42 Chapter 2 DISCUSSION In this study, we identified four student profiles that describe shared viewpoints on appreciation of small-group active learning. Although the profiles have some degrees of overlap, each profile can be characterized by distinct preferences for students’ own role in the learning process, their study groups, their tutors, and how they would like to be supported in their learning by their medical school. These preferences correspond to the students’ motives for learning. Students stated in the interviews how their motivation and engagement was (at least partly) dependent on the perceived match between their viewpoint and the learning activities. Comparing the profiles shows why engaging all students in a class can be difficult for teachers: they have conflicting preferences. When a teacher aligns with the preferences of one profile, for example with profile 1 by engaging in an in-depth group discussion not directly related to the course objectives, students in another profile might not see the value of that learning activity (in this case profile 2 would question the value of the discussion for the assessment). Epistemic beliefs We found that students in profile 2 have dualistic beliefs (‘there are correct and incorrect answers, and teachers should tell me so I can memorize them’). Students in profiles 1, 3, and 4 have multiplistic beliefs (‘multiple answers can be correct and discussing those is important for learning’). We did not find students with relativistic or committed beliefs in our sample. This is not surprising as students are expected to evolve more sophisticated beliefs over the course of their medical study (16). We found that students have low motivation and engagement when there is a mismatch between their beliefs and the teacher’s expectations or learning activities. When teachers design their classes to include learning activities in which there are no clear-cut right answers (i.e., cater to students with multiplistic beliefs), one can imagine how students with dualistic beliefs would be less motivated to engage. These students would experience the learning activity as an ineffective and inefficient use of their study time. Studies on epistemic beliefs show that it is effective to explicitly address and reflect on epistemological themes to promote more sophisticated beliefs (16). Related to this study, this means that teachers should acknowledge different epistemic beliefs among their students, and elaborate on the importance of small-group active learning for their development. This will help to align student beliefs and teacher expectations. A recent study by Deslauriers et al. (7) adds to that by recommending that teachers help students to appreciate active learning early in the learning process. Teachers could take time to elaborate on the value and requirements of active learning, and introduce formative or summative feedback early in the course to help students see their development. This could help to improve student motivation for active learning.
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