68 Chapter 3 elaborate on the significance of the two profiles we identified in this study, then on the changes in appreciation of small-group active learning over time. Tailoring education to success-oriented and development-oriented students The profiles we identified in this study indicate that fourth-year medical students vary in their appreciation of active learning. Whereas the success-oriented students value active learning for helping them to ‘do well’ on their exams and internships, the developmentoriented students value it for contributing to their personal and professional development. Just like in our original paper (12), we suggest teachers and course developers take these motives and associated preferences for learning into account when teaching and designing small-group active learning. Tailoring education to students can contribute in stimulating their motivation and engagement. To clarify, this does not necessarily mean teaching according to the profiles but using knowledge of the profiles to enhance learning. During meetings, teachers can, for example, initiate meta-learning discussions (12,23,45). They can discuss and reflect with students on how the small-group learning design and the way it is taught are aligned with students’ motives and how it will help them to achieve course objectives. Program level interventions to stimulate student appreciation of active learning The change in appreciation of active learning over the course of three years described in this paper has implications for designing courses and teaching at various stages of a study program. The first implication is that monitoring of student development over time is advised. By regularly checking with students what motivates and engages them in small-group active learning settings, it becomes possible to adapt education to their needs or have informed discussions about their learning. Active learning effectiveness has been shown to be a complex puzzle with interacting student-, teacher-, and contextual factors (5–8). This study shows how student factors can be dynamic in nature and change over time. By monitoring student development, we gain understanding of one piece of the complex puzzle. The second implication is that faculty needs to discuss the development of students. Is it necessary for students to reach Perry’s relativism or even the committed stage? Are certain approaches to learning more or less desirable? What is the responsibility of teachers and what is the responsibility of students with regards to student development? Depending on the answers, student development might become a more urgent topic for teachers. If this is the case, then targeted interventions can be designed to support the development of students. The interview data of this study indicate which educational experiences and pedagogical approaches contributed to participants’ development. Additionally, previous research has identified strategies to develop students’ epistemic beliefs (18,20–22) and influence their approaches to learning (25–27). As demonstrated in this study, student appreciation of small-group active learning changed little and as a consequence of many experiences
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