58 Chapter 2 about professional development were presented as separate from beliefs about teaching and learning. Our framework, however, integrates these beliefs as one of the dimensions of an educator’s beliefs about teaching and learning. The addition of two beliefs in the dimension (D9) ‘Students’ motivation’ may have become apparent due to our explicit questions on small group teaching during the interviews. A small group enables an educator to pay attention to the individual student’s intrinsic motivation, which is much more difficult in the setting of largescale lectures. The most learning-centred belief that an educator should foster the intrinsic motivation of the student (D9B) is in line with other literature which indicates that fostering a student’s intrinsic motivation is associated with deep learning.34,35 These refinements add to the descriptive power of the new framework, because the expansion of the constituent beliefs within the dimensions enables a sharper demarcation between the adjacent belief orientations. In the original framework the distinction between some adjacent belief orientations was based on only one belief dimension. Our new framework extends this to at least two dimensions, which makes it possible to determine a medical educator’s belief orientation more reliably. Significantly, these refinements create a more clearly demarcated boundary between teaching-centred and learning-centred orientations. In the original framework the two adjacent orientations on either side of this boundary (Orientation III and IV, see Table 2.1) still shared two common beliefs, whereas in our new framework for medical education this has been reduced to only one out of nine beliefs. This is significant as it underlines the sharp boundary between a teaching-centred and learning centred orientation, and reinforces Samuelowicz and Bain’s notion14 that transition from a teaching-centred to a learning-centred belief orientation means a profound shift in which, according to the new framework, eight out of nine beliefs would be required to change. As the other adjacent belief orientations have three to seven beliefs in common, the differences between these orientations are more subtle, suggesting that these orientations form a continuum. These boundaries may also be easier to cross. In Kember’s review article on teaching beliefs,6 a transitional belief orientation is proposed that would bridge the teaching-centred versus learning-centred orientations. However, our findings, like those of Kember and Kwan8 as well as Samuelowicz and Bain,14 do not support this bridging belief orientation.
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