Preparing medical students to be agentic learners is held to be increasingly important. This is because beyond sequencing, enhancing and varying of experiences across university and health care settings, medical students require epistemological agency to optimise their learning. The positioning of students in these settings, and their engagement with these is central to effective medical education. Consequently, when considering both the processes and outcomes of individuals' learning to become a doctor, it is helpful to account for the interrelated pedagogical factors of affordance, guidance, and engagement. Firstly, are the kinds of experiences and interactions that are provided for individuals, referred to here as affordances. Secondly, is how students are guided through these affordances. Finally, how students take up what is afforded them, referred to here as engagement is central to their learning. This paper focuses on the last set of concerns - the bases of student engagement - with particular consideration to how they shape the relations between what experiences (i.e. interactions and activities) are afforded through the medical program and how they elect to engage with them. Evidence from a qualitative study is used to present five salient factors that are central to assist medical students prepare as agentic learners.