109 Learning from the experts DISCUSSION In this study, we examined how expert teachers stimulated high levels of student engagement in small-group active learning. The theory we have constructed emphasizes three aspects. First, there was consensus among expert teachers on the importance of a supportive learning environment and the ability to facilitate an active learning process. Second, the expert teachers in this study described how they had developed and employed a personal educational approach, recognizing the contextual nature of student engagement. Third, student engagement was viewed as an integrated process consisting of all elements of the constructed theory. High levels of student engagement required extensive competencies in all the identified elements. Besides stimulating high levels of student engagement, participants reported that their competencies and practices prevented truly disruptive student behaviors in class. Figure 5.1 visualizes how the three components of the theory jointly stimulated student engagement. Our findings contribute to the discussion about the paradox between the effectiveness of faculty development initiatives and the continuous challenge of student engagement in medical education (15,21,27,28). First, the theory we constructed identified which knowledge, skills, and attitudes were essential for the expert teachers. Currently, faculty development in medical education is commonly short in duration (e.g., single workshops) and limited in scope (e.g., interactive techniques like questioning) (25,27). Acknowledging these limitations, it is apparent that while faculty development initiatives do enhance teacher competencies in student engagement, they may not fully encompass all the essential aspects of success as reported by the participants in this study. This observation is not to diminish the value of these initiatives, but to underscore the need for a more comprehensive approach that integrates all reported aspects. Second, building on the previous point, our findings indicate that student engagement is context-dependent, as shown by the three aspects of ‘personal educational approach.’ All participating expert teachers agreed that there is no one-size-fits-all method to engaging students. Although they reported that they had learned general strategies for stimulating student engagement through faculty development initiatives, the expert teachers had to figure out which to use and how to make them work. Consequently, teachers enrolled in faculty development initiatives could, and that is what the expert teachers in this study did, consider the question ‘which approach might be effective in this context, taking into account my own set of values and competencies, the characteristics of my students, and the specifics of the course I am involved in?’ Moreover, through the process of observing, analyzing, and deciding on a course of action, the expert teachers remained reflective on the impact of their approach and could adapt if needed. In conclusion, while faculty development serves as a cornerstone for developing teachers’ competencies in stimulating student engagement, our research highlights the importance of a comprehensive and contextualized approach to ensure a positive impact on actual teaching practices. 5
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