66 Chapter 3 Medical program Students reflected on their learning experiences in the past three years and how those experiences influenced their learning preferences. Most importantly, students mentioned how the shift to online learning in response to the COVID-19 pandemic had made them realize how important face-to-face meetings were. Online meetings felt impersonal, passive, and non-committal to them. Face-to-face small-group learning, in hindsight, formed a cornerstone of their studies. The regular meetings provided structure and a place to interact with peers. They could discuss personal or study-related issues and have fun. It allowed students to feel part of a group. The shift to online education made this, to a large degree, disappear. A second educational influence of change in learning preferences was the sense of urgency caused by upcoming internships and the start of their career thereafter. They described how in the first year passing exams had been important, but now they prioritized preparing for the future. This made them appreciate opportunities to practice and learn things needed as an intern – practical knowledge and skills, but also more personal characteristics like being a good intern, and dealing with uncertainty. A third influence was the design of small-group learning. Students reported that personalized feedback (as opposed to general or generic feedback given to a group) became increasingly important to develop themselves as they advanced through medical training and gained a better understanding of their qualities and areas for improvement. They also mentioned how they could increasingly teach themselves, as they acquired the basic knowledge needed to solve more advanced questions. They also reported learning more from peers in the third year, as students have acquired different knowledge, interests, and perspectives, which made discussions richer. This finding integrated well with students’ personal growth and appreciation of multiple perspectives as they experienced that often there is not a single answer to a question. Finally, assessment remained important over the three years. However, as the goals of smallgroup learning changed, so did the assessment, and therefore also what students found important in the design of small-group learning activities and meetings. In year one, more factual knowledge was assessed, while in year three it was more about practical and clinical reasoning skills. DISCUSSION In this study, we explored fourth-year medical students’ appreciation of small-group active learning, and how and why their appreciation changed since their first year. Our first main finding is the ‘success-oriented’ and ‘development-oriented’ profiles that describe how students in their fourth year appreciate small-group active learning. The second main
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