item questionnaire evaluated four primary domains: Teaching Quality, Administration, Process Awareness, and Tool Validity. Quantitative data were analyzed using Chi-square tests and ANOVA. Qualitative faculty interviews were analyzed thematically. Triangulation occurred through joint display matrices comparing student perceptions and faculty perspectives on evaluation purpose, process, and outcomes. RESULTS: While 71.0% (n=187) of students viewed course evaluation as a tool for instructional improvement, a significant majority (82.5-87.4%) identified procedural transparency, confidentiality, and closed feedback loops as essential prerequisites for meaningful engagement. Results revealed a statistically significant cross-cohort decline in evaluation awareness and engagement across cohort years (p = 0.002), with first-year students reporting the highest process engagement scores (Mean = 67.3, SD = 8.0) compared to year 4 students (Mean = 62.9, SD = 7.4). Triangulated thematic analysis revealed that the decline in process domain in senior student participation stems from unaddressed feedback expectations and faculty ambiguity regarding administrative data use. CONCLUSION: Unaddressed student feedback and unclear administrative outcomes drive a significant cross-cohort decline in evaluation engagement. To address this potential erosion in perceived utility, medical institutions must establish an explicit, closed-loop reporting system that visibly demonstrates constructive, longitudinal curriculum changes derived from student feedback. Making post-evaluation actions visible, institutions may rebuild students' trust in the process.