27 Appreciating small-group active learning INTRODUCTION Small-group active learning methods are effective in developing students’ knowledge, skills, and personal and professional attributes (1–3). They are therefore an important component of many medical programs, and medical students increasingly spend their contact time in small-group settings (4,5). To be effective, active learning methods require students to engage meaningfully in learning activities to construct their own knowledge (6). Students, however, can be reluctant to engage as they feel that these methods are not an effective or efficient use of their study time (7). Consequently, active learning becomes a source of negative emotions, like frustration and anxiety (8), as well as a reason for students to complain (9). In addition, teachers who perceive their students to resist active learning methods might be unable or unwilling to use these methods, and revert to less effective (i.e., more passive) learning methods, like lecturing, that require little student engagement (6, 9–11). Although (medical) education research has identified many factors that influence students’ appreciation of active learning methods, these mainly focus on aspects of curricula, courses, teacher behaviors, and student sociodemographic characteristics (1,7,8,12,13). Only recently have researchers begun to investigate the student’s perspective more deeply in an attempt to explain their continued reluctance towards active learning (7,14). These studies suggest that student appreciation of active learning is not a ‘one-size-fits-all’ issue. Because students have different beliefs about knowledge and learning, strive for different goals, and employ different learning strategies, they appreciate active learning differently. We need a better understanding of students’ diversity in appreciation of active learning to help teachers to improve all students’ motivation for these types of learning activities. Two conceptual frameworks help us to investigate students’ diversity in perception of active learning. Epistemic beliefs are beliefs about the nature of knowledge and the process of learning. Students have different beliefs about how to obtain, perceive, organize, and use knowledge (15,16). Perry’s model of intellectual and moral development describes different stages students can be at, ranging from dualist beliefs (black-and-white thinking: there is one correct answer to everything, students need to memorize these answers), to multiplistic beliefs (problems can have multiple answers and even when contradicting each other, all answers can be correct, knowledge is subjective), to relativistic beliefs (some answers are better than others, depending on your stance or context), to committed beliefs (using personal values to evaluate answers)(16,17). Relating epistemic beliefs to active learning; students in the dualistic stage appreciate teaching and learning activities that will help them to obtain the clear-cut correct answer to questions, while later stages are more open for activities that allow multiple answers to question to coexist, or even activities that allow students to conclude different answers. 2
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