51 Changes in student appreciation of small-group active learning INTRODUCTION Active learning is a common and generally effective way to develop students’ knowledge, skills, and attitudes (1–4). However, its effectiveness depends on a complex interplay of student-, teacher-, and contextual factors (5–8). An additional complicating factor is the development of students when they gain knowledge, skills, and attitudes during their studies, as this causes a change in those factors (9–11). This means that student factors can be dynamic in nature and change over time. In a previous study, we identified how first-year medical students appreciated active learning differently, depending on their study motives and preferences for learning (12). Students in that study reported how they were more motivated for active learning methods when these matched with their motives and preferences. However, recent publications in medical education emphasize the importance of active learning for later stages of medical training as students become interns and then physicians who should be capable of both independent and collaborative functioning (13–16). Therefore, in the present study, we aimed to explore changes in student appreciation for active learning over time, and evaluate the meaning of these changes for teachers who design and teach small-group active learning classrooms in various stages of a study program. Conceptual framework Two student factors that have been shown to influence students’ motives and preferences for learning are epistemic beliefs and approaches to learning. Both have been shown to change over time (17,18). Epistemic beliefs are defined as the personal convictions about the nature and process of knowledge, knowing, learning, and intelligence, although the concept varies across scientific fields and authors (19,20). Perry (21) describes that students develop through four different stages and that at each stage, students’ attitudes toward knowledge change. In the first stage, ‘dualism’, students perceive all knowledge to be either right or wrong, and that it is their task to learn the right knowledge from experts who have that information. In the second stage, ‘multiplicity’, students realize that not all knowledge is right or wrong and that there can be different answers depending on the perspective one takes. In the third stage, ‘relativism’, students weigh different answers and make choices dependent on contextual information. In the fourth stage, ‘commitment’, students reflect on their values, commit to taking action based on those values, and take responsibility for any outcomes (18,20–22). Research shows that students’ epistemic beliefs progress as students advance through their study program (18). Research also shows that differences in epistemic beliefs are related to differences in students’ preferences for teaching and learning methods (12,23,24). Dualist thinkers prefer experts who tell them what to know, whereas students in later stages prefer multiple sources of information and the opportunity to shape their own perspectives. 3
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