45 Appreciating small-group active learning the profiles reflect the preferences of participants in this study. We do not know how biased our sample was and if we have missed existing preferences. We are aware that some students are more inclined to participate in (medical) educational research than others and have tried to counteract this by communicating explicitly our wish to include all sorts of students. We have focused on the relationship between students’ appreciation for active learning and engagement. As students indicated in the interviews (and as is known from literature), other factors also affect their engagement. Future research A follow-up study with the same participants might show how the students and profiles develop over time, and what the causes of these developments are. For example, research shows that clinical experience influences the epistemic beliefs of medical students (16). It is unclear how perceptions of, and preferences for, active learning changes as more sophisticated epistemic beliefs evolve. This offers potentially valuable information for improving medical education. In addition, as we have given suggestions for teachers to improve motivation and engagement of students for (active) learning, the impact of these suggestions could be investigated. How effective are our suggestions in terms of student and teacher appreciation of active learning? Do they help teachers to motivate and engage students? A third suggestion is to focus on teacher appreciation of active learning. Teachers vary in their appreciation of active learning, depending on their conceptions of teaching and learning (39). Their appreciation might be reflected in their teaching practices, favoring other types of learning. This future study could yield suggestions to improve teacher motivation for active learning, as the current study did for students. CONCLUSION It can be difficult for medical teachers to motivate and engage their students in smallgroup active learning methods. In this study, we have identified four profiles that describe when and how students might be motivated for small-group active learning. We have used the concepts of epistemic beliefs and approaches to learning to explain the diversity in students’ appreciation for active learning. Teachers can use the profiles to reflect on the use of active learning in their courses and relate to the different motives and preferences of medical students. This allows teachers to optimize their course design choices regarding active learning, as well as communicating about it with their students, so that all students have higher motivation and engagement. Acknowledgment We would like to thank Femke Dijkstra for her help with the data collection and analysis. Funding This article was supported by funding from the International Association of Medical Science Educators. 2
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