145 General discussion Self-Directed Learning, and on-the-job and off-the-job learning activities (36). Learning to engage students was a challenge that was repeatedly set as a personal learning objective and examined during meetings. Through collaborative reflection on specific instances and creating awareness of essential aspects of those instances, participants achieved an increased understanding of student (dis)engagement. This understanding then facilitated the development of strategies aimed at stimulating engagement. Subsequent support from peers, supervisors, and faculty developers encouraged participants to apply these strategies, as teachers sometimes felt insecure about doing something new. Thus, the faculty development initiative we designed stimulated the transfer of active learning strategies by creating opportunities for teachers to engage in a cycle of obtaining authentic experiences, engaging in collaborative reflection, gaining in-depth understanding, and applying the lessons learned (36). In conclusion, the integrated perspective synthesizes the findings from the five studies conducted in this thesis, thereby addressing its central research question. First, we advanced theoretical understanding of the dynamic nature of in-class student engagement and identified how students’ epistemic beliefs and approaches to learning influence their appreciation of active learning. This advanced understanding of student engagement enables teachers to make better-informed decisions in their teaching practices. Second, we advanced understanding of active learning implementation by constructing a grounded theory that revealed how expert teachers consistently achieve high levels of student engagement in their classes. This theory emphasizes the importance for medical teachers and faculty development in considering the complexity of student engagement and adopting a comprehensive, context-sensitive approach. Third, we have used the knowledge gained in the first four studies to inform the design of a faculty development initiative that was focused on stimulated transfer. By combining self-directed learning, on-the-job learning, and off-the-job learning, new teachers felt supported, prepared, and guided in their roles as facilitators of their students’ active learning processes. Practical implications To improve the implementation of small-group active learning in medical education, the findings of this thesis indicate that a comprehensive and context-sensitive approach is needed. Although our focus has been on teachers, faculty development, and students, we recognize that other stakeholders (such as management, course coordinators, and policymakers) contribute to the successful implementation of active learning. From the recommendations below, these stakeholders can infer insights into how they can contribute. However, consistent with our research approach, the recommendations are primarily written for teachers, faculty development, and students. 7
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