56 Chapter 2 wrong. So they get a lot of credit for pointing out that I’m wrong.’ His assessments reflect the importance of being able to apply what they have learned: ‘The idea is they have to be able to apply what they learn in the class to the patients and also to be able to extract information from the journal articles that they can apply. […] If they try to memorise the course notes and take our final exam they won’t do very well, because we ask for synthesis in our final exam.’ Dr B sees teaching as ‘an alliance, a collaboration between the student and the teacher to learn.’ Knowledge for him is not only about the basic science material, but also about taking care of patients. He emphasises that a lot of reciprocal teaching occurs in his small group setting, and that by splitting the group up into pairs the teaching is ‘completely interactive.’ He is clear that creating a supportive learning environment is a prerequisite for the learning to occur. Thus he emphasises the importance of continuity with the same teacher over a longer period of time in the learning process. ‘They have to learn to trust me, that I won’t make fun of them.’ He places effort into trying to make the learning fun, for example by using competition or games. He sees it as his responsibility to figure out how to engage the students: ‘They come predisposed to learning and the reason is they have a very high incentive to learn because they are really concerned about preparing themselves to take care of patients in the near future and so they have a tremendous incentive to learn. But they’re always demanding to know if it is meaningful or relevant.’ The narratives as well as the results of the other implemented quality strategies support the utility of the new framework. DISCUSSION Our results confirm the relevance of the structure of the original Samuelowicz and Bain framework in the field of medical education. However, significant changes were required to adapt the framework to a medical education context. We will successively discuss the major changes in the belief dimensions, followed by the consequences for the belief orientations and for the boundaries between the belief orientations. The most important change in the dimensions is the identification of the new dimension ‘Creation of a conducive learning environment’ (Dimension 7), which was not present in the original framework. We presume that this can be explained by our focusing on small group teaching during the interviews. In this context in which the student is assumed to be actively involved, it is likely that an
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