Empowering non-vocational students to enhance professional identity and employability through learning and competence development: evaluation of a student-centered curricular intervention

Society expects higher education institutions (HEIs) to graduate employable students with both generic and discipline-specific competencies, work-ready to contribute to organizations after graduation (García-Aracil et al., 2021; Ferns et al., 2025). On the one hand, work-readiness among graduates means that they can transfer and apply the competencies, skills, and knowledge gained from their higher education into a workplace (Bredenkamp et al., 2023). On the other hand, higher education should also increase students' awareness of their own learning and include the development of a professional identity (García-Aracil et al., 2021; Biehl et al., 2025). This is important for students in both vocational and non-vocational education programs. However, students enrolled in non-vocational education programs have been shown to have more challenges in finding employment after graduation. They seem to a great extent to lack insights and clarity into the knowledge and generic skills gained through their education at HEIs. This ambiguity becomes a problem for graduates and employers alike (Heijke and Meng, 2011). In a higher education context, these expectations are also closely linked to broader educational ideals emphasizing student-centered learning, lifelong learning, and the role of higher education in supporting democratic participation and societal sustainability (Biesta, 2020).

Public health science is a non-vocational and multidisciplinary field with a focus on individual as well as societal health and sustainability factors and processes. It involves several disciplines, such as biomedicine, nursing science, epidemiology, pedagogy, psychology, sociology, as well as economics and law, due to the complexity of public health. The complex field relates to, for instance, strategies for health literacy, health promotion, and disease prevention. The multifaceted nature and breadth of this field create a variety of employment opportunities for public health students who can focus on different specialization areas, target groups, and levels (individual, group, society) for working as a public health- and/or health promotion practitioner after graduation (Gershuni et al., 2019). The multifaceted nature of the field can, however, also contribute to students experiencing challenges in understanding and navigating the labor market when transitioning from being a student to an employable professional. As a result, students experience a vague professional identity and find it difficult to communicate the complexity of their discipline area to potential employers (Biehl et al., 2025, 2021; Kratzke and Cox, 2020). The boundaries of the public health discipline area and the labor market are perceived as fluid and vague, which makes it unclear for students. Employers are also often asking for specialist competencies or regulated professionals when advertising for employees suitable for a public health and/or health promotion practice. This excludes students with public health scientific competencies from parts of the labor market (Kratzke and Cox, 2020; Blackford et al., 2024). The employability challenges experienced by students in public health sciences have also been noted in the literature regarding students in other non-vocational discipline areas. As such, public health science serves as an illustrative example of challenges that are also present in other non-vocational, multidisciplinary education programs within higher education (FAME Consortium, 2007; Clarke, 2018). Although context-specific, the issues addressed in this study reflect broader international concerns regarding professional identity and employability in higher education.

Framing theoretical discipline knowledge and generic competencies for future graduate employability requires that students are supported in understanding their learning as a formative and reflective process, including the development of identity, agency, and competence articulation in relation to working life (Biehl et al., 2021; Clarke, 2018). Such meta-cognitive training enhances the students´ employability through engagement in learning activities that promote their understanding of the usefulness of their competencies in professional life (Darling-Hammond et al., 2020; Chan et al., 2017). Students could use the learning activities to create a learning and competency portfolio throughout their educational program. This would provide opportunities for students to increase self-awareness of what they have gained from their higher education (McKenna et al., 2010). A learning and competency portfolio could be built on student-centered learning, including flexibility and interactive learning, where students take responsibility for their own learning process. Such a portfolio is recognized in the literature as a resource for meaningful and lifelong learning (Attard et al., 2010; Barrineau et al., 2019).

Non-vocational education programs should, therefore, create a supportive learning environment where students can develop and become strong in their professional identity, including various competencies, lifelong learning skills, and training for a sustainable professional life (Rusticus et al., 2020; Biehl et al., 2025). Previous research (e.g. Mancini et al., 2015; De Backer et al., 2015; Kratzke and Cox, 2020; Blackford et al., 2024) highlights that a student's employability, professional identity, and agency could be strengthened throughout an educational program by well-designed innovative curricula with learning activities that promote meta-cognitive thinking skills, reflection of knowledge, and self-awareness of competencies. From a curriculum perspective, this highlights the importance of designing program-wide structures that allow students to revisit and reinterpret their learning experiences over time, rather than relying on isolated course-based initiatives.

Student agency is the ability to act intentionally and reflectively within the learning context to shape one's own educational and professional trajectory. Developing agency is closely linked to employability and professional identity, as it involves students recognizing their capacity to influence, make informed decisions, and take responsibility for their ongoing competence development (Eteläpelto et al., 2013). Strengthening agency through structured reflection and self-directed learning can thus be seen as a pathway toward empowerment and sustainable professional growth. Likewise, continuous progression is needed during education where the students are given the opportunity to reflect on who they want to become in their new professional role in terms of how they think about, for example, social justice, equity, power, and inclusion or other parts of the relevant value base for the specific professional role (Blackford et al., 2024; Biehl et al., 2025).

Few program-wide initiatives in non-vocational higher education programs have been systematically evaluated from a longitudinal theory-based perspective. In the framework of Scholarship of Teaching and Learning (SoTL), challenges are not seen as curriculum design issues, but also as issues that require systematic research studies of teaching methods and students' learning processes. SoTL emphasizes educators' responsibility to critically examine their own practice of how pedagogical structures influence students’ development of competence, identity, and agency, across a program of study in order to adapt and meet students' needs (Felten and Geertsema, 2023). In particular, there is limited research examining how structured curricular interventions activate mechanisms and create conditions for identity formation and competence development at different stages of an educational program.

The purpose of this paper is to present and analyze the evaluation results of a student-centered longitudinal curricular intervention in higher education, designed to empower students and promote employability through enhanced awareness of professional competence and identity development in a non-vocational education program.

An evaluation study was conducted with a realist evaluation approach as described by Pawson and Tilley (1997). Realist evaluation aims to explain how results are generated through interactions between Context (C), Mechanisms (M), and Outcomes (O). It is particularly suitable for examining complex educational interventions where learning processes are influenced by social, institutional, and pedagogical conditions. The approach involves developing an initial program theory, identifying key contextual factors, collecting empirical data to test and refine this theory, and interpreting results to explain what works, for whom, and under what conditions.

In this study, our initial program theory was derived from research on employability, professional identity, and metacognitive learning (Clarke, 2018; Kratzke and Cox, 2020; Biesta, 2020; García-Aracil et al., 2021; Biehl et al., 2021). The program theory was operationalized through four sub-courses implemented across a three-year non-vocational bachelor's program (C). The evaluation focused on how specific learning mechanisms (M), such as structured reflection, peer dialog, and competence awareness, were activated within the educational context and how these mechanisms contributed to students' professional identity development and employability awareness at different stages of the program (O). A realist evaluation framework was chosen as it supports explanatory analysis and allows integration of qualitative and quantitative data within a mixed-methods design, making it possible to capture both learning processes and perceived outcomes over time.

In addition to a realistic evaluation approach, this study is situated within the framework of the Scholarship of Teaching and Learning (SoTL), in which teachers systematically examine their pedagogical methods and practices to generate scientific knowledge about student learning (Felten and Geertsema, 2023). The authors were involved in the design, development, and implementation of the program and the four sub-courses evaluated. Access to the students was gained through our roles as teachers. This dual position allowed for continued engagement with the pedagogical context and longitudinal insight into the processes being studied. We are aware that such proximity requires careful attention to potential bias and power asymmetry. Participation in the research was entirely voluntary and had no impact on assessment or progression. Students were informed about the study, and qualitative data were pseudonymized before analysis. Reflexive dialog between the authors was used throughout the analytical process to critically examine assumptions related to our dual roles. This study was funded with time for the authors to conduct the study as an operational development effort. The university continuously allocates program development funds for operational development through SoTL projects.

At a university in southern Sweden, the need for increased professional identity and employability had been identified among students in a non-vocational campus-based bachelor's education program in public health science for several years. The need for improvement also originated from the educators' insights into the students' need to transfer discipline competency, and to recognize job opportunities for their future professional working life.

In 2020, a new online public health science bachelor's education program was launched, the Public Health and Health Promotion education program with specialization in behavioral science. It is structured by: Year 1: Basic knowledge in the main field of Public Health and Health Promotion, as well as behavioral science-oriented disciplines. Year 2: Application and in-depth studies supported by elective courses, work-integrated learning, scientific and other methods and strategies within the field of Public Health and Health Promotion. Year 3: Application and in-depth studies supported by elective courses, work-integrated learning, and a bachelor's degree project. The bachelor education program has a student-centered approach to teaching and learning. It includes synchronous interactive online learning sessions, and a few voluntary on-campus meetings are available as an additional resource. For the new public health science education program to function better as a supportive environment for students' development of professional competencies, lifelong learning, and a sustainable working life, it was structured around four competency areas. In practice, these competence areas overlap, they are all equally important, and together they form an integrated whole. Therefore, the competence areas must be considered from a holistic perspective where the whole is greater than the sum of the four parts: Discipline Competency: involves interdisciplinary knowledge and skills in public health and health promotion, including 15 credits of work-integrated learning in total, and emphasizing sustainability and behavioral sciences like psychology, sociology, and pedagogy. Academic Competency: covers academic reading, writing, scientific methods, reference management, critical thinking, reflection, discussion, and empirical research. Health Competency: enhances self-awareness of health and well-being, equipping students with tools to support both their own and others' health literacy. Generic and Work-Life Competency: bridges theory and practice through work-integrated learning, developing cognitive, social, and technical skills while preparing students for professional roles.

From these four competence areas, a metacognitive student-centered educational model was developed and implemented as a process-oriented program assessment. The purpose of the program assessment is for the students to create metacognition about their own learning and competence development through continuous reflections during their education. Another goal was for students to develop systematic self-awareness of how they learn by reflecting on their learning experiences, identifying effective strategies, identifying challenges, and formulating areas for further development. Through structured reflection tasks and peer dialog, students examined how they approached tasks, managed their time, engaged with theory, and applied knowledge in different contexts. The work process was intended to strengthen their ability to take responsibility for their learning and to formulate their development of knowledge, skills, and competencies in relation to their future professional roles in public health and health promotion.

The program assessment was developed and gradually incorporated for three years, from 2020 to 2023, by a core group of seven educators in the public health education program. The assessment was co-produced by the seven educators who discussed the content of significant competency areas and the course curricula. The educators were three junior lecturers, three senior lecturers, and one accomplished associate professor. The educators have a bachelor's degree in public health science, including health promotion, and all hold a complementary master's or PhD degree.

The program assessment follows the education program structure from years 1–3 and consists of four sub-courses, a total of 7.5 credits (see Table 1). The four sub-courses (I-IV) were co-developed by two to four educators who created a proposal for a specific syllabus and course content for each of the sub-courses. One of the educators took part in the development of all four. The various proposals for course syllabuses and content were then discussed collaboratively by the entire team. The sub-courses were implemented gradually in line with the start of the new bachelor education program in Autumn 2020. The program assessment was named “Student-centered Learning and Competence Development” (SLCD), with each sub-course numbered I-IV. Sub-courses I and II provide basic knowledge in pedagogy during the first year, which is then applied in a course in semester 3, focusing on health communication at both group and individual levels in relation to health literacy. This progression leads to the third sub-course (III) in semester 4, where communication through digital platforms is the main focus. And in the last sub-course (IV), the students are evaluating the whole education program and looking ahead to their forthcoming working life.

The first sub-course (SCLD I) aims for students to gain insight into their own individual learning in relation to learning experiences during their first semester. The course is delivered in the first semester (parallel to other courses) of the education program. Students document their learning experiences, which are examples of different situations, events, or activities related to individual learning during the courses they engage with during that semester. At the end of the semester, the student writes a draft of a reflective text about a few learning situations, which also relates to pedagogic theory. The students meet with one educator in small groups of 5–6 students during a seminar, to discuss the group's reflective texts from pedagogic theory and identification of gaps in competencies that require further development. Each student is buddied with a “reflective friend” who is a peer from the same year and cohort, who provides feedback on the reflective text during a seminar. The reflective friend is also the conversation leader for the group dialog, which allows everyone to give their opinions and, above all, discuss what is covered in the text. Students then have the opportunity to improve their reflective text before submitting it for examination two weeks later. SCLD I account for a total of 1.5 credits, divided into oral group seminars (0.5 credits) and individual reflective written text (1 credit).

The second sub-course (SCLD II) is conducted in the same way as the first course, but the content now focuses on collaborative learning with others in social contexts. The course is delivered throughout semester 2, and like the first course, students document various learning situations which are then used as a basis for writing a reflective text with pedagogical theoretical connections and identified competency development needs. As pedagogical support, short podcasts (approximately 5 min each) about theories, in addition to literature, are also available. The students are asked to relate theory and the course literature to their individual reflective texts. Like in the first course, each student has a “reflective friend” within the group who provides feedback on their text draft and acts as a conversation leader during the seminar. The seminar group (5–6 students) and an educator meet and discuss the students´ reflective texts and theoretical connections. After the seminar, the students have a couple of weeks to revise their own text before they submit it for an examination. SCLD II accounts for a total of 1.5 credits, divided into an oral group seminar (0.5 credits) and an individually reflective written text (1 credit).

The third sub-course (SCLD III) is different from the first and second courses. In SCLD III, the aim is to develop the students' multimodality and digital competency in different ways by presenting themselves (knowledge, competence, and experiences) or an area that interests them, e.g. physical activity or adolescent health, in the format of a digital platform (a personal website or a social media page). Students enrolled in the Digital Design education program at the same university provided advice on the visual presentation of the digital platform. Students have the opportunity to publish their digital platform, but it is not a requirement. The students present and justify their digital platform and the thoughts behind it, and the texts during a group-based seminar. They receive feedback from their peers and educators participating in the seminar and can make improvements afterward if they wish. SCLD III accounts for a total of 1.5 credits, divided into individual digital production of a website prototype (0.5 credits) and a seminar with individual presentation followed by a group discussion (1 credit).

The fourth sub-course (SCLD IV) intends to be both retrospective and forward-looking in such a way that the students, through group work, make visible the strengths and weaknesses of the entire educational program. Preparatory work means that each small group prepares and films an oral presentation together, preferably with the support of a PowerPoint presentation or similar. During the presentation, perceptions and thoughts about the challenges and opportunities of working life are shared, i.e. looking ahead with a focus on public health and health promotion as a discipline area, as well as reflections on student-centered learning, i.e. looking back at the group's didactic educational experiences of their education. Before the seminar, all groups watch each other's films, aiming to find similarities and differences. During the seminar, new cross-groups (one student from each group) are formed that bring together members from various groups with an educator. A discussion is held on the similarities and differences found, and the new cross-group summarizes the most important points that stand out. These points are then presented when the students meet as a whole class at the end of the seminar. SCLD IV accounts for a total of 3 credits.

To gain student input on the evaluation of the development and implementation process, student data were collected from two sources: formative qualitative course evaluations and university-wide summative digital course evaluations. Formative evaluations consisted of oral discussions with students conducted during and at the end of each sub-course. These were documented through field notes by the educator responsible for implementing the sub-course and formed part of the ordinary pedagogical activities of the course. Students were informed that inclusion of their contributions in the research study was voluntary and separate from course requirements. Summative evaluations comprised anonymous online surveys administered after course completion, including closed-ended items and open-ended questions related to course structure, learning processes, and perceived competence development.

Participating students (n = 72) were enrolled in academic year two or three in the public health education program. Most of the participating students were female (n = 68) and ranged in age between 19 and 51 (at start in 2020). All participants gave their informed oral consent to the qualitative data collection and written informed consent to answer the survey. In line with the Swedish Law of Research Ethics, SFS 2003:460, ethical approval was not needed for this study.

Qualitative data from field notes and open-ended survey responses were analyzed deductively using Pawson and Tilley's (1997) realist evaluation criteria: what worked or did not work, for whom, and under what conditions. Results from the four sub-courses were subsequently compared to identify patterns, similarities, and differences across stages of the program, with particular attention to changes over time. Quantitative survey data were analyzed using Microsoft Excel 2019 and SPSS version 26. Descriptive statistics, including frequencies, means, and standard deviations, were calculated. Likert-scale items were coded from 1 (disagreement) to 5 (agreement).

This section presents both the qualitative and quantitative results from the formative and summative evaluations of the four sub-courses (SCLD I-IV). A qualitative summary of similarities found in the four sub-courses is first presented, followed by descriptions of each sub-course that differed. Thereafter, the statistical results from the survey data are presented.

Summary of similarities: The evaluation of the four sub-courses shows that they are generally well received by students, with positive ratings across all levels. A key strength highlighted by students is the focus on personal learning, self-reflection, and the connection between theory and practice. Students appreciate the opportunity to develop skills relevant to lifelong learning, employability, and professional development. Challenges that the student experiences are primarily related to the parallel nature of the courses with other subjects, requiring structured time management by the students. While some students initially found the parallel structure demanding, the longitudinal and self-contained design also seemed to create a distinct space for reflection that would likely not have arisen if the learning objectives had been embedded in existing subject-specific courses. Students' later realization of the cumulative value of the sub-courses shows that the separation served as a pedagogical boundary, allowing explicit attention to professional identity formation rather than allowing it to remain implicit within the subject content. Students consistently suggested increasing the number of online meetings, workshops, and literature discussions to provide better support throughout the semester. Over time, when students look back on the last sub-course, they acknowledge the cumulative benefits of these semester-long courses and recognize their value for both academic and professional growth.

SCLD I: This course received a positive evaluation, with students appreciating its focus on personal learning, group communication, and reflection based on pedagogical literature. While students found the course distinct from discipline-specific subjects, they recognized its relevance for both current and lifelong learning. The students' perception of the course as separate from subject-specific topics indicates that its purpose was not immediately obvious within a traditionally structured curriculum. However, the distinct nature of the sub-courses also seems to have been a prerequisite for highlighting metacognitive reflection and professional identity as explicit learning objectives. The alternative of integrating these learning objectives into existing subject courses could have risked that they would be overshadowed by subject-specific knowledge requirements. Also, as the course differs significantly from other courses and from what students are accustomed to in their previous study environments, they need even more clarification regarding the nature and purpose of the course: I had a hard time understanding what was expected […]. Because of that, I felt a bit stressed at first, but it got better once I familiarized myself with the task. Some students suggested clearer communication about the course's expectations and more reminders throughout the semester. Additional online meetings and workshops were introduced to support students in managing their workload and understanding the purpose and assessment requirements. Despite initial challenges with self-reflection, most students reported significant personal development during the sub-course: Good to be able to reflect on oneself as part of the education. It creates motivation for continued studies but also provides knowledge that appears important in relation to the other subjects in the educational program.

SCLD II: Building on SCLD I, students found this second course even more beneficial, as they had prior experience with the structure and expectations: Now I finally understand the purpose of this course, it all fell into place much more than during the first sub-course. The sequential nature of the assignments was appreciated for fostering deep learning. While time management was still a concern for some, most students valued the semester-long format, allowing flexibility in planning and time to think about the task. Students recommended more targeted online meetings, including discussions in breakout rooms and more adaptable seminar structures. The “one-after-one” discussion principle in seminars was well received, and the group discussions gave the students even more in-depth learning on this course since they were familiar with the structure from the previous course and dared to be more critical and reflective toward each other: The course provides an opportunity to reflect on what we have actually learned during the semester and what has been particularly valuable for us individually. Without this sub-course, we might not have taken the time to pause and reflect on these aspects. This is important not only for our well-being and learning but also for our ability to connect theories and concepts, which helps us think more deeply in the future. This comment illustrates the value of allocating protected curricular space for structured reflection. The stand-alone format ensured that reflection was not treated as an optional or secondary activity but as a central learning objective in its own right.

SCLD III: This third course was valued for its creative approach, allowing students to design a digital platform from their professional profile to enhance their employability. Students appreciated peer and collegial support, particularly from the collaboration and support from Digital Design students, but also from classmates. The students expressed that they also found guidance on job applications and job hunting empowering during the sub-course. While most students liked the course's distribution throughout the semester, a few experienced once again stress in managing parallel courses: The placement of this course alongside a challenging course meant that it did not receive as much time and engagement as it deserved. Students suggested an additional online meeting to support theoretical grounding before the final seminar. They wanted to deepen their learning about their personal development. The two-part assessment, which required presenting and discussing their digital platform, was seen as meaningful training for professional life: Courses and subjects related to self-development are always both challenging and educational, and this one was no exception. It is exciting to challenge oneself by doing something for and about oneself, a difficult but important task. We had many opportunities to connect through lectures and Q&A sessions. Much appreciated!

SCLD IV: The final course was particularly positively valued for its process- and reflection-oriented oral group exams. Although running parallel with the bachelor's thesis course was challenging, students did not want it to be rescheduled. By the end of their education, they recognized the value of the semester-long structure of all SCLD sub-courses, despite finding them demanding at the time. The retrospective appreciation expressed in the final course shows that the longitudinal parallel structure functioned as a cumulative developmental process. While initially experienced as demanding, the separation of the SCLD sub-courses appears to have enabled sustained development of professional identity across the program. This may have been more difficult to achieve through integration within existing courses in the program. The reflective assessments that were evaluating the whole education program and looking ahead to their professional life were seen as beneficial for personal development of a professional identity: Incredibly valuable to reflect on the education so far and the career ahead! Students expressed gratitude for the structured progress throughout the education program, recognizing that it enhanced their competencies in discipline knowledge, academic skills, health awareness, and professional preparedness for working life: The student-centered learning approach and this sub-course are phenomenal, but they go far beyond just this course. The education program's teachers live and breathe student-centeredness, which is evident in all courses. It's truly invaluable! Educators also found the final course useful for evaluating and developing the overall bachelor education program, including the program assessment.

The response rate for the summative evaluations varied between 32–51%. The questionnaire data showed a strong positive average response to all questions (see Table 2). The data shows that students evaluated courses even more positively as they progressed through the four courses. This was particularly the case with regard to their level of agreement that the information needed to pursue their studies was available, which increased gradually from course I to course IV (average scores increased from 3.94 for course I to 4.75 for course IV), and this difference is statistically significant.

In addition, the reported average time spent on the course decreases gradually from course I to course IV, where students spend less and less time on average as they progress through the courses (with an average score for course I at 2.97 and an average score for course IV at 1.29), and this difference was also statistically significant. Their perception of decreased demand is also reflected in their response to the question related to the demands the course puts on them, where, on average, their level of agreement that the demands are reasonable increased as they progressed, (average score course I at 4.20 and average score course IV at 4.57), however the difference in this response is not statistically significant.

The results are synthesized into Pawson and Tilleys (1997) realist evaluation frame of Context (C), Mechanisms (M), and Outcomes (O), see Table 3. The result shows how the SCLD intervention functions within a non-vocational higher education setting. In the context of a multidisciplinary public health bachelor program characterized by parallel coursework and initially limited clarity regarding professional roles (C), the SCLD sub-courses activate mechanisms such as structured reflection, peer dialog, progressive competence articulation, and authentic, work-oriented tasks (M). Further, how these mechanisms contribute to outcomes, including clarified professional identity, enhanced employability awareness, strengthened learning strategies, and a growing sense of agency among students over time (O). The cumulative and longitudinal self-contained structure of the intervention appears to be an important contextual prerequisite that allows these outcomes to emerge gradually throughout the program. By creating an explicit curricular space for structured reflection, competence development, and professional identity in relation to the subject, the SCLD sub-courses ensured that these goals were not subordinated to subject-specific knowledge requirements. The results, therefore, suggest that a dedicated parallel structure, within this non-professional context, was crucial in activating the mechanisms necessary for professional identity formation.

Combining the qualitative and quantitative results addresses the first analytical assumption of the study, stating that a longitudinal, student-centered intervention can contribute to students' professional identity development and enhance their awareness of employability. Overall, the results show increasingly positive feedback from students across the four SCLD sub-courses. Both qualitative and quantitative results indicate that students appreciated the focus on self-reflection, personal development, and the integration of theory and practice as a means of understanding their future professional identity in a deeper sense. This is consistent with the principles of work-integrated learning (Ferns et al., 2025), which emphasize that professional identity is developed through engagement with tasks and reflections that reflect complexity, responsibility, and connections to professional practice. The four SCLD sub-courses, thus, complement the work-integrated learning activities, with specific emphasis on reflection on complexity and metacognition for lifelong learning skills, within the program.

Professional identity refers to students' gradual development of their future professional role, values, and professional purpose in relation to working life (Pach et al., 2025). Results from the evaluation study related to the development of professional identity indicate that the SCLD modules function as a cumulative intervention. The structured reflection sessions, collegial dialog, and application of theoretical knowledge to understand practice progressively strengthen students' understanding of their professional role. This is consistent with previous research emphasizing reflection and experiential learning as central to professional identity development and professional action competence (Biehl et al., 2025; Murray et al., 2020; Pach et al., 2025). However, the evaluation study differs from previous research by demonstrating clear progression over time. Such cumulative development reflects models of supported work-integrated learning, where professional competence and autonomy are intentionally developed over successive stages of a program (Dean et al., 2020). Students' experiences of meaning and learning increased as their understanding of the purpose of the program assessment deepened, highlighting the importance of long-term and integrated learning elements in supporting professional identity development and employability. Unlike short-term or single-course interventions, the results illustrate how professional identity emerges through sustained engagement across multiple semesters, suggesting that duration and curricular integration are key explanatory mechanisms. The observed deepening of students' self-concepts over time can be understood as a cumulative developmental process rather than isolated course effects. Early uncertainty appears to serve as an essential starting point in identity formation, while later clarity reflects repeated engagement in structured reflection and skill development. By revisiting their learning experiences across the semesters, students gradually integrated fragmented insights into a more coherent professional self-understanding by the end of the last sub-course.

Metacognitive learning and competence development are understood as students' increasing ability to integrate theoretical and practical knowledge through reflective activities, collaborative learning, and authentic assessment (Barrineau et al., 2019). The evaluation result showed that these learning activities were generally perceived as meaningful, although students initially experienced challenges in managing reflective learning alongside parallel coursework. Over time, students increasingly recognized the value of the sub-courses in relation to their professional identity and employability development. This aligns with previous research showing that students come to value competence development as a part of professional identity as an important asset over the course of an educational program (Biehl et al., 2021). The decreasing reported weekly time commitment from SCLD I to SCLD IV may indicate that students developed more efficient learning strategies and increased metacognitive awareness, rather than reduced engagement. Nevertheless, some students continued to experience challenges related to parallel course demands, highlighting the importance of pedagogical support in managing complex learning situations relevant to future professional roles (Blackford et al., 2024).

The long-term program-wide structure of the SCLD sub-courses emerged as a central mechanism supporting students' professional identity formation. Similarly, Dean et al. (2020), state that professional identity development is most effectively promoted when work-integrated learning principles are integrated into an entire curriculum rather than confined to isolated modules. The cumulative design enabled students to build on previous experiences and relate their learning to other courses within the bachelor's program. As professional identity development is a gradual and complex process (Biehl et al., 2025), the student-centered approach allowed students to process course content in relation to their own experiences and evolving knowledge needs. This supports the development of lifelong learning and employability skills, as highlighted in previous research on student-centered learning environments (Attard et al., 2010; Barrineau et al., 2019). Within the realist approach, the longitudinal program structure can be understood as a contextual condition that activates mechanisms of structured reflection and competence development, which gradually enhances professional identity and agency among students.

The evaluation results also emphasized students´ need for sufficient time and support to engage in reflective learning, particularly in the initial sub-course. Lower evaluations of SCLD I can partly be explained by uncertainty regarding the purpose and structure of the program assessment, and challenges related to time management. As students became more familiar with the course format and expectations, and as communication and support structures were strengthened, their learning experiences improved. Quantitative results confirm this progression, showing a significant increase in students' perception that necessary information was available across the sub-course. These results point out that professional identity formation requires explicit scaffolding in early stages, particularly for students who are unfamiliar with reflective and self-directed learning approaches (Barrineau et al., 2019).

Employability includes transferable skills, self-efficacy, and reflective abilities that enable individuals to manage and adapt to complex professional environments (Tight, 2023; Clarke, 2018). Employability development was particularly evident in SCLD III, where students externalized and communicated their professional identity through creative and work-oriented formats. Students perceived the connection to the labor market as especially valuable, although they also expressed a need for continued support in linking creative processes to theoretical perspectives. Across the sub-courses, students increasingly perceived course demands as reasonable, indicating a balanced progression. This development reflects increased empowerment (Rappaport, 1984) and self-efficacy (Bandura, 1997), both individually and collectively, as students gained greater control and manageability in relation to their learning context.

The overall positive evaluation of the SCLD sub-courses holds broader significance beyond academic achievement. Through peer-learning and reflective activities, students developed academic self-esteem, self-efficacy, and critical competencies such as self-reflection and could apply and integrate theory with practice (Murray et al., 2020; Biehl et al., 2025). These competencies are essential for professional environments characterized by problem-solving, independent thinking, and continuous learning (Babenko et al., 2017; Bredenkamp et al., 2023). Over time, students increasingly perceived themselves as active participants in their education, aligning with conceptualizations of professional identity formation as a process involving agency and negotiation of values and roles (Eteläpelto et al., 2013; Biesta, 2020).

Compared to previous research that has focused primarily on vocational education, this study provides new insights into the development of professional identity in non-vocational higher education. The results illustrate how a longitudinal design at the program level can create cumulative learning conditions in which professional identity, employability, and capacity for lifelong learning gradually develop. Rather than emerging from isolated learning activities, professional identity appears to develop through continued engagement in structured reflection, progressive skill development, and a conscious integration of theory, learning situations, and future professional contexts. These mechanisms, although implemented within a non-vocational public health program, are not subject-specific and may therefore be transferable to other academic settings. As emphasized by Dean et al. (2020), our results also demonstrate the importance of progressive support within a program of study. This suggests that professionalism and autonomy are most effectively promoted through integrated curriculum structures rather than course-based interventions.

The evaluation approach used in this study was based on the realistic evaluation model developed by Pawson and Tilley (1997). This approach provides a framework for evaluating interventions by considering the interplay between contexts, mechanisms, and outcomes. While this model offers insights into the conditions under which the intervention is experienced as effective, certain methodological considerations also need to be discussed from a quality perspective.

A limitation of the study concerns the response rate in the summative online evaluations (32–51%), including some variation across the four sub-courses. When participation is voluntary, online surveys in higher education typically yield moderate response rates. The fluctuation over time may reflect differences in students' workloads, particularly in later semesters, when courses coincided with more demanding tasks, such as the bachelor's thesis. Given the program's student-centered design, with formative feedback continuously integrated throughout the courses, students may have perceived less need to participate in the final survey. It is possible that students who had positive experiences of the SCLD-courses also chose to participate in the evaluation of the courses to a greater extent, which may have contributed to a positive bias. Student representatives from the program have, however, also described that students are less likely to take part in course evaluations if a course lives up to their expectations, indicating that some of the neutral to positive student experiences might be missing in the findings. Data collection through both oral communication and anonymous surveys indicates that the study design respects students' perspectives and encourages honest feedback. By incorporating both quantitative and qualitative data, this study ensures a comprehensive understanding of the effectiveness of the sub-courses (SCLD I-IV). The combination of qualitative and quantitative data allows for a more nuanced interpretation of student experiences and outcomes. Rather than eliminating potential bias, this triangulated design strengthens the analytical transparency and credibility of the results by drawing on multiple data sources.

The structured analysis of qualitative data using Pawson and Tilley's criteria (i.e. what worked or not, for whom, and under what conditions) further strengthens the study's credibility by systematically identifying the mechanisms that contribute to successful outcomes and show potential improvement possibilities in each sub-course, but also what advantages and disadvantages the sub-courses shared.

A challenge in this study is the generalizability and transferability of the results. Given that the study is conducted within a specific bachelor's education program and university setting, the results may not be fully transferable to other institutions with different educational structures, student demographics, or cultural contexts. Thus, the detailed and transparent description of context, mechanisms, and outcomes enables analytical transferability. The realistic evaluation model aims to address this by emphasizing the importance of context, but further studies in diverse settings would be beneficial to validate and expand upon these results.

This study has shown that students' experiences of the four sub-courses within the program assessment (SCLD I–IV) were predominantly positive, with a clear increase in appreciation over time. The sub-courses’ focus on self-reflection, personal development, and the connection between theory and practice contributed to strengthening the students' understanding of their future professional identity and employability. The long-term course design, with recurring opportunities for reflection over three years, was especially appreciated as it allowed students to gradually integrate new knowledge with previous experiences. The increased sense of meaning and self-efficacy throughout the program assessment indicates that the educational model has a cumulative value. Furthermore, the study shows that students developed both academic self-confidence and social competence through a student-centered learning approach, which are highly valued skills in professional life. The study also highlights the importance of providing students with sufficient time and support, both from educators and peers, to process complex meta-cognition related to learning and professional identity.

The positive outcomes from this study suggest that similar course designs and/or program assessment could be beneficial in other educational programs, particularly within non-vocational fields. The results suggest that higher education programs aiming to strengthen students' employability and professional identity should explicitly address empowerment processes to develop student agency. By designing curricula that progressively foster autonomy, reflection, and self-directed competence development, HEIs can create empowering environments that prepare students not only for employment but for active participation and leadership in complex professional settings. Future research applying the program assessment model across various academic disciplines would be valuable to evaluate its adaptability and effectiveness in diverse educational contexts. Future research could also include interviews or focus groups with students to explore more in-depth how they experience and interpret the development of their professional identity over time. This would allow, for example, to examine how students themselves describe turning points and milestones in their learning process, scaffolding, and how structured reflections contribute to their development of self-understanding. In addition, longitudinal studies that follow students after graduation could provide deeper insights into how the development of professional identity during education influences employability, early career experiences, agency, and overall job satisfaction.

All participants gave their informed consent to the data collection, in line with the Swedish Law of Research Ethics, SFS 2003:460, and thereby, ethical approval was not needed for this study.

We sincerely thank the students who participated as research participants and shared their experiences. We also thank the educators in the courses where the study was conducted for their engagement and support in making this research possible.