147 General discussion my own set of values and competencies, the characteristics of my students, and the specifics of the course I am involved in?’, recognizing the contextual nature of student engagement. These teachers had experienced that engaging students in active learning did not follow a cookbook approach, in which a prearranged method of teaching led to optimal student engagement. Consequently, they deviated from the course manual to tailor learning activities, course structure, and other aspects of their teaching to better fit their needs and the needs of their students (1–3). Consistent with the previous recommendation, we suggest that teachers include the voice of the student and elicit student perceptions of their learning in the course. This suggestion supplements the concepts of ‘reflective teaching’ or ‘reflective practice’, which has been described as a method of achieving increasingly effective teaching practices through continuous self-reflection (40,41). We suggest that teachers include reflections about their impact on their students’ engagement in their reflective practices. Adaptability Beyond the contextual nature of student engagement and adopting a reflective mindset, small-group active learning requires teachers to use their knowledge and skills flexibly to deal with unexpected situations. In all our studies, we encountered situations in which such flexibility was demanded. Examples included students who felt overwhelmed by an exam earlier in the day, teachers who experienced technical problems, classroom designs unsuitable for small-group collaborations, etc. We do not believe that general practical solutions are the answer (such as ‘do not plan small-group active learning sessions after an exam’, ‘before starting a class make sure the technology is working’, and ‘switch to another classroom if it is set up for large lectures with fixed desks and chairs’). It seems that unexpected situations are common and that expert teachers can make judgments on the spot to attend to them (29). Through their continuous observation and analysis of the behavior of their students, they can intervene quickly if necessary. The ability to adapt to unexpected or changing circumstances is called ‘adaptive expertise’ in educational literature and clinical practice (42). It is beyond the scope of this thesis to go in depth on how to develop this competency. We refer to a scoping review that conceptualized adaptive expertise into a framework of predisposing (beliefs and attitudes, knowledge), enabling (skills, resources, social and physical environment), and reinforcing (reminders, feedback) factors, offering suggestions on how to develop this competency (43). For faculty developers Employ the constructed theory of expert teaching practice The theory of expert teaching practice that we constructed provides a comprehensive understanding of how expert teachers stimulated high levels of student engagement. It not only describes the required competencies of teachers but also how they are related and jointly influence student engagement (29). The theory could inform the design of faculty development initiatives and support medical teachers who want to teach in ways 7
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