159 Appendices distinct study motives and preferences about the learning process, related to students’ epistemic beliefs and their approaches to learning. The research revealed variations in when students appreciated active learning as a teaching and learning strategy and how they perceived their roles and responsibilities in the learning process, those of their study groups and their teachers, and their expectations of the medical school. Students reported increased engagement when their educational experiences aligned with their specific profile. The identification of the four profiles offers a valuable insight into the challenges of engaging all students in a class: they have different and sometimes conflicting needs. The four profiles can help teachers make better-informed decisions about designs and teaching practices for active learning settings. Chapter 3 Chapter 3 of the thesis describes a follow-up Q-methodological study conducted three years after the initial study (chapter 2) to explore whether, how, and why student appreciation of active learning changes during a bachelor’s program. The study procedure was repeated with twenty students from the original sample, and seven of these students participated in a subsequent interview to reflect on any changes in their appreciation of small-group active learning since their start of medical training. We identified two new profiles, which we characterized as 1) success-oriented students and 2) development-oriented students. Given a high correlation between the factors of the initial and this follow-up study, it was concluded that the appreciation of active learning remained fairly stable over time, although key aspects related to students’ epistemic beliefs and approaches to learning developed, resulting in the emergence of the two new profiles. The interviews revealed several factors that contributed to the observed changes. These factors included personal growth, interpersonal aspects, teacher influence, and curricular aspects. The research shows that as students progress through their studies, their active learning needs change, necessitating a modified educational approach to ensure sustained student engagement. Based on the findings of this study, we advise monitoring and regularly checking with students what engages them and a program-level approach to student engagement as changes occur over a longer period of time. Chapter 4 Chapter 4 presents a stimulated recall study conducted with fifteen second-year students to advance understanding of in-class student engagement processes in small-group active learning settings. In this study, a framework is used that views student engagement as a multidimensional concept that includes behavioral, cognitive, and emotional components. Data were collected by observing and video-recording a small-group active learning session from two study groups, followed by semi-structured interviews. In the interviews, fragments of the recordings were used as prompts to reflect on moments of apparent engagement and disengagement. The study yielded three main findings. First, the cognitive, behavioral, and emotional components of student engagement were found to be interconnected in a spirallike fashion. Students who engaged in one dimension tended to become engaged in the A
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