53 Changes in student appreciation of small-group active learning meetings, and aimed to integrate and apply knowledge, skills, and attitudes gained at those meetings. In the first two years, students chair the meetings, meaning they take turns leading the meetings, brainstorm for the cases and assignments, and complete these cases and assignments in subgroups to present to each other. Teachers in the tutoring course are called tutors. Tutors work for the medical school and usually have a medical or research background. Tutors guide the process, give feedback on professional behavior and personal competencies, and support professional development. In the third year, students meet once per week and tutors are in charge of the meeting. The third year has a focus on clinical reasoning skills because students can enter medical practice as interns in the following year. Tutors are therefore also actively involved in discussing the content in year three. Study design We conducted a Q-methodology study (35–38). “Q-methodology is a research technique, and associated set of theoretical and methodological concepts, originated and developed by William Stephenson, which focuses on the subjective or first-person viewpoints of its participants” (38). This method is used to create clusters of people with similar viewpoints (i.e., factors or profiles), which can be compared and contrasted with each other. As such, it is a way to do person-centered analysis, instead of variable-centered analysis (39). Q-methodology has been used in education to investigate the viewpoints of students, teachers, and other educational professionals (40). The Q-set (set of statements for participants to rank-order according to agreement) and distribution grid (prearranged frequency distribution for placing the statements) used in the present study were developed, used, and published in a previous paper (12). A summary of the Q-set development has been included in the legend of Table 3.1. We refer the reader to Grijpma et al., 2021 (12) for further information. The Q-set consisted of 54 statements regarding various aspects of active learning, epistemic beliefs, and approaches to learning (Table 3.1). 3
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