61 Changes in student appreciation of small-group active learning themselves. This means that study groups should regulate their behavior and attention to time management (3 +1), solve problems that might arise in a study group (13 +2), and regularly evaluate their functioning (24 +1). Role of tutor Students in this profile appreciate tutors who give responsibility for learning to the group and act as an observer and as a source of non-clinical information. As an observer, tutors should give feedback that stimulates their development as doctors and human beings (16 +5). Feedback allows them to draft personal learning objectives and to critically reflect on their performance. To create a sense of urgency and relevance for working on these personal learning objectives, tutors should share personal experiences and anecdotes (2 +2). Because these students focus on development, they appreciate comments on how to do better more than compliments (17 -4). As a source of non-clinical information, tutors should have diverse backgrounds. Examples given were research, psychology, philosophy, and management (37 -3). Their vision and experiences help to develop the broad understanding of healthcare students in this profile are looking for (7 -2). Students in this profile also place more importance on the tutor’s ability to guide the learning process, rather than instructing them about the content (51 -2). Students have developed their own way of studying the content, and tutors should allow that (36 -5; 8 -4). Role of medical training Students in this profile want to be challenged (14 -5). When study content and assignments develop new insights, students are more motivated and engage with each other meaningfully to achieve understanding. Study group meetings do not always have to prepare students for the exam (25 +1) or their upcoming internships (34 -1). Students in this profile appreciate learning about diverse healthcare-related subjects, and their perspectives on (clinical) problems. They realize that ambiguity and uncertainty are part and parcel of (clinical) practice and that context and personal expertise or vision decide what makes a solution better or worse (35 -3). That is why these students feel medical training should aim to develop the person behind the doctor, and not only their ability to diagnose patients (50 +3; 54 +1). Changes in learning preferences Here, we report the findings according to the guidelines we created and described in Part 2: identifying how and why factors changed. 1. The mean correlation between participants’ Q-sorts at Timepoint 1 (T1, original study, data from 2018, when participants started the first year of medical training) and Timepoint 2 (T2, this follow-up study, three years later) was 0.54, with a range of 0.22-0.70. The moderately high and positive correlations indicate that, for most participants, their appreciation for small-group active learning remained fairly stable over three years. 3
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