158 Appendices SUMMARY Medical education has adopted active learning as a fundamental teaching and learning strategy due to its potential to enhance student learning. However, faculty and students often encounter difficulties implementing active learning into their educational practices, reducing effectiveness. A major contributor to active learning effectiveness is student engagement. Stimulating this engagement can be complex and challenging. Therefore, in this thesis, we aim to improve the implementation of active learning by deepening our understanding of the student engagement process and illuminating how teachers can optimize it. Chapter 1 In chapter 1, the general introduction of this thesis, we introduce the concepts of active learning and student engagement. Both concepts are defined, findings from the literature are highlighted, and critical reflections are provided. We conclude this part of the introduction by stating that active learning can work, but how it is implemented matters. The focus then shifts to medical education and how active learning is implemented there. We describe that active learning plays a fundamental role in the typically employed teaching and learning strategies and identify three challenges regarding implementation. First, medical students generally appreciate active learning, but their engagement varies. How can their engagement be optimized? Second, teachers play a pivotal role in engaging students, but may need to develop competencies to effectively do so. Which knowledge, skills, and attitudes are essential? Third, faculty development can develop teachers’ competencies, but incorporating these competencies into educational practice proves difficult. How can the transfer of competencies from training to practice be stimulated? From there, we continue with the overarching objective and central research question of this thesis: “How can medical teachers be supported in implementing small-group active learning into their teaching practices in such a way that student engagement is optimized?” We contextualize the conducted research and introduce our methodological approach, which is based on a constructivist research paradigm and a combination of qualitative and mixed-methods research designs. The chapter concludes with a reflexivity paragraph and an overview of the thesis. Chapter 2 Chapter 2 marks the start of our research into students’ perspectives on active learning. The chapter presents findings from a Q-methodological study conducted among first-year medical students. The study aims to explore the variety in medical students’ appreciation of small-group active learning, based on their epistemic beliefs and approaches to learning. In this study, 52 participants completed a Q-sorting procedure and provided elaborations on their viewpoints. The analyses, employing a by-person factor analysis, identified four student profiles, each representing a shared perspective of a group of students. We characterized the profiles as 1) understanding-oriented students, 2) assessment-oriented students, 3) grouporiented students, and 4) practice-oriented students. Each profile was distinguished by
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