101 Learning from the experts INTRODUCTION Small-group active learning methods, which involve interactive student-centered activities, can improve medical students’ knowledge, skills, and personal and professional competencies when they stimulate student engagement (1,2). Student engagement, more recently also called learning engagement (3), has been conceptualized as the cognitive, emotional, and behavioral aspects of students’ involvement in learning activities (4). When students engage in interactive and constructive ways with the subject matter, their learning increases (5). In reviews describing the specific conditions necessary for student engagement in active learning methods, ‘the teacher’ is mentioned consistently as a determinant of success (6–11). Teachers need to be competent in cultivating a learning environment in which students can engage with each other and the subject matter to develop themselves. Students who perceive active learning to be poorly designed or executed by their teacher have been shown to disengage from learning (12,13). Therefore, for small-group active learning to be successfully implemented and contribute to student development, there is an urgent need for both novice and advanced medical teachers to improve their mastery in student engagement (14–17). The challenges that medical teachers encounter when engaging their students seem to arise from various sources. First, teachers themselves have personal views on education, which may or may not align with active learning as an effective strategy, and which can affect how they approach their teaching tasks (15,18–20). Active learning requires specific teaching competencies that not all teachers may have developed (14,15,21). Second, student beliefs about learning and associated competencies may or may not align with active learning as an effective strategy, which can influence their behavior in class (14,17,22). Third, pedagogical and didactical issues may affect the conditions necessary for student engagement, such as class size and the amount of time available for learning activities (14,15). Finally, institutional challenges may limit the time that teachers can spend on teaching and professional development (15,23,24). When teachers fail to deal with these challenges, they have been shown to revert to more passive (i.e., less effective) ways of teaching (16). To support medical teachers in engaging their students and dealing with associated challenges, faculty development serves as a critical resource (15,25,26). Through faculty development initiatives, teachers are instructed in strategies to positively impact student engagement. These initiatives can yield favorable knowledge, attitudes, and behavioral outcomes (21,27,28). However, these successes are not the end of the story. In practice, medical teachers continue to encounter difficulties in engaging students in their classrooms. Even experienced medical teachers with advanced knowledge, skills, and positive attitudes toward active learning face challenges when trying to implement the lessons learned from training (15). Thus, despite the effectiveness of faculty development in offering student engagement strategies, there is a need for additional understanding to support medical teachers in engaging their students. 5
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